Laparoscopic Minimally Invasive Approach for Pelvic Solitary Fibrous Tumor.

Abstract

A solitary fibrous tumor (SFT) is a rare mesenchymal fibroblastic tumor characterized by intermediate behavior, with a peak incidence in the fifth and sixth decades of life. SFTs have been reported at almost every anatomic site, with approximately 20% of cases involving the abdominal cavity.¹ SFTs are often asymptomatic and may be discovered as an incidental finding on imaging. Sometimes when the tumor size is large, it may produce symptoms related to pressure effects of adjacent organs.² The standard treatment for SFTs consists of surgical resection with free resection margins. Given the rarity of SFTs, there is no global consensus for their treatment with respect to radiotherapy and adjuvant chemotherapy.³ A minimally invasive laparoscopic approach has been described in the literature, especially in cases where surgery is not extremely demolitive.^4,5This report presents the case of a 66-year-old female with a preoperative diagnosis of SFT confirmed by percutaneous needle biopsy. A computed tomography scan showed a voluminous solid expansive formation in the pelvic area measuring 96 × 89 × 92 mm, which was attached to the ipsilateral ureter and was in contact with the internal iliac artery for over 180° (Tinelli's score grade 3). ⁶ The patient underwent surgery consisting of laparoscopic removal of the pelvic mass, with resection and re-implantation of the ipsilateral ureter and ligation of the internal iliac vessels. Video 1 provides a step-by-step description of the surgical strategy adopted. Minimally invasive surgery is feasible in selected patients with large mesenchymal tumors and could be a viable option for optimizing the multidisciplinary approach to treating this rare tumor.