High-grade Sarcomatous Overgrowth in Solitary Fibrous Tumors: A Clinicopathologic Study of 10 CasesCollini, Paola MD*; Negri, Tiziana PhD*; Barisella, Marta MD*; Palassini, Elena MD†; Tarantino, Eva PhD*; Pastorino, Ugo MD‡; Gronchi, Alessandro MD‡; Stacchiotti, Silvia MD†; Pilotti, Silvana MD*The American Journal of Surgical Pathology: August 2012 - Volume 36 - Issue 8 - p 1202–1215 doi: 10.1097/PAS.0b013e31825748f0 Original Articles Abstract Author Information We describe 10 solitary fibrous tumors (SFT) with high-grade malignant overgrowth, all of which showed the presence of a synchronous or previous classic SFT/malignant SFT (MSFT) component. Seven were “dedifferentiated,” with an abrupt transition from a classic SFT/MSFT to a high-grade component consisting of a nondistinctive high-grade sarcoma in 4 cases and divergent differentiation in 3. The nondistinctive high-grade component consisted of epithelioid and/or spindle cells often associated with overt pleomorphism or small round cell sarcomas. The divergent differentiation featured a rhabdomyosarcoma in 2 cases and an osteosarcoma in 1. Three cases (tentatively called “evolved”) showed a gradual transition from classic SFT/MSFT to a nondistinctive high-grade sarcoma or presented features of high-grade sarcoma at the time of metastasis (assessed by fine-needle aspiration cytology) without any component suggesting a diagnosis of classic SFT/MSFT. The high-grade component showed loss of CD34 expression in half of the dedifferentiated SFTs and all of the dedifferentiated SFTs with divergent differentiation, whereas Ki-67 was markedly increased in all of the evaluable cases and paralleled the tumor grade. In 4 cases, the expression and phosphorylation status of key factors that control transcription and protein synthesis were also investigated. Both S6 and 4E-BP1 showed low activation in the low-grade MSFT and a high level of activation in the high-grade component. Seven of the 10 patients died of their disease during follow-up, with a median overall survival of 73 months (range, 5 to 288 mo). The median time to distant metastasis was 156 months after the initial diagnosis, and median overall survival from the first signs of metastasis was 8 months. Departments of *Diagnostic Pathology and Laboratory Medicine †Clinical Oncology ‡Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy Conflicts of Interest and Source of Funding: Supported by grants from the Associazione Italiana per la Ricerca sul Cancro (AIRC) and Alleanza Contro il Cancro (ACC) to S.P. S.S. and E.P. received research funds from Pfizer S.r.l. for clinical studies. Correspondence: Paola Collini, MD, Department of Diagnostic Pathology and Laboratory Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori, Via Venezian 1, 20133 Milan, Italy (e-mail: email@example.com). © 2012 Lippincott Williams & Wilkins, Inc.