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Background <p>Solitary fibrous tumor (SFTs) of the head and neck (H&amp;N) are rare mesenchymal neoplasms with varied clinical behavior. Since 2019, advances in immunohistochemistry, particularly nuclear STAT6 expression, have improved diagnostic accuracy. A comprehensive update is needed to reassess clinical presentation, diagnosis, and outcomes.</p> Purpose <p>The aim of this systematic review was to evaluate the clinical presentation, diagnosis, management, and outcomes of solitary fibrous tumor of the head and neck reported between June 2019 upto 10th June 2025. The review includes pooled analysis of demographics, tumor characteristics, histopathologic and immunohistochemical features, treatment approaches, recurrence rates, and follow-up outcomes among patients diagnosed with H&amp;N SFTs.</p> Study Selection <p>Eligible studies were English-language case reports, case series, and observational studies that reported solitary fibrous tumor arising in the head and neck region in humans. Exclusion criteria included non-English publications, non-H&amp;N SFTs, editorials, review articles, and studies without individual patient data. Two independent reviewers performed screening and full-text assessment based on PRISMA guidelines, resolving discrepancies by consensus. Of 503 identified studies, 103 met inclusion criteria (36.1%).</p> Results <p>The review included 103 studies comprising 281 patients with head and neck SFTs. The median age was 47 years (range: 6 months–84 years); 53% were female. Common sites included the oral cavity (27.5%), orbit (18.5%), and sinonasal region (13.3%). Most patients presented with painless swelling. Histologically, tumor demonstrated spindle cell morphology; 99.1% were STAT6-positive. Surgical excision was the primary treatment in 96.4% of cases, with negative margins achieved in 85%. Recurrence occurred in 10.3%, primarily associated with positive margins, increased mitotic activity, and nuclear atypia. Adjuvant radiotherapy was administered in 5.3% of cases. Distant metastases were rare (&lt;5%). The average follow-up period was 25 months.</p> Conclusions <p>Head and neck SFTs exhibit indolent behavior but carry a risk of recurrence, especially in tumors with high-risk histologic features. STAT6 immunohistochemistry is highly sensitive and should be considered the gold standard for diagnosis. Complete surgical excision with negative margins is essential for optimal outcomes. This review underscores the need for long-term follow-up in patients with H&amp;N SFTs to detect late recurrences or metastasis.</p>

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Solitary Fibrous Tumor of the Head and Neck Region: A Systematic Review of Diagnostic Approaches, Surgical Management, and Outcomes

  • 期刊论文

  • 发表日期：

    2026年3月5日

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  • Rajesh Chauhan,
  • Ajay Kumar Verma,
  • Jishnu Mohan,
  • Virendra Singh,
  • Amrish Bhagol,
  • Mohd Sabir Khan

摘要

Background

Solitary fibrous tumor (SFTs) of the head and neck (H&N) are rare mesenchymal neoplasms with varied clinical behavior. Since 2019, advances in immunohistochemistry, particularly nuclear STAT6 expression, have improved diagnostic accuracy. A comprehensive update is needed to reassess clinical presentation, diagnosis, and outcomes.

Purpose

The aim of this systematic review was to evaluate the clinical presentation, diagnosis, management, and outcomes of solitary fibrous tumor of the head and neck reported between June 2019 upto 10th June 2025. The review includes pooled analysis of demographics, tumor characteristics, histopathologic and immunohistochemical features, treatment approaches, recurrence rates, and follow-up outcomes among patients diagnosed with H&N SFTs.

Study Selection

Eligible studies were English-language case reports, case series, and observational studies that reported solitary fibrous tumor arising in the head and neck region in humans. Exclusion criteria included non-English publications, non-H&N SFTs, editorials, review articles, and studies without individual patient data. Two independent reviewers performed screening and full-text assessment based on PRISMA guidelines, resolving discrepancies by consensus. Of 503 identified studies, 103 met inclusion criteria (36.1%).

Results

The review included 103 studies comprising 281 patients with head and neck SFTs. The median age was 47 years (range: 6 months–84 years); 53% were female. Common sites included the oral cavity (27.5%), orbit (18.5%), and sinonasal region (13.3%). Most patients presented with painless swelling. Histologically, tumor demonstrated spindle cell morphology; 99.1% were STAT6-positive. Surgical excision was the primary treatment in 96.4% of cases, with negative margins achieved in 85%. Recurrence occurred in 10.3%, primarily associated with positive margins, increased mitotic activity, and nuclear atypia. Adjuvant radiotherapy was administered in 5.3% of cases. Distant metastases were rare (<5%). The average follow-up period was 25 months.

Conclusions

Head and neck SFTs exhibit indolent behavior but carry a risk of recurrence, especially in tumors with high-risk histologic features. STAT6 immunohistochemistry is highly sensitive and should be considered the gold standard for diagnosis. Complete surgical excision with negative margins is essential for optimal outcomes. This review underscores the need for long-term follow-up in patients with H&N SFTs to detect late recurrences or metastasis.