Clinicopathologic correlates of solitary fibrous tumors.

Soft-tissue sarcomas (STS) are rare tumors that account for 1% of all adult malignancies, with over 100 different histologic subtypes occurring predominately in the trunk, extremity, and retroperitoneum. This low incidence is further complicated by their variable presentation, behavior, and long-term outcomes, which emphasize the importance of centralized care in specialized centers with a multidisciplinary team approach. In the last decade, there has been an effort to improve the quality of care for patients with STS based on anatomic site and histology, and multiple ongoing clinical trials are focusing on tailoring therapy to histologic subtype. This report summarizes the latest evidence guiding the histiotype-specific management of extremity/truncal and retroperitoneal STS with regard to surgery, radiation, and chemotherapy.

https://acsjournals.onlinelibrary.wiley.com/doi/pdf/10.3322/caac.21605

Soft-tissue sarcoma in adults: An update on the current state of histiotype-specific management in an era of personalized medicine.

The Leaky Pipeline of Women in Plastic Surgery: Embracing Diversity to Close the Gender Disparity Gap.

Solitary Fibrous Tumor (SFT) is a distinct soft tissue neoplasm associated with NAB2-STAT6 gene fusion. It can involve a number of anatomic sites and exhibits a wide spectrum of histological features. Apart from diversity in morphological features seen even in conventional SFT, two histologic variants (fat-forming and giant cell-rich) are also recognized. In addition, a malignant form and dedifferentiation are well recognized. Owing to diverse histological features and involvement of diverse anatomic locations, SFT can mimic other soft tissue neoplasms of different lineages including schwannoma, spindle cell lipoma, dermatofibrosarcoma protuberans, liposarcoma, gastrointestinal stromal tumor (GIST), malignant peripheral nerve sheath tumor (MPNST), and synovial sarcoma. SFT is classified as an intermediate (rarely metastasizing) tumor according to World Health Organization Classification of Tumors of Soft tissue and Bone, 5th edition. The management and prognosis of SFT differs from its malignant mimics and correct diagnosis is therefore important. Although SFT expresses a distinct immunohistochemical (IHC) profile, the classic histomorphological and IHC profile is not seen in all cases and diagnosis can be challenging. NAB2-STAT6 gene fusion has recently emerged as a sensitive and specific molecular marker and its IHC surrogate marker signal transducer and activator of transcription 6 (STAT6) has also shown significant sensitivity and specificity. However, few recent studies have reported STAT6 expression in other soft tissue neoplasms. This review will focus on describing the diversity of histological features of SFT, differential diagnoses and discussing the features helpful in distinguishing SFT from its histological mimics.

/pdf/the-many-faces-of-solitary-fibrous-tumor-diversity-of-3a7tapvjdo.pdf

The many faces of solitary fibrous tumor; diversity of histological features, differential diagnosis and role of molecular studies and surrogate markers in avoiding misdiagnosis and predicting the behavior

Background There has been increasing attention to gender inequity in speakers at professional meetings. The aim of this study was to evaluate temporal trends in representation of women at the Academic Surgical Congress (ASC) and American College of Surgeons Clinical Congress (CC), 2 prominent general interest, national surgical meetings. Study Design We reviewed ASC (2014–2019) and CC (2013–2018) meeting programs to determine counts and proportions of invited panelists and moderators by gender, including the frequency of men-only panels. We conducted trend analyses to assess for temporal change in gender representation and univariate tests of association between different measures of gender representation. Results The overall proportions of women panelists were 35% (ASC) and 28% (CC). There was a significant increase in the proportion of women panelists over the study period at the CC (23% to 34%, p = 0.007) but not at the ASC (37% to 36%, p = 0.79). The proportion of men-only panels decreased significantly over time at the CC (38% to 23%, p = 0.04), but not at the ASC (23% to 17%, p = 0.50), while the proportion of moderators at the ASC increased significantly (31% to 43%, p = 0.01), but not at the CC (29% to 37%, p = 0.40). Conclusions Women remain in the minority of panelists and moderators at the ASC and CC meetings, and approximately 1 in 5 panels are composed entirely of men. Although progress has been made at both meetings, ongoing and deliberate attention is needed to ensure continued progress toward the goal of equitable gender representation in academic surgery.

Trends in Gender Representation at the American College of Surgeons Clinical Congress and the Academic Surgical Congress: A Mixed Picture of Progress.

Solitary fibrous tumor (SFT) is a rare tumor of mesenchymal origin that account for less than 2% of all soft tissue masses. Initially identified in the pleura, SFT has been identified in multiple anatomic locations and can arise anywhere in the body. The varying histologic features along with non-specific means of identification have led SFT to be associated with several different names. Over the last several decades, sustained advances through research and technology have led to more reliable methods for differentiating this distinct soft tissue tumor. Advances specifically in immunohistochemistry and molecular diagnostics have identified CD34 as the most consistent marker in SFT, however even this lacks specificity to conclusively narrow down the broad differential for exact identification. More recently the discovery of the NAB2-STAT6 fusion gene has led to more precise diagnosis of SFT. Like many other soft tissue tumors, surgical management is the mainstay of treatment for SFT with emphasis on obtaining tumor-negative margins. Radiation therapy and chemotherapy regimens have not demonstrated global effectiveness, and thus no standardized treatments have been identified. Given the rarity of SFT and current supportive evidence for therapies, management should be focused on tumor extirpation. Nonetheless, individualized therapy, determined within a multidisciplinary setting should be considered.

https://tgh.amegroups.com/article/download/4708/pdf

Solitary fibrous tumor.

Solitary fibrous tumor

/pdf/current-state-of-women-in-academic-surgical-subspecialties-1e111azngp.pdf

Current State of Women in Academic Surgical Subspecialties: How a New Metric in Measuring Academic Productivity May Change the Equation

In the August 2016 issue of the Journal of the Am Coll Surg, our group reported the differences between male and female academic surgeons by faculty rank, academic output, and NIH funding rates using data of faculty from the 55 departments of surgery with the most National Institutes of Health funding.1 Overall, metrics from 4015 surgical faculty members were examined. The objectives of the study were to identify potential barriers that might be preventing the academic success of all surgical faculty members. Men comprised 76.9 per cent (3087) and females comprised 23.1 per cent (928) of the faculty we could identify. Male surgical faculty also comprised a greater fraction of older surgeons. Overall, male cumulative scholarly output was higher than that of females as measured by total publications (43 ± 97.5 vs 19 58, p < 0.05) and total citations (723 ± 3322 vs 317 ± 1,774, p < 0.05). In terms of gender-based differences in academic rank, female surgical faculty members were far more likely to be represented at lower academic levels. Overall a higher proportion of women faculty are at junior faculty ranks with 49.7 per cent of the female surgical faculty at the assistant professor rank, compared with only 31.8 per cent of male faculty. An equal proportion of male and female surgical faculty were at the associate professor level (27%); with only 22.7 per cent of female surgical faculty being at full professor rank compared with 41.2 per cent of males. This is disproportionate even accounting for the differences in the demographics of medical students and residents five and 10 years prior.2, 3 At higher academic ranks, the publications and citations for women were similar to those of their equivalently ranked male counterparts. Gender-based differences in leadership positions and academic degrees were also found. Female surgical faculty members were, in fact, half as likely to be in divisional leadership positions. The fraction of women by surgical subspecialty examined also differed. Cardiothoracic surgery had the lowest fraction of female full professors (11%). Among thoracic surgeons, 22 per cent of the female faculty were full professors, compared with 48 per cent male surgical faculty. These numbers were lower for female cardiac surgery professors. The findings of lower percentages of women at the rank of full professor were observed for other surgical specialties as well, including both vascular surgery and surgical oncology.1 The data from this analysis are supported by other analyses performed by a variety of other approaches and across different medical specialties or other professions. Nonnemaker, for example, analyzed the promotion trends across all disciplines and departments of academic medicine and evaluated differences in medical student gender and its effect on promotion and academic position by decade.4 The article, published in the N Engl J Med, showed that there were higher numbers of female medical students graduating than men in the 1980s. However, overall promotion of females from assistant professor to associate professor, as observed in our data set, was much less common for women. Similarly, female faculty advancing from associate to full professor deviated from the predicted values considerably. In the same group, the percentage of male full professor faculty was 34 per cent, compared with only 12 per cent for female faculty, regardless of department. This suggests that even accounting for differences in demographics between the graduating medical students and junior residents, the promotion of women in academic surgery has been slow. To evaluate whether female assistant and associate professors were being promoted with similar academic measures, the scholarly output for each academic rank Address correspondence and reprint requests to Leonidas G. Koniaris, M.D., M.B.A., F.A.C.S., 545 Barnhill Drive EH 511 Indianapolis, IN 46202. E-mail: lkoniari@iu.edu.

Megan E. Lisy

Papers

Solitary fibrous tumor.

Solitary fibrous tumor

Current State of Women in Academic Surgical Subspecialties: How a New Metric in Measuring Academic Productivity May Change the Equation

Current State of Women in Academic Surgical Subspecialties: How a New Metric in Measuring Academic Productivity May Change the Equation