Purpose

To report a rare case of a Solitary Fibrous Tumor (SFT) in an adolescent patient. SFT is a mesenchymal neoplasm that typically presents in the fifth decade of life, with very few documented cases in the pediatric population. We emphasize the importance of this diagnosis in young patients due to the high risk of late recurrence and the necessity for lifelong surveillance.

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Methods

A 16-year-old female presented with a slow-growing, painless swelling in the medial upper eyelid of the right eye. Computed Tomography was performed instead of Magnetic Resonance Imaging to avoid metallic artifacts from recently placed orthodontic braces. The patient underwent surgical excision, and the specimen was submitted for histopathological and immunohistochemical analysis.

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Results

Imaging revealed a well-delimited, isodense pre-septal lesion (8 × 15 mm) in the medial orbit, initially suggestive of a dermoid or epidermoid cyst. Surgical excision revealed a cystic-appearing mass. Histopathology showed a capsulated mesenchymal neoplasm with spindle cells and “staghorn” vasculature. Immunohistochemistry was definitive, showing positive expression for CD34 and STAT-6, and negative for S100, SMA, and Desmin. Although the tumor was classified as low risk for malignancy, the histopathological report noted a marginal exeresis. Post-operative follow-up at one month showed excellent healing.

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Conclusion

This case is of exceptional rarity, with fewer than ten documented reports of orbital SFT in the global pediatric population. A marginal excision in a 16-year-old is of significant clinical concern. Literature suggests that incomplete resection or capsular disruption increases the risk of recurrence to 30–60%. Because SFTs often recur decades later, this young patient requires rigorous, lifelong surveillance. This case underscores the need to include SFT in the differential diagnosis of adolescent orbital masses to ensure appropriate surgical planning and long-term follow-up.

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Additional Authors

First name	Last name	Base Hospital / Institution
Diogo	Ferreira	Centro Hospitalar Universitário de São João
Cristina Maria	Sousa	Centro Hospitalar Universitário de São João

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