PARATESTICULAR SOLITARY FIBROUS TUMOR : CASE REPORT

H. Ncir, M. Errehan, M.A Lakmichi, Z. Dahami, M.S Moudouni and I. Sarf  ...................................................................................................................... Manuscript Info Abstract ......................... ........................................................................ Manuscript History Received: 28 May 2020 Final Accepted: 30 June 2020 Published: July 2020


Picture 2:-CT scan of the tumor.
A scrotal surgical exploration was performed showing a well-limited mass of approximately 7 cm, with anarchic, non-pedicled vascularization. The extemporaneous examination is not done. The therapeutic decision was to perform a large tumerectomy.  The post-operative consequences were unremarkable and the outcome at 4 months was favorable.

Discussion:-
TFS is a benign tumor in adults characterized by the proliferation of spindle cells, of mesenchymal origin, which are relatively ubiquitous. Originally reported in the pleura in 1931 by Klemperer and Rabin and long considered to be exclusively pleural, this tumor has gained more interest since its description in other organs and locations [1,2]. Likewise, TFS localized to the male genitalia are rare. Only a few cases have been reported: 3 cases in the seminal vesicles [3,4], 1 case in the spermatic cord [5], 1 case in the testicular vagina [6] and 3 others in the gonadal area [13 ]. The age group is between 19 and 85 years old, with an average age of around 50 years [7].
Macroscopically, it typically presents as a single, hard, oval, bumpy, well-defined, encapsulated mass, in principle easily cleavable with the finger, pinkish-gray, sometimes with pseudocystic lacunae.
The anatomopathological characteristics do not contain any specificity linked to localization [8]. Microscopically, their characteristics are based on the combination of three components in varying proportions: a cellular contingent, fibrous tissue and dilated vessels of varying diameter. The cells form short, crisscrossing bundles around branching capillaries, or around thicker fibrohyaline-walled vessels. Tumor cells are spindle-shaped or oval, with scant cytoplasm, with blurred cytoplasmic boundaries, with rounded nuclei or in circumflex accent. In immunohistochemistry, cells are most often positive for CD34 (90 to 100% of tumors) [10], CD99 (70%) and Bcl2 (around 30%) [11]. They are generally negative for cytokeratins, smooth muscle actin, desmin, S-100 protein and ckit [9]. No anatomopathological criterion currently makes it possible to predict the behavior of TFS, which therefore remains uncertain. Nevertheless, TFS is considered to be benign or low-grade of malignancy, regardless of the location. The forms of poor prognosis are evaluated from 11 to 22% [4,12].
The majority of TFS behave noninvasively and do not recur after complete resection, which appears to be the best prognostic factor [4,12]. Recurrences occur between a few months to 20 years, raising the question of the quality of the initial excision in some cases. Given the histological heterogeneity of this little-known tumor and the small number of long-term studies, the recurrence rate is difficult to assess.

Conclusion:-
The solitary fibrous tumor is far from being a tumor exclusive to the serosa. This is a rare, ubiquitous tumor. The localization at the level of the urogenital tract remains exceptional and its diagnosis difficult. Its prognosis remains unpredictable, despite the absence of formal criteria for malignancy, and depends on the quality of the surgical resection, which remains the therapeutic indication of choice.