Clinical Scorecard: STAT6 positivity supported diagnosis of giant intrapulmonary SFT

At a Glance

Key Highlights

• The mass enlarged on serial CT and was associated with cardiac displacement, atelectasis, pericardial effusion, and a hepatic nodule suspicious for metastasis.
• Core biopsy showed a low-grade spindle cell neoplasm; diffuse nuclear STAT6 positivity and partial CD34 positivity supported SFT diagnosis.
• The hepatic lesion was not histologically confirmed as metastatic disease.
• Upfront resection was deferred after multidisciplinary evaluation because of disease extent and suspected metastatic spread; the patient received six cycles of chemotherapy.
• Follow-up imaging showed persistent tumor burden, while the patient remained clinically stable; the case cannot establish chemotherapy effectiveness.

Guideline-Based Recommendations

Diagnosis

• The authors emphasized integrating clinical, radiologic, histopathologic, and immunohistochemical findings to establish the diagnosis.
• In this case, diffuse nuclear STAT6 positivity supported SFT diagnosis; biopsy also showed partial CD34 positivity and negative staining for CK7, desmin, smooth muscle actin, and S100.

Management

• Management was individualized following multidisciplinary evaluation.
• Upfront surgical resection was deferred because of the extent of disease and suspected metastatic spread; the patient subsequently received six cycles of doxorubicin, cisplatin, vincristine, and cyclophosphamide.

Monitoring & Follow-up

• Serial CT was used to assess tumor size, local extension, and possible metastatic spread.
• Follow-up included pulmonary function testing; spirometry was preserved and diffusing capacity was 67%.

Risks

• Despite low-grade histologic features, the tumor had substantial size and extensive local involvement.
• The hepatic lesion was suspicious for metastasis on imaging but was not histologically confirmed.
• Earlier hypoglycemia raised suspicion for Doege–Potter syndrome; serum IGF-2 was not assessed, so the syndrome could not be confirmed.

Patient & Prescribing Data

One 57-year-old woman with giant intrapulmonary SFT, progressive chest pain and dyspnea, and a hepatic lesion suspicious for metastasis.

After resection was deferred, the patient received six cycles of doxorubicin, cisplatin, vincristine, and cyclophosphamide. Follow-up CT showed persistent mass; she remained clinically stable. The case cannot establish treatment effectiveness.

Clinical Best Practices

• The authors emphasized combining clinical presentation, imaging, histopathology, and immunohistochemistry when evaluating suspected giant intrapulmonary SFT.
• The hepatic lesion was suspicious for metastasis on imaging but was not histologically confirmed.
• Earlier hypoglycemia raised suspicion for Doege–Potter syndrome; IGF-2 was not assessed in this case.
• Serial imaging and pulmonary function testing documented the reported clinical course.

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