title: Massive malignant solitary fibrous tumor arising from the bladder serosa: a case report.
abstract: BACKGROUND
  Solitary fibrous tumors are rare neoplasms of mesenchymal origin. They are often of low malignant potential and rarely metastasize. While they frequently arise from the pleura, they can occur at any soft tissue site in the body. We present a case of a large (28 × 21 cm) malignant solitary fibrous tumor arising from the bladder serosa. In addition, the clinicopathologic features, differential diagnosis, cytogenetics and management of this rare disease are discussed, along with a review of the existing literature on this topic.
  
  
  METHODS
  An otherwise healthy 41-year-old Caucasian man presented with weight loss and progressive abdominal bloating. A subsequent computed tomography scan of his chest, abdomen and pelvis revealed a 26.8 × 21 cm intra-abdominal mass occupying most of his abdominal cavity. The inferior vena cava was compressed, and the mass extended inferiorly to his upper pelvis abutting the superior dome of his bladder. He underwent operative resection and the resected mass measured 28 × 21 × 18 cm and weighed 4.8 kg. The cut surface revealed a gray-white mass with an ill-defined whorled-like pattern, with randomly assorted tan fleshy nodules. A histologic evaluation revealed variable, alternating hypercellular and hypocellular areas, with areas of necrosis. The tumor cells varied from spindle to epithelioid within a hyalinized stroma. In the hypercellular areas, the tumor cells showed moderate atypia with high mitotic activity. The histological features combined with immunophenotyping were suggestive of a malignant solitary fibrous tumor that grossly appeared to be growing from the bladder serosa, specifically the intraperitoneal superior dome of the bladder. Our patient is currently eight months post-surgery without evidence of recurrence.
  
  
  CONCLUSIONS
  Extrapleural occurrences of solitary fibrosis tumors are being increasingly observed. Malignant solitary fibrosis tumors of the urinary bladder, however, are very rare. As there are no pathognomonic features of malignancy, surgical resection is often both diagnostic and therapeutic, as was the case in our report.
authors.affiliation: Department of Surgery, Division of Surgical Oncology, Hackensack University Medical Center, 20 Prospect Avenue, Hackensack, NJ, 07601, USA. Dozierjm@njms.rutgers.edu.
authors.forename: Jordan
authors.initials: J
authors.lastname: Dozier
authors.affiliation: Department of Pathology, Hackensack University Medical Center, 30 Prospect Avenue, Hackensack, NJ, 07601A, USA. Jameelze@gmail.com.
authors.forename: Zena
authors.initials: Z
authors.lastname: Jameel
authors.affiliation: Department of Surgery, Division of Surgical Oncology, Hackensack University Medical Center, 20 Prospect Avenue, Hackensack, NJ, 07601, USA. Drdonaldmccain@aol.com.
authors.forename: Donald A
authors.initials: DA
authors.lastname: McCain
authors.affiliation: Department of Pathology, Hackensack University Medical Center, 30 Prospect Avenue, Hackensack, NJ, 07601A, USA. PHassoun@HackensackUMC.org.
authors.forename: Patrice
authors.initials: P
authors.lastname: Hassoun
authors.affiliation: Department of Surgery, Division of Surgical Oncology, Hackensack University Medical Center, 20 Prospect Avenue, Hackensack, NJ, 07601, USA. Bamboatz@cancersurgeryassociates.com.
authors.forename: Zubin M
authors.initials: ZM
authors.lastname: Bamboat
mesh_terms: D000328:Adult; D003937:Diagnosis, Differential; D006801:Humans; D008297:Male; D012704:Serous Membrane / Q000473:pathology*; D054364:Solitary Fibrous Tumors / Q000473:pathology* / Q000601:surgery; D014057:Tomography, X-Ray Computed; D001743:Urinary Bladder / Q000000981:diagnostic imaging / Q000473:pathology*; D001749:Urinary Bladder Neoplasms / Q000473:pathology* / Q000601:surgery