An 81-year-old woman presented with a 3-month history of a slow-growing mass in her left cheek. She denied having any symptoms, tenderness, numbness, or facial nerve weakness. Physical examination revealed a mass in the buccinator space that was smooth, was nontender to palpation, and had no overlying cutaneous changes. A contrast-enhanced maxillofacial computed tomography scan demonstrated a 1.8 × 1.8 × 1.9-cm rounded, well-circumscribed lesion at the anterior aspect of the left masticator space (Figure 1). The mass was abutting the parotid duct, which did not appear dilated, and appeared to have a peripheral rim of hyperenhancing soft tissue with a central cystic/necrotic component. Results of ultrasound-guided fine-needle aspiration revealed rare epithelial cells with degenerative changes and inflammatory cells present. Findings from a core biopsy demonstrated a spindle cell neoplasm of uncertain origin. On immunostaining, spindle cells were CK8/18, S100, and SOX10 negative; myosin and smooth muscle actin (SMA) negative; and CD31 negative. However, STAT6 staining was diffusely positive.
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D. Solitary fibrous tumor
Solitary fibrous tumors (SFTs) are rare, spindle-cell neoplasms of mesenchymal origin that preferentially arise in serosal membranes, intracranial and spinal cord meninges, and the extremities.1 While pleural SFTs are most common, an estimated 6% to 18% of SFTs occur in the head and neck region, most frequently involving the oral cavity, sinonasal tract, orbit, or salivary glands.2 Peak incidence is in middle-aged adults (median age, 51 years); there is no sex predilection. Patients most commonly present with a small (<5 cm), painless, slow-growing mass, with or without site-related compressive symptoms. Standard of care is wide surgical resection; however, rates of positive surgical margins are high, and postoperative radiation therapy may be considered.2 Under the 2020 World Health Organization Classification of Soft Tissue and Bone Tumors, SFTs are categorized as fibroblastic/myofibroblastic neoplasms with intermediate—rarely metastasizing—biological behavior, and multiple case series have described the indolent nature of SFT.1- 3 However, the clinical behavior of individual tumors is notoriously difficult to predict: there is a predilection for late local recurrence in 5% to 40% of patients,1 with varying reports of median time to recurrence between 37 and 120 months.1 Several risk-assessment schema have been proposed to predict the behavior of SFT (ie, risk of metastasis, risk of recurrence, disease-free and overall survival).1,4 These schema consider factors such as patient age, tumor size, depth of location, cellularity, pleomorphism, and mitotic rate/index to stratify SFTs as very low, low, moderate/intermediate, or high risk.1,4
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Corresponding Author: Karthik Rajasekaran, MD, Department of Otorhinolaryngology–Head and Neck Surgery, University of Pennsylvania, 800 Walnut St, 18th Floor, Philadelphia, PA 19107 (email@example.com).
Published Online: August 11, 2022. doi:10.1001/jamaoto.2022.2249
Conflict of Interest Disclosures: None reported.
Additional Contributions: We thank the patient for granting permission to publish this information.
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