Case Report Solitary Fibrous Tumor of the Kidney ...downloads.hindawi.com/journals/criu/2016/2426874.pdf · Case Report Solitary Fibrous Tumor of the Kidney Developing Local Recurrence

Case ReportSolitary Fibrous Tumor of the KidneyDeveloping Local Recurrence

Wataru Usuba,1 Hideo Sasaki,1 Hidekazu Yoshie,1 Kazuki Kitajima,1 Hiroya Kudo,1

Ryuto Nakazawa,1 Yuichi Sato,1 Masayuki Takagi,2 and Tatsuya Chikaraishi1

1Department of Urology, St. Marianna University, 2-16-1 Sugao, Miyamae, Kawasaki 216-8511, Japan2Department of Pathology, St. Marianna University, 2-16-1 Sugao, Miyamae, Kawasaki 216-8511, Japan

Correspondence should be addressed to Wataru Usuba; [email protected]

Received 21 January 2016; Revised 30 March 2016; Accepted 7 April 2016

Academic Editor: Phillip M. Pierorazio

Copyright © 2016 Wataru Usuba et al. This is an open access article distributed under the Creative Commons Attribution License,which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Solitary fibrous tumor (SFT) of the kidney is a rare entity and usually displays a favorable prognosis.We herein report a second caseof renal SFT developing local recurrence. A 50-year-oldmanwas referred to our hospital because of a left renal mass. An abdominalCT detected a large renal tumor and radical nephrectomy was performed with a possible diagnosis of renal cell carcinoma. Theresected tumor size was measured at 17 × 11 × 8 cm. Grossly, necrosis was observed in central lesion of the tumor but hemorrhagewas not observed. Microscopically, the tumor consisted of spindle-shaped cells with scant cytoplasm accompanied by hyalinizedcollagenous tissue, which displayed hemangiopericytomatous patterns. The cellularity was normal and nuclear pleomorphism wasnot observed. Ki-67 labeling index was less than 3%. The pathological diagnosis of SFT was made without obvious malignantfindings. Three years after the surgery, a follow-up CT scan detected a mass lesion in the tumor bed. Surgical resection wasperformed and the resected tumor was compatible with local recurrence of the SFT without obvious malignant findings. RenalSFT should be carefully monitored even in the absence of obvious malignant findings.

1. Introduction

Solitary fibrous tumor (SFT) is a clinical entity that was firstreported as a tumor of the pleura in 1931 and usually arisesin the pleura [1]. SFT is a rare spindle cell neoplasm and itis postulated that the tumor originated from mesenchymaltissue [2]. Histologically SFT shows hemangiopericytoma-like growth pattern and immunohistochemical staining forCD-34 and Bcl-2 is helpful for diagnosing the SFT. SFTtypically is strong and diffusely positive for CD-34 and 70%of the SFT is positive for Bcl-2 [3]. The disease commonlyarises from the thoracic cavity, yet itmay arise fromother sitesincluding the kidney [2]. SFT of the kidney is an extremelyrare and generally indolent tumor, unlikely to recur locally ordistantly. Up to the present, only 81 cases of occurring renalSFT have been reported. SFT of the kidney usually displaysa favorable prognosis and only two cases were reported todevelop a distant metastasis. Furthermore local recurrence ofSFT of the kidney had been reported in only one case [4].

Herein, we describe the second case of local recurrence ofrenal SFT after radical.

2. Case Presentation

A 50-year-old male was referred to our hospital becauseof a left renal mass, which had been incidentally detectedby ultrasonography performed in a routine health check-up. A physical examination and blood chemical analysiswere normal. Subsequent computed tomography (CT) scandetected a well-enhanced large left renal tumor (Figure 1(a)).He was diagnosed with left renal cell carcinoma preoper-atively, and radical nephrectomy was performed. Grossly,the tumor was measured at 17 × 11 × 8 cm, was well-circumscribed, and displayed necrosis with a gray-whitecut surface. Hemorrhage was not observed. Microscopically,the tumor was composed of spindle-shaped cells, whichdisplayed hemangiopericytomatous patterns (Figure 2(a)).The tumor displayed normal cellularity without nuclear

Hindawi Publishing CorporationCase Reports in UrologyVolume 2016, Article ID 2426874, 8 pageshttp://dx.doi.org/10.1155/2016/2426874

2 Case Reports in Urology

(a) (b)

(c) (d)

Figure 1: Radiological findings of the renal SFT. Enhanced abdominal CT revealed 17 × 11 × 8 cm tumor located in the left kidney (a). Follow-up plain CT revealed suspicions of recurrent tumor (1 × 0.7 cm) in the tumor bed at 3 years after the nephrectomy (b). Three months afterthe CT, which detected suspicions of recurrent tumor, follow-up CT scan and PET-CT were performed. (c, d) The mass lesion was increasedin size (1.7 × 1.1 cm).

pleomorphism. Mitotic count was less than 1 per 10 highpower fields. Immunohistochemical staining was positive forCD-34 (Figure 2(b)), Bcl-2 (Figure 2(c)), CD-99, and STAT-6,all of them representing conventional immunohistochemicalmarkers for SFT. Meanwhile, SMA stain was negative and Ki-67 labeling index was less than 3% (Figure 2(d)). Thus, hewas histologically diagnosed with SFT of the kidney withoutobvious malignant findings. Postoperatively, follow-up CTexamination was performed regularly every 3-4 months.Three years after the operation, a mass lesion was detected inthe tumor bed (Figure 1(b)). The mass lesion was increasedin size after 3 months (Figure 1(c)). Fluorodeoxyglucose(FDG) positron emission tomography (PET) was orderedbut the tumor did not accumulate FDG (Figure 1(d)).Nonetheless, as a local recurrence or lymph node metastasiscould not be denied, we planned a surgical removal of thetumor. Although the recurrent tumor displayed spindle-shaped cells with hemangiopericytomatous patterns as in theoriginal tumor, the cellularity was increased and cytologicalatypia was observed (Figure 2(e)). These results suggestedan increased malignant potential of the tumor, but mitoticcount was less than 4 mitoses per 10 high power fields.Immunohistochemical staining for CD-34 (Figure 2(f)), Bcl-2 (Figure 2(g)), and CD-99 all remained positive. Ki-67labeling index was less than 15% (Figure 2(h)) and SMA

stain was positive in the resected tissue from the tumor bed.Although an increased malignant potential was suggested,pathological findings did not meet the diagnostic criteria ofmalignant SFT [5]. The recurrent tumor was developed froman extra nodal connective tissue not from the lymph node(Figure 3). Therefore, we diagnosed local recurrence of renalSFT without evidence of obvious malignant findings. Twelvemonths after the second operation, the patient is followed upon the outpatient basis with no evidence of local recurrenceor distant metastasis.

3. Discussion

In 1931, SFTwas firstly reported as a tumor of the pleura [1]. Itis a rare tumor comprising spindle-shaped cells, which mightoriginate from mesenchymal tissue [2]. Although SFT iscommonly thought of as an intrathoracic tumor, it could arisefrom extrathoracic organs, including the kidney [2]. Surgicalresection is a standard treatment and complete resection canbe associated with a favorable prognosis, even if the SFT ishistologically diagnosed as malignant [4, 6].

SFT of the kidneys is a rare neoplasm, and Sasaki et al.reviewed the 68 cases of SFT in 2013 [7], and additional 13cases were reported up to now. All reported cases, includingour case, are summarized in Table 1. Most of the tumors

Case Reports in Urology 3

HE

(a)

CD-34

(b)

Bcl-2

(c)

Ki-67

(d)

HE

(e)

CD-34

(f)

Bcl-2

(g)

Ki-67

(h)

Figure 2: Histological findings of the solitary fibrous tumor. The primary tumor displayed hemangiopericytomatous patterns ((a), HE ×40).Immunohistochemical staining of the primary tumor was positive for CD-34 and Bcl-2 ((b) and (c), ×40) and Ki-67 labeling index was lessthan 3% ((d), ×40). Cellularity was increased in the tumor that recurred at the hilar portion of the kidney (e). Immunohistochemical stainingfor CD-34 and Bcl-2 was positive ((f) and (g), ×40). Ki-67 labeling index was less than 15% ((h), ×40).

L

T

Figure 3: Histological finding of local recurrence of the solitaryfibrous tumor. The recurrent tumor was developed from an extranodal connective tissue (×10). L: lymph node; T: tumor.

were incidentally found with no apparent clinical symptoms.Preoperatively, most of them were diagnosed as renal cellcarcinoma, and 72 out of 82 cases underwent radical nephrec-tomy. Mean age at diagnosis was 52.8 ± 17.7 (3–85) yearsand mean tumor size was 9.5 ± 6.2 (2–29) cm. Histologi-cally, 68 tumors showed a benign appearance, whereas 11cases exhibited a malignant one. Most patients displayed afavorable prognosis with no evidence of recurrence duringthe follow-up period, ranging from 0.1 to 96 months. Only4 patients experienced recurrence; 2 patients developeddistant metastasis; and 2 patients, including the present case,developed local recurrence.

As SFT commonly expresses CD-34, Bcl-2, and CD-99[8], these surface antigens can serve as useful diagnosticmarkers [8]. And negativity in CD-34 and Bcl-2 reportedlyrepresents increased malignant potential [8, 9]. Fine et al.documented a case of malignant renal SFT without express-ing CD-34, which developed distant metastasis four monthsafter surgery [10]. We also reported a similar case previously,which did not express CD-34 and went on to metastasize tothe lung and liver [7]. In that case, half of the cross sectionarea of the primary tumor was positive for CD-34, while theremaining area was negative for it. The patient developeddistantmetastases 8 years after nephrectomy. Resection of themetastatic tumors had revealed that CD-34 was totally absentin the tumors. Thus, the loss of CD-34 staining in SFT of thekidney may promote tumor metastasis to other organs [7].Similarly to CD-34 staining, Bcl-2 staining was commonlyobserved in SFT and the loss of Bcl-2 staining was reportedto be associated with malignant potential in retroperitonealSFTs [9].

On the contrary, malignant potential is rather low in thepresent case, which developed local recurrence 3 years afternephrectomy. In this case, no obvious malignant findingswere observed in either primary or recurrent tissue from thetumor bed. Furthermore, CD-34 and Bcl-2 were positive inthe primary tumors and remained positive in the recurrenttissue. It seems that the local recurrence does not necessarilyaccompany the loss of expression of CD-34 and Bcl-2, andanother explanation for unpredicted local recurrence wouldbe incomplete resection at surgery [5]. However, from adifferent standpoint, the tumor in the present case may


Table1:Clinicop

atho

logicalfi

ndings

ofrenalsolitary

fibrous

tumorsintheliterature.

Case

Year

Age

Sex

Symptom

Side

Affected

site

Tumor

size

(cm)

Treatm

ent

Histology

Follo

w-up

(mon

th)

Outcome

CD-34∗

Authorsa

ndjournals

11996

48M

Back

pain

and

macrohematuria

RRe

nalcapsule

3Nephrectomy

BEN

0.1

DNOD

POS

Gelb

etal.A

mJS

urgPathol

20:12

882

1996

45F

Incidental

RKidn

ey6

Nephrectomy

BEN

8NED

POS(2/3)

Fain

etal.J

UrolP

atho

l4:227

31996

46F

Incidental

RKidn

ey7.2

Nephrectomy

BEN

33NED

POS(2/3)

Fain

etal.J

UrolP

atho

l4:227

41996

51M

Incidental

LKidn

ey4.5

Nephrectomy

BEN

2NED

POS(2/3)

Fain

etal.J

UrolP

atho

l4:227

51997

33F

Abdo

minalpain

RPerip

elvis

3.5

Nephrectomy

BEN

89NED

POS

Fuku

naga

etal.H

istop

atho

logy

30:451

61997

36F

Abdo

minalpain

LPerip

elvis

2Nephrectomy

BEN

12NED

POS

Fuku

naga

etal.H

istop

atho

logy

30:451

71998

59M

Incidental

LRe

nalcapsule

NA

Nephrectomy

BEN

NA

NA

POS

Ookou

ciSetal.Jpn

JRadiol

58:53

9

81998

57M

Incidental

LKidn

ey7

Tumorectomy

BEN

NA

NA

POS

TanahashiC

etal.P

rocJpn

Soc

Pathol87:510

91999

64M

Macrohematuria

RKidn

ey4.5

Nephrectomy

BEN

8NED

POS

Hasegaw

aetal.Hum

Pathol

30:14

64

101999

71F

Incidental

LKidn

ey9

Nephrectomy

BEN

NA

NA

NA

Kojim

aKetal.Jap-D

euMed

Beric

he44

:185

112000

66F

Abdo

minalpain

and

macrohematuria

RKidn

ey9

Nephrectomy

BEN

9NED

POS

Leroyetal.U

rolInt

65:49

122000

72F

NA

LKidn

ey8

Nephrectomy

BEN

10NED

POS

Morim

itsuetal.A

PMIS

108:617

132000

56F

Incidental

LRe

nalcapsule

5Tu

mor

resection

BEN

NA

NA

NA

IkedaA

etal.J

Hiro

shim

aMed

Assoc

53:640

142001

70M

Incidental

RRe

nalp

elvis

6Nephrectomy

BEN

60NED

POS

Yazakietal.Int

JUrol8:504

152001

28F

Abdo

minalpain

LKidn

ey15

Nephrectomy

BEN

12NED

POS

Cortes-Gutierrez

etal.J

Urol

166:60

162001

41M

Macrohematuria

LKidn

ey14

Nephrectomy

BEN

48NED

POS

WangJetal.Am

JSurgPathol

25:1194

172001

72M

Abdo

minal

discom

fort

RKidn

ey13

Nephrectomy

BEN

5NED

POS

WangJetal.Am

JSurgPathol

25:1194

182002

57M

Incidental

LKidn

ey6

Nephrectomy

BEN

NA

NA

POS

MiyazakiN

etal.Jpn

RedCr

oss

Med

J54:182

192002

58M

Incidental

LKidn

eyNA

Nephrectomy

BEN

9NED

NA

Inokaw

aEJH

iroshim

aMed

Assoc

55:10

5720

2002

31F

Flankpain

RKidn

ey8.6

Nephrectomy

BEN

8NED

POS

Magro

GPatholRe

sPract198:37

212003

64F

Microhematuria

RKidn

ey4

Nephrectomy

BEN

7NED

POS

LiSetal.H

inyokika

Kiyo

49:12

1

222003

51F

NA

R/L

Kidn

ey25

and2

Tumor

resection

BEN

NA

NA

NA

LlarenaI

barguren

etal.A

rchEsp

Urol56:835


Table1:Con

tinued.

CaseYear

Age

Sex

Symptom

Side

Affected

site

Tumor

size

(cm)

Treatm

ent

Histology

Follo

w-up

(mon

th)

Outcome

CD-34∗

Authorsa

ndjournals

232003

35M

NA

RKidn

ey17

Nephrectomy

BEN

6NED

NA

DurandXetal.P

rogUrol13:491

242003

60F

NA

RKidn

ey11

Nephrectomy

BEN

48NED

NA

BugelH

etal.P

rogUrol13:1397

252004

67M

Incidental

LKidn

ey4.5

Tumorectomy

BEN

5NED

POS

Toriy

amaS

etal.H

inyokika

Kiyo

50:13

826

2004

83M

NA

RKidn

ey9

Nephrectomy

BEN

18NED

POS

GresP

etal.P

rogUrol14:65

272004

53M

Flankpain

and

swellin

gR

Renalcapsule

14Tu

mor

resection

BEN

36DNOD

POS

KuniedaK

etal.SurgTo

day

34:90

282004

59M

Incidental

LRe

nalcapsule

6.8

Nephrectomy

BEN

48NED

POS

YamadaH

etal.Patho

lInt

54:914

292005

29NA

Incidental

NA

Kidn

ey2.2

Nephrectomy

BEN

NA

NA

POS

PiersonDM

etal.M

odPathol

18:15

9

302005

NA

NA

Incidental

NA

Kidn

eyNA

Nephrectomy

BEN

NA

NA

POS

PiersonDM

etal.M

odPathol

18:16

0

312005

NA

NA

Incidental

NA

Kidn

eyNA

Nephrectomy

BEN

NA

NA

POS

PiersonDM

etal.M

odPathol

18:16

1

322005

NA

NA

Incidental

NA

Kidn

eyNA

Nephrectomy

BEN

NA

NA

POS

PiersonDM

etal.M

odPathol

18:16

2

332005

NA

NA

Incidental

NA

Kidn

eyNA

Nephrectomy

BEN

NA

NA

POS

PiersonDM

etal.M

odPathol

18:16

3

342005

NA

NA

Flankpain

NA

Kidn

eyNA

Nephrectomy

BEN

NA

NA

POS

PiersonDM

etal.M

odPathol

18:16

4

352005

79NA

Flankpain

NA

Perir

enal

10.1

Nephrectomy

BEN

NA

NA

POS

PiersonDM

etal.M

odPathol

18:16

536

2005

51F

Flankpain

NA

Renalcapsule

10Nephrectomy

BEN

NA

NA

POS

Yamaguchi

TUrology

65:17

5

372005

51F

Fevere

levatio

nR

Renalcapsule

13Nephrectomy

BEN

NA

NA

POS(fo

cal)

Jhon

sonTR

etal.J

Com

put

Assist

Tomogr2

9:481

382005

83F

Incidental

LKidn

ey11

Nephrectomy

BEN

NA

NA

POS

Kawagoe

MNish

inihon

JUrol

67:568

392006

76M

Incidental

LKidn

ey12

Nephrectomy

MAL

4Lu

ngmetastasis

POS(benign

site)

Fine

SWetal.A

rchPatholLab

Med

130:857

402006

18F

Flankpain

LKidn

ey3

Nephrectomy

BEN

15NED

POS

Koroku

Metal.H

inyokika

Kiyo

52:705

412006

4M

NA

RKidn

ey8

Nephrectomy

BEN

NA

NA

NA

Provance

etal.C

linPediatr

45:871

422006

85M

Flankpain

LKidn

ey4.5

Nephrectomy

BEN

NA

NA

POS

Kohl

SKetal.A

rchPatholLab

Med

130:117


Table1:Con

tinued.

Case

Year

Age

Sex

Symptom

Side

Affected

site

Tumor

size

(cm)

Treatm

ent

Histology

Follo

w-up

(mon

th)

Outcome

CD-34∗

Authorsa

ndjournals

432006

54M

Incidental

RKidn

eyNA

Nephrectomy

BEN

16NED

POS

Tanaka

Metal.H

inyokika

Kiyo

52:79

442006

36M

Flankpain

RKidn

eyNA

Nephrectomy

BEN

NA

NA

NA

Alvarez

Mug

icaM

etal.A

rchEsp

Urol59:195

452007

26M

Incidental

RKidn

ey7

Nephrectomy

BEN

6NED

POS

Con

stantinidisCetal.Th

eCan

JUrol14:3583

462007

70M

Flankpain

and

macrohematuria

LKidn

ey15

Nephrectomy

BEN

6NED

POS

ZnatiK

etal.R

eviesinUrol9:36

472007

51F

Flankpain

LKidn

ey4

Nephrectomy

BEN

10NED

POS

BozkurtSUetal.A

PMIS

115:259

482007

66F

Abdo

minal

massa

ndmacrohematuria

RKidn

ey11

Nephrectomy

BEN

NA

NA

NA

KakoiN

etal.JapnJU

rolSurg20

supp

le598

492007

60s

MIncidental

RKidn

ey3

Nephrectomy

BEN

3NED

NA

YoshidaT

etal.H

inyokika

Kiyo

53:74

550

2008

34F

Flankpain

LKidn

ey9

Nephrectomy

MAL

21NED

POS

Magro

Getal.A

PMIS

115:1020

512008

67M

Macrohematuria

LKidn

ey7

Nephrectomy

BEN

10NED

POS

AmanoTetal.H

inyokika

Kiyo

54:357

522008

44F

Incidental

LKidn

ey5.8

Nephrectomy

BEN

40NED

POS

Hira

bayashiJ

etal.H

inyokika

Kiyo

54:357

532009

75F

Incidental

LKidn

ey4.5

Nephrectomy

BEN

9NED

POS

Hira

noDetal.M

odMol

Morph

ol42:239

542009

64F

Cou

ghL

Kidn

ey2.5

Biop

syBE

N12

NED

POS

Petre

llaFetal.M

inerca

Chir

64:669

552009

35M

Incidental

RKidn

ey8

Partialn

ephrectomy

BEN

NA

NA

POS

Makris

Aetal.C

anJU

rol

16:4854

562009

72F

Abdo

minal

mass

LKidn

ey19

Nephrectomy

MAL

NA

NA

NA

MarziM

etal.U

rologia7

6:112

572009

76F

Incidental

RKidn

ey2.5

Nephrectomy

BEN

48NED

POS

YoneyamaT

etal.H

inyokika

Kiyo

55:479

582009

50M

Incidental

LKidn

ey5.5

Nephrectomy

BEN

NA

NED

POS

MatsumotoTetal.JapnJU

rol

Surg

22:230

592009

63M

Incidental

LKidn

ey5.3

Nephrectomy

MAL

NA

NA

POS

Murayam

aSetal.JapnJU

rol

Surg

22:230

602009

51F

Incidental

RKidn

ey12

Nephrectomy

BEN

NA

NA

POS

OgushiS

etal.JapnJU

rolSurg

22:230

612009

75M

NA

LKidn

ey3

Nephrou

reterectom

yBE

NNA

NA

POS

Kobo

riYetal.H

inyokika

Kiyo

55:305


Table1:Con

tinued.

Case

Year

Age

Sex

Symptom

Side

Affected

site

Tumor

size

(cm)

Treatm

ent

Histology

Follo

w-up

(mon

th)

Outcome

CD-34∗

Authorsa

ndjournals

622010

39M

Dysuria

LKidn

ey25

Nephrectomy

BEN

12NED

POS

Taza

Letal.A

ctas

UrolE

sp34:568

632010

39F

Abdo

minal

fulln

ess

LKidn

ey20

Embo

lizationand

neph

rectom

yBE

N6

NED

POS

Yamaguchi

Yetal.H

inyokika

Kiyo

56:435

642011

44M

Macrohematuria

LKidn

eyNA

Embo

lizationand

neph

rectom

yBE

NNA

NA

NA

SaegusaM

etal.N

ishinihon

JUrol68:187

652011

52F

Abdo

minalpain

RKidn

ey18

Nephrectomyand

thrombectom

yBE

N6

NED

POS

NaveenHNetal.U

rolA

nn3:158

662011

72F

Abdo

minal

mass

LKidn

ey19

Nephrectomy

MAL

15NED

POS(fo

cal)

MarziM

etal.M

inerva

Urol

Nephrol63:10

967

2011

50F

Flankpain

RKidn

ey15

Nephrectomy

MAL

30NED

POS

Tsan-YuHsie

hDiagPathol6:96

682012

68F

Flankpain

NA

Kidn

eyNA

Nephrectomy

MAL

NA

NA

POS

M.deM

artin

oAktuelU

rol2012;

43(01):59–

62

692012

72M

Flankpain

LKidn

ey7

Nephrectomy

MAL

45NED

POS

Sfou

ngaristos

SPrague

Med

Rep/Vo

l113

No.3,246–

250

702012

56M

Shortnesso

fbreath

LKidn

ey10,10

Nephrectomy

MAL

10NED

POS

G.Z

haoetal.O

ncolog

yLette

rs4:993–995,2012

712013

49F

Dyspn

eaL

Kidn

eyNA

Nephrectomy

BEN

23SD

POS

J.Cu

elloetal.C

aseR

epOncol

Med

2013;2013:564980

722013

48M

Abdo

minal

mass

RKidn

ey29

Nephrectomy

BEN

96NED

POS(55%

)SasakiHetal.C

aseR

epNephrol

Urol3:1–

8

732013

57M

Lumbarp

ain

LKidn

ey14

Nephrectomy

BEN

26NED

POS

Abdu

llahDetal.C

aseR

eportin

Urol147496:4

742013

3M

NA

NA

Kidn

eyNA

Nephrectomy

NA

NA

NA

NA

WuWW

etal.Int

JSurgPathol

23(1):3

4–47

752013

49F

Fevere

levatio

nandflank

pain

RKidn

ey5

Nephrectomy

BEN

NA

NED

POS

Nazih

Ketal.U

rolInt

2013;

91:37

3–383

762013

43M

Acuter

ecurrent

pancreatitis

NA

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have had a great tendency to local recurrence, as the tumoraccompanies multiple clinical features such as extrathoraciclocation, large tumor size, increased cellularity, and presenceof necrosis among the risk factors for local recurrencedescribed by Jason et al. [11].

Overall, we believe that there is no strict dichotomybetween benign and malignant SFTs and that all tumorslikely have some degree of metastatic potential, albeit quitelow. Therefore, although renal SFT is thought to be a benigntumor, an adequate follow-up period is required to evaluatethe precise clinical outcome of renal SFT, and the follow-up period in this report of 82 patients may not be sufficient(Table 1). Furthermore, most reported renal SFTs were largein size at the diagnosis and it might be leading cause ofmissing the malignant features in whole tumor tissue. Weshould also concern this issue for evaluating the real featureof renal SFTs in future.

FDGaccumulationwas not observedwithin the tumor onFDG-PET. To date, there is no reported association betweenSFTs and FDG accumulation, and our result suggests thatPET-CT may be invalid. Further detailed examination is alsorequired to clarify this point.

In conclusion, a case of SFT of the kidney exhibiting localrecurrence was reported. In our case, no obvious malignantfindings were observed in either the primary tumor or therecurrent tumor. Loss of expression in CD-34 and Bcl-2,which is closely associated with malignant potential, was notobserved. Although SFT of the kidney usually displays afavorable clinical course, careful and sufficient follow-upmaybe required even in the absence of malignant findings.

Consent

The patient described in the case report has given hisinformed consent for the case report to be published.

Competing Interests

The authors declare that there is no conflict of interestsregarding the publication of this paper.

References

[1] P. Klemperer and C. B. Rabin, “Primary neoplasm of the pleura:a report of five cases,” Archives of Pathology & LaboratoryMedicine, vol. 11, pp. 385–412, 1931.

[2] J. R. Goodlad and C. D. M. Fletcher, “Solitary fibrous tumourarising at unusual sites: analysis of a series,”Histopathology, vol.19, no. 6, pp. 515–522, 1991.

[3] G. T. MacLennan and L. Cheng, “Solitary fibrous tumor of thekidney,” Journal of Urology, vol. 181, no. 6, pp. 2731–2732, 2009.

[4] S. Sfoungaristos, M. Papatheodorou, A. Kavouras, and P. Per-imenis, “Solitary fibrous tumor of the kidney with massiveretroperitoneal recurrence. A case presentation ,” Prague Medi-cal Report, vol. 113, no. 3, pp. 246–250, 2012.

[5] D. M. England, L. Hochholzer, and M. J. McCarth, “Localizedbenign and malignant fibrous tumors of the pleura. A clinico-pathologic reviewof 223 cases,”TheAmerican Journal of SurgicalPathology, vol. 13, no. 8, pp. 640–658, 1989.

[6] Y. Morimitsu, M. Nakajima, M. Hisaoka, and H. Hashimoto,“Extrapleural solitary fibrous tumor: clinicopathologic study of17 cases andmolecular analysis of the p53 pathway,”APMIS, vol.108, no. 9, pp. 617–625, 2000.

[7] H. Sasaki, T. Kurihara, Y. Katsuoka et al., “Distant metastasisfrom benign solitary fibrous tumor of the kidney,” Case Reportsin Nephrology and Urology, vol. 3, no. 1, pp. 1–8, 2013.

[8] T. Yokoi, T. Tsuzuki, Y. Yatabe et al., “Solitary fibrous tumour:significance of p53 andCD34 immunoreactivity in itsmalignanttransformation,” Histopathology, vol. 32, no. 5, pp. 423–432,1998.

[9] I. Takizawa, T. Saito, Y. Kitamura et al., “Primary solitary fibroustumor (SFT) in the retroperitoneum,” Urologic Oncology: Sem-inars and Original Investigations, vol. 26, no. 3, pp. 254–259,2008.

[10] S. W. Fine, D. M. McCarthy, T. Y. Chan, J. I. Epstein, and P.Argani, “Malignant solitary fibrous tumor of the kidney: reportof a case and comprehensive review of the literature,”Archives ofPathology and Laboratory Medicine, vol. 130, no. 6, pp. 857–861,2006.

[11] J. S. Gold, C. R. Antonescu, C. Hajdu et al., “Clinicopathologiccorrelates of solitary fibrous tumors,” Cancer, vol. 94, no. 4, pp.1057–1068, 2002.

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