A case of primary hepatic solitary fibrous tumor with simultaneous intrahepatic metastasis and pancreatic metastasis

Solitary fibrous tumor (SFT) is a relatively rare tumor that develops mostly as an intrathoracic lesion related to the pleura. Hepatic malignant SFTs are rare. Here, we present a case of a 56-year-old man with a bulky tumor in the right hepatic lobe. The tumor was found incidentally by abdominal CT as part of an examination for hepatic dysfunction. The definitive diagnosis of SFT was established after liver biopsy, and the patient was referred to our hospital for surgical treatment. At the first visit, imaging studies revealed the primary focus of the malignancy as well as metastatic lesions in the hepatic S2 segment and pancreatic body. The treatment regimen was as follows: after antecedent TAE, primary hepatic and intrahepatic metastatic foci were first resected by extended resection of the two central areas. Nine months later, the pancreatic head tumor was enucleated and distal pancreatectomy was performed to remove metastatic foci including the new lesion on the pancreatic head. Postoperative adjunctive therapy was not administered, and the patient is currently alive without recurrence 22 months postoperatively. To the best of our knowledge, there have only been a few reports on primary hepatic malignant SFTs and this is the only SFT case involving pancreatic metastases reported thus far. This case indicates that total tumor resection allows patients with distant metastasis to achieve recurrence-free survival. Should recurrence occur, we would proactively consider the use of molecular-targeted drugs (approved in 2012), with re-resection in mind.