The central nervous system solitary fibrous tumor: a review of clinical, imaging and pathologic findings among all reported cases from 1996 to 2010

Solitary Fibrous Tumor With an Acute Subdural Hematoma: A Case Report and Review of the Literature

Solitary fibrous tumor (SFT) is a rare interstitial tumor that originates from various soft tissues, and SFTs occurring within the cranium are extremely rare. While intracranial SFTs with cerebral hemorrhage or subarachnoid hemorrhage have been reported, there have been no reports of intracranial SFTs causing subdural hematoma. In this case, we report on an intracranial SFT accompanied by a subdural hematoma. A 29-year-old female was emergently transported due to the sudden onset of persistent headache and vomiting that began the night before. CT and MRI imaging revealed a hemorrhagic tumor under the tentorium and an acute subdural hematoma extending along the tentorium. The excised tumor was diagnosed as an SFT through histopathological examination. After undergoing radiation therapy, no recurrence has been observed. This is the first case report of an SFT accompanied by a subdural hematoma, and it is vital to recognize that SFTs can be associated with subdural hematomas for proper diagnosis and treatment planning.

Solitary Fibrous Tumor of the Central Nervous System: A Report of Two Cases with Emphasis on Diagnostic Pitfalls

Solitary fibrous tumor (SFT) is a rare primary central nervous system neoplasm that usually presents as a dural-based mass. Awareness of the entity is limited by the rarity of the tumor which renders it prone to misdiagnosis. We present two cases of SFT located in the right parafalx and intraventricular region. The cases were classified as WHO grade 1 and grade 2, respectively. The present study discusses the radiological, histomorphological, and immunohistochemical features of SFT, with emphasis on potential diagnostic pitfalls that may lead to erroneous diagnosis.

Impact of extent of resection and postoperative radiotherapy on survival outcomes in intracranial solitary fibrous tumors: a systematic review and meta-analysis

The knowledge of optimal treatments for patients with intracranial solitary fibrous tumor (SFT) is limited, with inconclusive results from previous studies. In this study, we conducted a meta-analysis of relevant studies to identify the prognostic impact of the extent of resection (EOR) and postoperative radiotherapy (PORT) on survival outcomes of patients with intracranial SFT. We searched the Medline, Embase, and Cochrane Central Register of Controlled Trials (CENTRAL) to identify relevant studies published till April 2022. Progression-free survival (PFS) and overall survival (OS) were the outcomes of interest. Differences between two cohorts (gross total resection [GTR] vs. subtotal resection [STR] and PORT vs. surgery only) were estimated by calculating hazard ratios. Twenty-seven studies were selected for the meta-analysis, including data of 1348 patients (GTR, n = 819 vs. STR, n = 381 and PORT, n = 723 vs. surgery only, n = 578). Pooled hazard ratios of PFS (1, 3, 5, and 10 years) and OS (3, 5, and 10 years) revealed that the GTR cohort showed sustained superiority over the STR cohort. In addition, the PORT cohort was superior to the surgery-only cohort with respect to all PFS periods. Although the 10-year OS between the two cohorts was not statistically different, PORT showed significantly better 3- and 5-year OS than surgery only. The study findings suggest that GTR and PORT provide significant benefits for PFS and OS. Aggressive surgical resection of tumors to achieve GTR followed by PORT should be implemented as optimal treatments for all patients with intracranial SFT when feasible.

[Recurrent petrosal tumor: meningioma or solitary fibrous tumor?]

Intracranial meningeal solitary fibrous tumors (SFT) originating from mesenchymal tissue are much less common than those with lesions of the visceral pleura or liver and were isolated as a nosological form only in 1996. These tumors are identical in clinical manifestations, MRI and light microscopy data to meningiomas. The pathognomonic difference of SFT, according to the 5th edition of the WHO classification, is the detection of overexpression of the protein encoded by the STAT6 gene. Estimation of other immunohistochemical markers is variable. At the same time, SFT has a tendency to more frequent recurrence and delayed malignancy. Transitional forms are possible. To form a clearer nosological outline of the SFT, it is necessary to accumulate clinical observations. A case of a giant meningioma of the posterior cranial fossa, which recurred 18 years after total removal at a 5-year annual control, is presented. Light microscopy of both primary and recurrent tumors revealed fibrous meningioma (WHO GI). Immunohistochemically revealed diffuse overexpression of CD34 and CD99. Determining the expression of the STAT6 protein was not technically possible. This case is regarded as a meningioma of the posterior surface of the pyramid of the temporal bone, growing into the cavity of the IV ventricle, with late recurrence without malignancy, with specific immunohistochemical profile.

Recurrent meningeal malignant tumor: Assessment of differences in the solitary fibrous tumor/hemangiopericytoma spectrum through a case report

Solitary fibrous tumors (SFTs) are neoplasms that grow from mesenchymal fusiform cells. In the central nervous system, meninges are the common origin of these neoplasms. Although literature reports mostly SFT as benign neoplasm, malignancy data have been described in recurrences or metastatic lesions. Definitive diagnosis includes immunohistochemical profiles assessing cellular positivity for CD34, vimentin, CD99 and Bcl-2. Recent studies have demonstrated NAB2-STAT6 gene fusion as a distinct molecular feature of SFT with overexpression of the fusion protein NAB2-STAT6 in nuclei of these cells. Since several years, pathologists have grouped SFT and hemangiopericytomas (HPC) as different phenotypes of the same entity although both neoplasms do not share numerous features. This article, based on a case of a recurrent malignant SFT, aims to emphasize differences in the SFT/HPC spectrum due to the diagnostic, therapeutic and prognostic implications.

Rare magnetic resonance imaging findings of intracranial solitary fibrous tumor: A case report

RATIONALE

Solitary fibrous tumor (SFT) is a rare mesenchymal spindle cell tumor. SFT in the central nervous system (CNS) is rare. This case reports rare magnetic resonance imaging (MRI) findings of intracranial SFT (ISFT).

PATIENT CONCERNS

We report a 47-year-old female patient who was found to have weakness in her right limb with walking instability 2 months before the visit.

DIAGNOSES

Based on imaging, the provisional diagnosis was meningioma. Postsurgical histopathological diagnosis confirmed World Health Organization (WHO) grade I SFT/hemangiopericytoma (HPC).

INTERVENTIONS

The lesion was totally excised. The patient improved remarkably after the operation, without any signs of associated limb movement disorder.

OUTCOMES

No local recurrence or metastases were observed in the follow-up 3 months after the surgery.

LESSONS

Intracranial SFT is a rare mesenchymal tumor. Due to different tumor components, imaging manifestations are diverse and lack of characteristics, so preoperative diagnosis is challenging. Our case provides a rare ISFT with significantly decreased signal intensity in T2 weighted images (T2WI), which is an important supplement to the rare imaging findings of intracranial SFT.

Grade III solitary fibrous tumor/hemangiopericytoma: An enthralling intracranial tumor—A case report and literature review

Hemangiopericytomas account for less than 1% of all intracranial tumors. In 2016, World Health Organization (WHO) unified the two terms into a single medical condition known as solitary fibrous tumor/hemangiopericytoma (SFT/HPC). Our patient is an 80-year-old woman with a past medical history of sick sinus syndrome status post pacemaker placement. She presented to the emergency department with progressive headaches for one month duration. Her headaches worsened at night, waking her up from sleep. They also increased in intensity by bending forward. Review of systems was significant for bilateral lower extremity weakness accompanied by difficulty walking. The motor exam was remarkable for right upper and right lower extremity 3/5 weakness. The gait was ataxic. A Computed tomography scan of the head without contrast revealed a large dural-based right parietal hyperdense mass with surrounding edema, mass effect, and compression of the right lateral ventricle atrium. A right-to-left midline shift was also noted. Given the fact that our patient had a pacemaker, she was not a candidate for a brain MRI. Neurosurgery successfully resected the mass. Histopathological studies confirmed WHO grade III anaplastic solitary fibrous tumor/hemangiopericytoma. The patient was discharged on adjuvant radiation with imaging surveillance given the grade and the extent of resection. This case highlights a rare type of intracranial mass that resembles meningioma on imaging studies. It also illustrates that solitary fibrous tumor/hemangiopericytoma should be kept as a differential diagnosis for brain masses, given its aggressive nature, and its potential of metastasis and recurrence.

Intracranial solitary fibrous tumor/hemangiopericytoma: Role and choice of postoperative radiotherapy techniques

Background

Intracranial solitary fibrous tumor/hemangiopericytoma (SFT/HPC) is a novel rare disease after the 2016 WHO reclassification. Surgery is the main treatment. Postoperative adjuvant radiotherapy is often used, but the effects of different radiotherapy techniques are still unclear. The purpose of this study was to analyze the effects of postoperative radiotherapy (PORT) and different radiotherapy methods on the efficacy of patients with intracranial SFT/HPC.

Materials and methods

We retrospectively analyzed 42 patients with intracranial SFT/HPC who underwent surgical treatment from 2008 to 2022, 20 of whom were treated with postoperative intensity-modulated radiotherapy (IMRT) and 22 with postoperative stereotactic radiosurgery (SRS). The Kaplan–Meier method was used to analyze the disease-free survival (DFS) of all the 42 patients receiving postoperative radiotherapy and the time to progression (TTP) of 22 of these patients experiencing recurrence. A multivariate Cox proportional hazards model was used to detect prognostic factors of survival.

Results

In the analysis of PORT patients, the median DFS was 8.33 years for PORT IMRT patients and 3.04 years for PORT SRS patients. The 10-year DFS incidence was 46.0% in the PORT IMRT group and 27.5% in the SRS group. Among the 22 patients who relapsed, the median TTP of other patients was 1.25 years, of which 3 received radiotherapy alone and 1 received symptomatic treatment, while the median TTP of surgical and surgical combined with radiotheray patients were 1.83 and 2.49 years, respectively (p=0.035).

Conclusion

PORT IMRT could prolong DFS compared with PORT SRS. It indicated that PORT IMRT radiotherapy technology was a feasible option for SFT/HPC. Moreover, TTP results of relapsed patients showed that, surgery and surgery combined with radiotherapy treatments have no significant difference on TTP in relapsed patients, but both of them were better than other treatments.

Toward Better Understanding and Management of Solitary Fibrous Tumor

Solitary fibrous tumor (SFT) comprises a histologic spectrum of soft tissue neoplasms that are characterized by the unique NAB2-STAT6 gene fusion. Changes in diagnostic terminology and site-specific classification over the past few decades have resulted in a disjointed literature. Complete surgical excision with preservation of function remains the mainstay of treatment. New risk stratification systems including risk factors such as mitotic rate, age, tumor size, and presence of necrosis, among others, can be used to predict risk of recurrence or metastasis. Long-term follow-up after surgical resection is recommended. The clinical manifestations, diagnosis, management, and prognosis of SFT are reviewed here.

Malignant solitary fibrous tumor in the central nervous system treated with surgery, radiotherapy and anlotinib: A case report

BACKGROUND

Solitary fibrous tumor (SFT) of the central nervous system is rare. It is predominantly benign and rarely malignant. There is no established standardized treatment regimen for malignant intracranial SFTs.

CASE SUMMARY

We present a rare case of SFT in a 9-year-old girl with a space-occupying effect in the frontal-parietal lobes. She underwent craniotomy, and the mass was resected. Immunohistochemistry examination of the specimen showed that Ki-67 proliferation index staining was highly positive in 80% of tumor cells. Whole exome sequencing of the surgical tissue showed 38 somatic gene mutations and 1 gene amplification such as fibroblast growth factor receptor 4 or TP53. At 1.5 mo after surgery, head magnetic resonance imaging revealed that the tumor had recurred. The patient received 60 Gy and 30 fractions of intensity modulated radiotherapy. The patient then received anlotinib 8 mg po qd for 1-14 d of a 21 d cycle. Following this regimen, the patient achieved stable disease for > 17 mo. Magnetic resonance imaging at 1.5 year after surgery showed that the tumor had not progressed.

CONCLUSION

This is the first reported case of SFT of the central nervous system treated with surgery, radiotherapy and anlotinib. This regimen may be an effective treatment option for malignant intracranial SFT patients.

Two cases of solitary fibrous tumor/hemangiopericytoma with different clinical features according to the World Health Organization classification: case report and review of the literature

Solitary fibrous tumors (SFTs) and hemangiopericytomas (HPCs) have been classified as one entity by the World Health Organization in 2016 due to gene fusion between NAB2 and STAT6. In the Central Nervous System (CNS), a hypocellular, collagenized tumor with a classic SFT phenotype is considered grade I, whereas more densely cellular tumors mostly corresponding to the HPC phenotype are classified as grade II or III (anaplastic) depending in mitotic count (<5 vs. >5 mitoses per 10 high-power fields). Herein, we report two cases of targeted SFT/HPC in which pathological differences and WHO grading affect clinical features. A 75-year-old woman presented with headache and had an intradural extramedullary tumor at the C1 to C2 level. The tumor was well-circumscribed and attached only to the dura mater. It was totally removed and diagnosed SFT/HPC grade I. In contrast, a 68-year-old woman presented with numbness in the right upper limb and had an intradural extramedullary tumor at the medulla to C3 levels The tumor was irregularly marginated and strongly adherent to the spinal cord and involved the vertebral artery. It was sub totally removed and diagnosed SFT/HPC grade II. To the best of our knowledge, there are only 12 cases of SFT/HPC at the craniocervical junction, including the present two cases, of which four that were adherent to the spinal cord or involved the vertebral artery were grade II or III. Although the location of the tumor was almost the same, there were significant differences in the intraoperative findings according to the WHO grading.

Rare hypervascular pancreatic tumors diagnosed as asynchronous metastases of central nervous system solitary fibrous tumor/hemangiopericytoma

A 70-year-old woman was referred to our hospital for asymptomatic pancreatic tumors. She had a history of hemagiopericytoma (HPC) about 20 years ago, and no apparent recurrence has been observed. Contrast-enhanced computed tomography revealed two hypervascular tumors in the head and uncinate process of the pancreas, and no obvious neoplastic lesions were found in other organs. Endoscopic ultrasound guided fine-needle aspiration cytology was performed and histopathology showed that spindle-shaped tumor cells were arranged in a hemangiopericytoma-like pattern and positive for STAT6, which was a characteristic feature of solitary fibrous tumors (SFTs). Immunohistochemical staining for surgical pathology specimens from past HPC showed positive expression of STAT6, which was Grade 2 central nervous system solitary fibrous tumor/hemagiopericytoma (CNS SFT/HPC) according to the current WHO classification. From these findings, the pancreatic tumors were preoperatively diagnosed as pancreatic metastases of CNS SFT/HPC. She underwent pancreaticoduodenectomy. Histopathological examination of the surgically resected specimen proved that the both pancreatic tumors were SFT/HPC. Thus, pancreatic tumors were finally diagnosed as asynchronous pancreatic metastases from CNS SFT/HPC. Although extremely rare, metastatic pancreatic tumors derived from SFT/HPC should be considered as a differential diagnosis for hypervascular pancreatic tumors, especially when having a past history of brain tumors.

Angioarchitecture and Pre-Surgical Embolization of Central Nervous System Solitary Fibrous Tumor/Hemangiopericytoma

Objective

Hemangiopericytomas (HPCs) and solitary fibrous tumors (SFTs) have been categorized as the same disease entity, SFT/HPC, since 2016. SFT/HPC is one of the most highly vascularized brain tumors, distinct from meningioma. The angioarchitecture also differs between these tumors. Understanding these differences can help interventionalists perform presurgical embolization more safely and effectively.

Methods

Vascular structures were analyzed in eight patients with central nervous system (CNS) SFT/HPCs, all of whom received presurgical embolization. The type of embolic materials used and the complication rates were compared between the CNS SFT/HPC cases and 39 meningioma cases treated within the same period. Characteristic angiographic features of SFT/HPC were identified, and we present their interpretation and utilization to inform embolization strategies.

Results

Four angiographic features of SFT/HPCs were identified. 1) Persistence of tumor stain and 2) feeders from branches of the internal carotid artery or vertebral artery were observed in all cases, while 3) connecting feeders (highly dilated vessels that originate from branches of other feeder vessels and run along the surface of one tumor compartment to feed another compartment) were observed in five out of eight cases. 4) Finally, an intratumoral arteriovenous shunt was identified in one case. The frequency of liquid embolic material use was significantly higher in SFT/HPC cases than in meningioma cases. No complications were observed in SFT/HPC cases, and all tumors were effectively removed.

Conclusion

The most appropriate presurgical embolization strategies differ between SFT/HPCs and meningiomas depending on the tumor angioarchitecture. A thorough understanding of the vascular anatomy is necessary for safe and effective embolization of SFT/HPCs.

Salvage carbon ion radiotherapy for recurrent solitary fibrous tumor: A case report and literature review

BACKGROUND

Malignant solitary fibrous tumor (MSFT) arising from the spinal cord is extremely rare and poorly understood mesenchymal neoplasms: only a few MSFT in the spinal canal has been described. We describe the clinical course of the patient with MSFT arising from the thoracic spinal cord.

CASE REPORT

We describe the clinical course of the patient and the radiological and pathological findings of the tumor. The tumor had been resected by microscopic posterior approach and video-assisted thoracic surgery, but local recurrence was observed by MRI at 1-year follow-up period. No metastatic lesion was confirmed. Then, carbon ion radiotherapy (CIRT) was administered to the recurrent lesion. Local suppression has been observed for 40 months after irradiation.

CONCLUSION

Dumbbell-shaped MSFT arising from thoracic spinal cord is a highly unusual presentation. CIRT might be effective for treatment of recurrent tumors.

Solitary fibrous tumour of cervical spinal cord

Solitary fibrous tumors (SFTs) are rare mesenchymal neoplasms of fibroblastic origin. They commonly arise from visceral pleura, but also arise from nonserosal sites such as meninges, central nervous system parenchyma, and spinal cord. In the spinal cord, SFTs commonly arise from the thoracic spinal cord, followed by cervical spinal cord, lumbar spinal cord, and sacrum. Histologically, SFTs can be similar to hemangiopericytoma, schwannoma, fibrous meningioma, fibroma, gliofibroma, and ependymoma. Immunohistochemistry (IHC) plays an important role in differentiating SFTs from other identical tumors. Here, we report a rare case of SFT of the cervical spinal cord, which was initially reported as hemangiopericytoma, and the diagnosis of SFT was confirmed by IHC.

Solitary fibrous tumor/hemangiopericytoma in the cerebellopontine angle mimicking vestibular schwannoma: A case report and literature review

RATIONALE

Intracranial solitary fibrous tumors (SFTs) and hemangiopericytomas (HPCs) are rare spindle cell tumors of mesenchymal origin that include benign and malignant neoplasms.

PATIENT CONCERNS

We present a 66-year-old male with a 5-year history of headache and dizziness, with left progressive sensorineural hearing loss over 1 month.

DIAGNOSES

WHO grade II SFT/HPC originating from the internal auditory canal in the left cerebellopontine angle.

INTERVENTIONS

surgical resection.

OUTCOMES

No local recurrence or metastases were observed in the follow-up 3 months after the surgery.

LESSONS

Intracranial SFTs/HPCs are rare mesenchymal neoplasms that are challenging to manage. If the imaging characteristics of tumor are not typical, clinicians should depend on tissue biopsy and immunohistochemistry to make a definitive diagnosis.

Cervical, Intradural Extramedullary Solitary Fibrous Tumor of the Spinal Cord: A Case Report and Review of the Literature

Solitary fibrous tumors (SFTs) are rare, spindle cell neoplasms of the mesenchymal origin. Lesions localized to the spine are exceptionally uncommon, only described in the literature in case reports and small case series. While these lesions are typically benign, there are a few reports in which they recur or present as malignancies. The patient presented in the case herein was a 72-year-old male, who presented with a 1-year history of lower extremity weakness, pain, and numbness and was found to have a cervical, intradural extramedullary tumor. In addition to the case report, the authors perform a thorough review of all previously published cases of spinal SFT.

Spinal Intramedullary Solitary Fibrous Tumor: A Rare and Challenging Diagnosis

Background

Solitary fibrous tumor (SFT) is a benign neoplasm arising in the soft tissue, which can occur anywhere in the body, while it is predominantly found in the visceral pleura. Spinal SFT is quite uncommon, with limited cases having been reported in the literature; especially, SFT occurring in the intramedullary site is extremely rare.

Case presentation

We present a case of a 35-year-old woman presenting with progressive numbness and weakness in the legs and urinary incontinence. Magnetic resonance imaging (MRI) showed an intramedullary lesion with bright enhancement. A diagnosis of spinal hemangioblastoma was suspected, and thus a three-dimensional computed tomographic angiography reconstruction was requested, which also demonstrated an angiomatous lesion. The tumor was completely resected under neurophysiological monitoring. However, histopathological and immunohistochemical examinations revealed an SFT. No adjuvant radiotherapy or chemotherapy was scheduled. The symptoms were relieved completely, and no recurrence or progression was noted during the follow-up.

Conclusion

Though SFT has been considered similar to malignant hemangiopericytoma and the histological classification has always been controversial, the intramedullary location and benign behavior in the present case add to the current understandings of this extremely rare entity.

Intradural-Extramedullary Solitary Fibrous Tumor/Hemangiopericytoma with a Negative Result on Fluorodeoxyglucose-Positron Emission Tomography/Computed Tomography

Intradural-extramedullary solitary fibrous tumor/hemangiopericytoma (SFT/HPC) is a rare entity. SFT/HPCs can recur after surgery, even if a benign histology of the tumor is observed. We herein report a 68-year-old woman with intradural-extramedullary SFT/HPC. On magnetic resonance imaging (MRI), the intradural-extramedullary mass was isointense on T1-weighted images and hypointense on T2-weighted images with heterogeneous gadolinium enhancement. Whole-body fluorodeoxyglucose-positron emission tomography/computed tomography (¹⁸F-FDG-PET/CT) was also performed, showing no accumulation. We performed surgery for the intradural-extramedullary mass, and the pathological findings of the resected specimen were a benign histology consistent with World Health Organization (WHO) grade I SFT/HPC. She had no evidence of tumor recurrence three years after the surgery for intradural-extramedullary SFT/HPC. ¹⁸F-FDG-PET/CT before surgery may be useful for predicting the postoperative behavior of spinal SFT/HPCs.

Intracranial anaplastic hemangiopericytoma presenting with simultaneous extra-cranial metastases: A case report and review of the literature

Background:

Intracranial solitary fibrous tumor/hemangiopericytoma (SFT/HPC) is a rare mesenchymal tumor with a propensity to recur and metastasize extracranially years after treatment. Accordingly, there are no reported cases of a patient presenting with a simultaneous intracranial primary and extracranial metastases. We present the case of a patient presenting with an intracranial SFT/HPC and simultaneous liver metastases and propose a treatment paradigm.

Case Description:

A 74-year-old male smoker presented with confusion. An MRI of the brain revealed a heterogeneously enhancing left frontal extra-axial mass. Systemic workup revealed multiple small liver lesions concerning for metastases. The patient underwent gross total resection (GTR) of the intracranial lesion with adjuvant CyberKnife stereotactic radiotherapy to the resection cavity. Pathology was consistent with a WHO Grade III SFT/HPC (previously known as anaplastic HPC). The liver lesions were biopsied and confirmed to be metastases. They were subsequently treated with stereotactic body radiation therapy, temozolomide, and bevacizumab. Eighteen months postoperatively, the patient is alive with no evidence of intracranial malignancy and regression of the hepatic lesions.

Conclusion:

Several studies support GTR and adjuvant radiotherapy to treat intracranial SFT/HPC. The role of adjuvant chemotherapy is less clear. Metastatic disease is typically detected several years after the initial diagnosis, and there is no consensus regarding the optimal treatment strategy. We propose that the rare presentation of intracranial SFT/HPC with simultaneous extracranial metastases should be treated in a multidisciplinary fashion with surgical resection, adjuvant radiotherapy, and chemotherapy.

Cystic appearance - a new feature of solid fibrous tumours in the lacrimal gland: a case report with literature review

Background

Solitary fibrous tumours (SFTs) rarely occur in the orbit, especially in the lacrimal area. These tumours are mostly solid. Cystic changes have been documented, but they remain very rare. Only three cases of primary orbital solitary fibrous tumours with cystic changes have been reported in the literature, but no cases have been reported to occur in the lacrimal gland. Solitary fibrous tumours generally follow a benign course and are treated definitively with surgical excision. Data from the literature suggest that the cystic nature of SFT presents a risk of recurrence and could be a harbinger of malignancy.

Case presentation

A 42-year-old woman was admitted to the endocrinology department for right unilateral exophthalmia and epiphora in the last 8 months. An ophthalmological evaluation showed exophthalmia only in the right eye (22 mm) and normal visual acuity, visual field and extraocular movements. Investigations revealed normal thyroid function. Orbital magnetic resonance imaging detected a 4 × 2,2 × 2,7 cm septate pseudocystic mass in the right lacrimal gland. Given her lacrimal gland tumour diagnosis, the patient was submitted for neurosurgical intervention with total ablation of the tumoural mass and complete right dacryoadenectomy. Although the intraoperative extemporaneous examination results were suggestive of a haemangiopericytoma, histological and immunocytochemical examination showed an extrapleural SFT. The postoperative clinical evolution was favourable, with remission of the exophthalmia. Fifteen months after surgery, no signs of recurrence were noticed.

Conclusions

We report the first case of an SFT with cystic changes in the lacrimal gland. Although the presence of cavitary lesions alone does not necessarily indicate aggressive behaviour, cystic changes pose a risk of recurrence and may suggest malignant transformation over time. As a result, our case requires long-term follow-up due to recurrence and malignant potential.

Solitary fibrous tumor of the pineal region with delayed ectopic intracranial metastasis: A case report and review of the literature

RATIONALE

Solitary fibrous tumors of central nervous system are rare spindle-cell mesenchymal tumors. Although most are benign in nature, malignant transformation and extracranial metastasis have been reported. Up to now, only one case of CSF dissemination was described. Here we described an extremely rare case of intracranial Solitary fibrous tumors arising from the pineal region with a delayed ectopic metastasis.

PATIENT CONCERNS

A 35-year-old female presented with double vision, memory disturbance and unsteady gait was referred to our center. MRI showed an irregular mass in the pineal region.

DIAGNOSES

The patient was diagnosed as pineal tumor, with unknown pathology.

INTERVENTIONS

Gross total resection was achieved and the pathologic studies confirmed a solitary fibrous tumor. Thirty-nine months later local recurrence occurred and gamma-knife radiotherapy was offered. Seven months later, MRI found a metastasis in the left temporal lobe. Surgical resection was conducted and pathological analysis revealed changes in cell morphology, counts and Ki-67 level, confirmed the diagnosis of solitary fibrous tumor/hemangiopericytoma (WHO Grade III). The patient received post-operational radiotherapy.

OUTCOMES

The patient was followed up for 7 months with no signs of recurrence.

LESSONS

Here, we report an extremely rare case of primary solitary fibrous tumor of pineal region with delayed intracranial ectopic metastasis, together with literature review of metastatic solitary fibrous tumors. Strict surveillance is strongly recommended, considering the malignant potential of this seemingly benign disease entity. Complete resection of the tumor is the treatment of first choice and radiotherapy might be an effective adjuvant therapy for high grade SFT/HPCs.

Clinical outcomes of intracranial solitary fibrous tumor and hemangiopericytoma: analysis according to the 2016 WHO classification of central nervous system tumors

OBJECTIVE

The authors conducted this retrospective study to investigate the clinical outcomes of intracranial solitary fibrous tumor (SFT) and hemangiopericytoma (HPC), defined according to the 2016 WHO classification of central nervous system (CNS) tumors.

METHODS

Histopathologically proven intracranial SFT and HPC cases treated in the period from June 1996 to September 2014 were retrospectively reviewed and analyzed. Two neuropathologists reviewed pathological slides and regraded the specimens according to the 2016 WHO classification. Factors associated with progression-free survival (PFS) and overall survival (OS) were statistically evaluated with uni- and multivariate analyses.

RESULTS

The records of 47 patients—10 with SFT, 33 with HPC, and 4 with anaplastic HPC—were reviewed. A malignant transition from conventional SFT to WHO grade III SFT/HPC was observed in 2 cases, and 13 HPC cases were assigned grade III SFT/HPC. Mean and median follow-ups were 114.6 and 94.7 months, respectively (range 7.1–366.7 months). Gross-total resection (GTR) was significantly associated with longer PFS and OS (p = 0.012 for both), and adjuvant radiation therapy versus no such therapy led to significantly longer PFS (p = 0.018). Extracranial metastases to the liver, bone, lung, spine, and kidney occurred in 10 patients (21.3%). Grade III SFT/HPC was strongly correlated with the development of extracranial metastases (p = 0.031).

CONCLUSIONS

The 2016 WHO classification of CNS tumors reflected the different types of pathological malignant progression and clinical outcomes better than prior classifications. Gross-total resection should be the primary treatment goal in patients with SFT/HPC, regardless of the pathological grade, and radiation can be administered as adjuvant therapy for patients with SFT/HPC that shows an aggressive phenotype or that is not treated with GTR.

Solitary fibrous tumor of central nervous system masquerading as meninigioma: Report of a rare case

INTRODUCTION

Solitary fibrous tumor (SFT) is a rare neoplasm of mesenchymal origin that occurs most often in the visceral pleura. It rarely occurs in the central nervous system (CNS). If they occur intracranially, they are extra-axially located and develop from the meninges.

CASE REPORT

Herein, we present a case of SFT in a 45 years old female. MR imaging showed isointense to hypointense signal intensity, and marked enhancement. Microscopically, the tumors showed characteristic "patternless-pattern" architecture. Elongated tumor cells formed fascicles alternating with hypocellular densely collagenous stroma. Immunohistochemistry for STAT6, CD34, BCL2 and CD99 favours the definitive diagnosis of SFT.

CONCLUSION

In general, complete surgical resection may offer the best chance of a favourable clinical outcome. Their biological features remain largely unknown. Hence, the clinical management and prognosis is often challenging due to the lack of comprehensive data.

MR imaging of intracranial solitary fibrous tumor: a retrospective study of 7 cases

OBJECTIVE

To investigate the MR imaging diagnostic features of intracranial solitary fibrous tumors (ISFTs).

MATERIALS AND METHODS

Seven patients (mean age of 52.9 years; M:F=3:4) with histopathologically proven ISFTs were identified at our institute. Clinical presentations and pathological features were reviewed. MR Imaging findings including signal intensity, gadopentetate dimeglumine enhanced pattern, and diffusion-weighted imaging (DWI) characterization of the tumors were retrospectively evaluated.

RESULTS

Six tumors showed a multi-lobular contour. Five tumors showed heterogeneous signal intensity, and two tumors showed homogeneous signal intensity on T1WI. Low signal intensity linear, curved or interlacing lines were observed within the tumors in all seven cases. Seven tumors demonstrated moderate or strong enhancement, six showed heterogeneous enhancement, and one homogenous enhancement. All tumors showed heterogeneous signal intensity on DWI.A ring-like high signal intensity band distributed around within the tumor was noted in six cases on DWI.

CONCLUSION

Diagnostic evidence for ISFT on MR image includes heterogeneous signal intensity, intense enhancement of T2 signal intensity, low signal intensity lines within the tumor, heterogeneous signal intensity on DWI and a ring-like band around the tumor on DWI.

The Role of Adjuvant Radiation in the Management of Solitary Fibrous Tumors of the Central Nervous System: A National Cancer Database Analysis of 155 Patients

Solitary fibrous tumors (SFT) are a rare neoplasm of mesenchymal origin. There is limited evidence on the epidemiology, treatment, and outcomes of SFT in the central nervous system (CNS). The National Cancer Database (NCDB) was queried for patients diagnosed with an SFT in the CNS as their only tumor diagnosis between 2003 and 2011. The final cohort included 155 patients who received surgery and had adequate information for analysis. Descriptive statistics, logistic regression, and Kaplan-Meier survival analyses were performed. Significance was calculated using a t-test, Fisher’s exact test, chi-square, log-rank test, or Cox model. Twenty-three patients (15%) underwent both surgery and adjuvant radiation while 132 (85%) underwent surgery alone. The treatment groups had comparable demographics and tumor size; median age 53 (range 25-80) and 11 females (48%) in the surgery and adjuvant radiation group, compared to 55 (20-89) and 71 (54%) in the surgery alone group, respectively. Radiotherapy methods included conventional and stereotactic dose and fractionations schemes. Information on margin status and re-resection rates was not available. No variables were significantly associated with receipt of adjuvant radiation. In single (p = 0.78) and multivariable (p = 0.86) survival analyses, the addition of adjuvant radiation did not significantly affect overall survival. Five-year overall survival was 88% with surgery alone versus 93% with adjuvant radiation. SFTs are rare neoplasms, especially in the CNS. Our study did not demonstrate an overall survival benefit for adjuvant radiation. The role of adjuvant radiation is still unclear and warrants further investigation.

Endoscopic Transnasal Resection of Solitary Fibrous Tumor in the Optic Canal

BACKGROUND

Tumors extending into the optic canal can cause progressive visual impairment because of optic nerve compression. Prompt surgical resection is often necessary. When the tumor is located medially in the optic canal, endoscopic transnasal surgery provides a safer, less invasive alternative to a transcranial approach.

CASE DESCRIPTION

We recently encountered a case of small solitary fibrous tumor in the optic canal causing rapid visual deterioration. The radiographic findings of preoperative imaging studies were compatible with those of meningioma; however, unlike meningioma, bleeding from the tumor was profuse during the operation. The endoscopic transnasal approach was effective for handling the highly vascularized tumor in this delicate region, and gross total removal was achieved with postoperative gradual improvement in his visual function. Nevertheless, the tumor recurred after 6 months, and re-resection was performed using the same surgical corridor, followed by adjuvant radiotherapy.

CONCLUSIONS

Endoscopic transnasal surgery is a valuable option for aggressive lesions in the optic canal. Although the efficacy of radiotherapy for solitary fibrous tumor remains controversial, it should be considered when the tumor shows progressive features.

Grading of meningeal solitary fibrous tumors/hemangiopericytomas: analysis of the prognostic value of the Marseille Grading System in a cohort of 132 patients

The finding that meningeal solitary fibrous tumors (SFTs) and meningeal hemangiopericytomas (HPCs) are both characterized by NAB2-STAT6 gene fusion has pushed their inclusion in the WHO 2016 Classification of tumors of the central nervous system (CNS) as different manifestations of the same entity. Given that the clinical behavior of the CNS SFT/HPC spectrum ranges from benign to malignant, it is presently unclear whether the grading criteria are still adequate. Here, we present the results of a study that analyzed the prognostic value of an updated version of the Marseille Grading System (MGS) in a retrospectively assembled cohort of 132 primary meningeal SFTs/HPCs with nuclear overexpression of STAT6. The median patient follow-up was 64 months (range 4-274 months); 73 cases (55%) were MGS I, 50 cases (38%) MGS II and 9 cases (7%) were MGS III. Progression-free survival (PFS) and disease-specific survival (DSS) were investigated using univariate analysis: the prognostic factors for PFS included MGS, extent of surgery, radiotherapy, chemotherapy and mitotic activity ≥5/10 high-power field (HPF). Moreover, MGS, radiotherapy, mitotic activity ≥5/10 HPF, and necrosis were the prognostic factors measured for DSS. In multivariate analysis, extent of surgery, mitotic activity ≥5/10 HPF, MGS I and MGS III were the independent prognostic factors measured for PFS while necrosis, MGS III and radiotherapy were the independent prognostic factors for DSS. In conclusion, our results show that assessing the malignancy risk of SFT/HPC should not rely on one single criterion like mitotic activity. Therefore, MGS is useful as it combines the value of different criteria. In particular, the combination of a high mitotic activity and necrosis (MGS III) indicates a particularly poor prognosis.

Radiation Therapy as Sole Management for Solitary Fibrous Tumors (SFT): A Retrospective Study From the Global SFT Initiative in Collaboration With the Sarcoma Patients EuroNet

PURPOSE

Solitary fibrous tumors (SFTs) are extremely rare mesenchymal malignancies. Given the lack of large prospective studies on radiation therapy (RT) with definitive and/or palliative intent in SFT patients, this retrospective study aimed to better define the benefit of RT in this disease.

METHODS AND MATERIALS

A retrospective observational study was performed across 7 sarcoma centers. Clinical information was retrieved from all patients receiving RT without surgery over the course of their locally advanced and/or metastatic disease. Differences in treatment characteristics between subgroups were tested using analysis-of-variance tests. Local control (LC) and overall survival (OS) rates were calculated as time from the start of RT until local progression and death from any cause, respectively.

RESULTS

Since 1990, a total of 40 patients were identified. RT was applied with definitive intent in 16 patients and with palliative intent in 24. The median follow-up period was 62 months. In patients treated with definitive RT (receiving approximately 60 Gy), the objective response rate was 67%. At 5 years, the LC rate was 81.3%, and the OS rate was 87.5%. In the case of palliative RT (typically 39 Gy), the objective response rate was 38%. The LC and OS rates at 5 years were 62.5% and 54.2%, respectively. In both subgroups, RT-associated toxicities were mild with predominantly grade 1 acute and late side effects.

CONCLUSIONS

This retrospective study suggests a clinically meaningful benefit for RT given with either definitive or palliative intent without surgery in SFT management. Prospective registries potentially in collaboration with patient advocacy groups are warranted to further assess the role of RT in patients with this rare malignancy.

Magnetic resonance features of meningeal solitary fibrous tumors

The aim of the present study was to investigate magnetic resonance (MR) features of meningeal solitary fibrous tumors (SFTs) in order to improve their recognition. The study retrospectively analyzed MR manifestations in 12 cases of meningeal SFTs confirmed by surgery. The lesions were analyzed in terms of the site of their growth, growth mode, morphology, size, changes in the MR signal and the edge of the focus. The tumors were malignant in 3 cases, benign in 7 cases and borderline in 2 cases. A total of 3 cases spanned the tentorium cerebelli, 3 spanned the falx and another case was close to the falx. Overall, 4 superficial tumors were accompanied by adjacent bony destruction. One case was located at the triangular area created by the right lateral ventricles. The tumors were all lobular, with a large diameter and more cystic areas in the center of the focus. The signals were often heterogeneous. The parenchyma in the tumors was significantly enhanced. For certain tumors, the signal was usually inhomogeneous and not uniform. The MR features of a SFT were often similar to other intracranial tumors and easily misdiagnosed. There were certain innate characteristics, for example, the tumor was often a solitary large soft-tissue mass with an irregular edge and a clear boundary, with a lobulated contour, and was widely involved with other tissues. The tumors often grew across either the falx or tentorium cerebelli. A significantly inhomogeneous signal was found and either a low or low-high mixed signal on T2-weighted images in particular. These features are useful for the differential diagnosis of SFTs and other tumors.

Solitary fibrous tumour of the spine: imaging features of a commonly misdiagnosed entity

OBJECTIVE

Solitary fibrous tumours (SFTs) occurring in the spine are rare. Herein, we review the clinical and imaging data of spinal SFT.

METHODS

We retrospectively analysed eight cases of pathologically confirmed spinal SFT imaging and clinical data, pathological manifestations, surgical methods, and follow-up results.

RESULTS

Five SFTs cases occurred in the cervical spine, two in the thoracic spine, and one in the lumbosacral spine. Five cases showed a dumbbell-shaped or lobulated soft tissue mass that grew across the intervertebral foramen, two cases showed an expansive intraosseous mass formation in the vertebral body and/or posterior element, and one case showed a long-spindle shaped intraspinal canal mass growing along the spinal canal. Seven caused local invasion and destruction of the vertebral body and posterior element. Benign SFTs displayed a good prognosis, whereas malignant SFTs were prone to recurrence and metastasis (3/4).

CONCLUSION

Spinal SFTs are difficult to characterise with imaging and required pathological and immunohistochemical investigation. Prolonged follow-up is recommended once a diagnosis of spinal SFTs has been established because of the unclear biology.

KEY POINTS

• Spinal solitary fibrous tumours are extremely rare. • SFTs should be showed the differential of masses developing though the foramen. • Combing imaging with pathology and immunochemistry assesses the diagnosis and establish nature.

Solitary fibrous tumour/haemangiopericytoma of the spinal cord

Solitary fibrous tumours/haemangiopericytomas (SFT/HPC) are fibroblastic mesenchymal neoplasms that harbour a genetic fusion of NAB2/STAT6. There are few reported cases in the central nervous system (CNS), of which spinal tumours are minority. We present a case of a 63-year-old woman with progressive paraparesis and a sensory level of T6. On the MRI we detected an intradural extramedullary lesion on T9-T10. We performed a laminectomy with an intraoperative ultrasound study in which we observed a heterogeneous lesion with an infiltrating pattern affecting the medulla at several points, and resection of the lesion. Immunohistological findings revealed positivity for vimentin, CD34 and STAT6; Ki-67 was 2%. A final diagnosis of SFT/HPC with SFT phenotype was made. SFT/HPC of the CNS is a rare neoplasm that should be taken into account in the differential diagnosis of these kinds of lesions, as clinical and MRI findings often lead to errors in diagnostic approach. The support of intraoperative ultrasound can assist in surgical decision-making.

Solitary fibrous tumor/hemangiopericytoma: treatment results based on the 2016 WHO classification

OBJECTIVE

Solitary fibrous tumor/hemangiopericytoma (SFT/HPC) is a new combined entity for which a soft-tissue-type grading system, ranging from grades I to III, has been introduced in the 2016 WHO classification of tumors of the CNS. The results of the treatment of this new disease entity require evaluation.

METHODS

The authors retrospectively reevaluated the pathological findings and medical records of patients with SFT/HPC. This study included 60 patients (27 men and 33 women, median age 42.5 years, range 13-69 years) treated at Severance Hospital between February 1981 and February 2016. Four, 40, and 16 patients were categorized as having SFT/HPC grades I, II, and III, respectively. Among these patients, SFTs diagnosed in 7 patients were regraded as grades I (n = 4), II (n = 2), and III (n = 1).

RESULTS

The median overall survival (OS) was 73.2 months (range 1.4-275.7 months), and the progression-free survival (PFS) after the first operation was 53.8 months (range 1.4-217.7 months). Six patients (10%) showed extracranial metastasis during a median period of 103.7 months (range 31.9-182.3 months). Nineteen patients (31.7%) presented with tumor recurrences. The patients in the grade III group had shorter PFS and OS, as well as a shorter period to extracranial metastasis, compared with patients in the grade II group. In the grade II group, patients who underwent gross-total resection showed longer PFS than those who underwent subtotal resection; however, there was no difference in OS. Patients who underwent adjuvant radiation therapy (RT) after surgery had longer PFS compared with that of patients who did not undergo adjuvant RT.

CONCLUSIONS

The SFT/HPC grade I group showed a relatively benign course compared with those of the other groups. The grade III group presented a course with a more aggressive nature than that of the grade II group. In the grade II group, the extent of resection and adjuvant RT was significantly associated with longer PFS. The long-term follow-up and periodic systemic evaluation are mandatory to detect systemic metastasis.

Solitary Fibrous Tumors of the Orbit and Central Nervous System: A Case Series Analysis

Introduction:

Solitary fibrous tumor (SFT) is rarely diagnosed in clinical practice. Since its initial descriptions in the central nervous system (CNS) and the orbits, very few case reports and small case series have expanded their clinical and pathological characterization. We sought to describe a cases series of SFT from a single laboratory of neuropathology belonging to a tertiary university hospital.

Methods:

Retrospective clinical and histopathological description of eight cases of CNS and orbital SFT diagnosed over a 21-year period of time.

Results:

Median age was 47.3 years and four were males. Clinical presentation was related to local mass effect in all. Tumors occurred in the orbits (5/62.5%), intracranial dura attached (2), and the spinal medulla (1). The neuropathology showed the presence of hemangiopericytoma type (2), classic type (3), and mixed type (3). Histological anaplasia was present in two cases. Widespread/total immunoreactivity for vimentin, CD34, and Bcl-2 was present in all. Gross total removal was conducted in the majority (6/75%) and subtotal removal in 2 (25%). Three patients were submitted to adjuvant treatment (radiosurgery and radiotherapy). Recurrence occurred in four patients, 13–120 months after surgical intervention. Anaplasia was present in one case of recurrence.

Conclusion:

Our case series confirms the clinical and neuropathological diversity of CNS and orbital SFTs. Studies with longer follow-up periods are necessary to better understand the clinical behavior and prognosis of the SFT in the CNS and orbits.

[Recommendations for the organ donation from patients with brain or medullary primitive tumors on behalf of the Association of the Neuro-oncologists of French Expression (ANOCEF) and the Club of Neuro-oncology of the French Society of Neurosurgery]

Requests of organs to be transplanted increase. As a matter of urgency, it is not always easy to decide if a patient carrier of a brain tumor can be candidate in the donation. After a review of the literature, the members of the Association of the Neuro-oncologists of French Expression (ANOCEF) and the Club of Neuro-oncology of the French Society of Neurosurgery propose consensual recommendations in case of donor carrier of primitive tumor intra-cranial or intra-medullary. A contact with the neuro-oncologist/neurosurgeon will allow to discuss the indication in case of glioma of grade I/II/III, according to the grade, the current status (absence of progressive disease), the number of surgeries and of lines of treatment. The taking is disadvised in case of glioma of grade IV (glioblastoma), of lymphoma or meningioma of grade III. No contraindication for the meningiomas of grade I, and individual discussion for the meningiomas of grade II. It is advisable to remain careful in case of hemangiopericytoma and of meningeal solitary fibrous tumor. The patients in first complete remission of a medulloblastoma or intra-cranial primitive germinoma seem good candidates for the taking of organ if the follow-up is of at least 10 years (3 years for non germinomas). In every case, a multidisciplinary discussion is desirable when it is materially possible.

Dumbbell-Shaped Jugular Foramen Tumors Extending to the Neck: Surgical Considerations Based on Imaging Findings

OBJECTIVE

Dumbbell-shaped jugular foramen tumors (DSJFTs) extending to the neck present diagnostic and management difficulties because of their rarity, various pathologies, and multidisciplinary involvement. Accurate imaging findings are of great importance for surgical planning and clinical outcomes. However, few articles have discussed this issue to date.

METHODS

Thirty-one patients with DSJFTs extending to the neck were surgically treated in a single stage at our institute. Their clinical and radiologic features, operative procedures, and outcomes were retrospectively reviewed.

RESULTS

Preoperative correct diagnosis of DSJFTs extending to the neck was made in all cases of benign tumor and in only 3 cases of malignant tumors in this series. All tumors were removed via a craniocervical approach by a multidisciplinary skull base team because of both their intracranial and neck extensions. Total removal was achieved in 26 patients (83.9%). Preoperative symptoms were improved in 18 patients, whereas new or worsening lower cranial nerve deficits occurred in 4 patients postoperatively. Follow-up (1-132 months, mean 64.4 months) was available in 90.3% of the patients. No clinical or radiologic signs of tumor recurrence were observed.

CONCLUSIONS

Preoperative radiologic evaluation of DSJFTs extending to the neck is essential for differential diagnosis, patient selection, and surgical planning. Favorable surgical outcomes can be achieved via a craniocervical approach, and some detailed imaging findings are helpful to increase the safety of tumor resection and reduce the morbidity of lower cranial nerve deficits and cerebrospinal fluid leakage.

Solitary fibrous tumors of the spine: a pediatric case report with a comprehensive review of the literature

Solitary fibrous tumors of the spine are rare lesions. Their description in the literature is limited to case reports and small case series. While generally benign lesions, they can recur and occasionally occur as malignancies. Here the authors present the case of a 10-year-old boy, the youngest patient and first preadolescent reported thus far, with this condition. In addition, they perform a comprehensive review of all previously published cases of spinal solitary fibrous tumors.

Intracranial Solitary Fibrous Tumor

Solitary fibrous tumours are rare mesenchymal spindle-cell tumours that occur most often in the visceral pleura or liver. If they occur intracranially, they are extra-axially located and develop from the meninges. In those cases, the differential diagnosis has to be made with other intracranial extra-axial-located tumours, such as meningeoma and hemangiopericytoma. We report a 32-year-old woman with an intracranial solitary fibrous tumour and review the latest literature regarding the imaging characteristics of this tumour.

Solitary Fibrous Tumors: 2016 Imaging Update

Optimal management of solitary fibrous tumor requires a multidisciplinary approach with proper histopathological mapping and use of various imaging modalities for exact delineation of primary tumor and metastatic disease if present. In this article, the authors present a comprehensive review of the spectrum of imaging findings of solitary fibrous tumors involving various organ systems and discuss the role of molecular targeted therapies in the management of metastatic disease.

Malignant solitary fibrous tumor of thoracic spine with distant metastases: Second reported case and review of the literature

Solitary fibrous tumor (SFT) usually originates from the pleura because of abnormal proliferation of fibroblast cells. It is extremely rare for the tumor to originate from the spine. Here, we report the second case of malignant SFT of thoracic spine with distant metastases in a 35-years-old female.

Hypervascular Lesions of the Cerebellopontine Angle: The Relevance of Angiography as a Diagnostic and Therapeutic Tool and the Role of Stereotactic Radiosurgery in Management. A Comprehensive Review

BACKGROUND

The cerebellopontine angle (CPA) is a narrowed skull base area containing important cranial nerves and vessels and bordering with eloquent areas of the posterior fossa. Tumors of the CPA are a heterogeneous group and can have extradural, intradural/extra-axial, or intra-axial origins. Their vascular supply changes depending on their anatomic origin. Symptomatic, large CPA tumors require surgical resection in order to prevent irreversible, severe neurological damages. However, its tight and strategical location make surgery in the CPA very challenging and require appropriate pre-surgical planning. Pre-surgical diagnosis is of great importance as it allows us to choose the optimal management for the particular patient. This is of further significance when encountering high-risk lesions such as hypervascular tumors. Neurosurgeons should utilize every available pre-surgical diagnostic modalities as well as neo-adjuvant treatments in order to reduce such risks.

METHODS

We review all reported cases of hypervascular lesions of the CPA and discuss the roles of angiography and stereotactic radiosurgery in their management.

RESULTS

Three lesions of the CPA can be considered as truly hypervascular: hemangioblastomas, hemangiopericytomas and paragangliomas. All lesions share many radiological features. However, each lesion has a different anatomical origin and hence, has a characteristic vascular supply. Pre-surgical angiography can be utilized as a diagnostic tool to narrow down the differential diagnosis of a vascular CPA lesion, based on the predominant supplying vessel. In addition, pre-surgical embolization at time of angiography will narrow the associated surgical risks.

CONCLUSIONS

Angiography is a crucial diagnostic and therapeutic tool, helping both in narrowing the presurgical differential diagnosis and in controlling intraoperative bleeding. Because of the high surgical risks associated with resection of vascular tumors in the CPA, noninvasive treatments, such as stereotactic radiosurgery, also may have a crucial role.

Solitary Fibrous Tumor/Hemangiopericytoma Dichotomy Revisited: A Restless Family of Neoplasms in the CNS

Solitary fibrous tumor (SFT) and hemangiopericytoma (HPC) both entered the literature as separate entities in the early to mid 1900s. In contrast to their central nervous system (CNS) counterparts, there has been a tendency to consider these 2 entities as 1 since the early 1990s, as soft tissue SFT gradually included the tumors previously diagnosed as HPC. The most recent World Health Organization (WHO) classification of the tumors of soft tissue considered the term HPC obsolete, and places all such tumors within the extrapleural SFT category. In contrast, CNS SFT and HPC continue to be regarded as different entities in the latest version of the WHO CNS tumor classification. A change in this approach is currently being considered for the upcoming revision of the WHO scheme, but it is not quite clear whether such a change will be as drastic as the one adopted by the soft tissue and bone tumor working group. This article focuses on the historical evolution of these 2 labels as primary CNS neoplasms, and reviews their differences and similarities in terms of clinical, pathologic, and molecular features.

Intraventricular Hemangiopericytoma: A Case Report and Literature Review

BACKGROUND

Hemangiopericytomas are rare intracranial neoplasms that generally occur in the fifth decade of life and are commonly dural-based, supratentorial tumors. They are classified as World Health Organization grade II or III because of their aggressive nature with high rates of local recurrence and distant metastasis. This case is of an intraventricular hemangiopericytoma in a 23-year-old man. Intraventricular locations are rare, with only 10 cases reported in the literature. Our patient is the youngest to be diagnosed with an intraventricular hemangiopericytoma outside a pediatric case discovered at autopsy.

CLINICAL PRESENTATION

A 23-year-old man with a left intraventricular hemangiopericytoma presenting with headache, word-finding difficulties, blurred vision, nausea, vomiting, photophobia, and right-sided weakness and numbness. Using a left superior parietal lobule approach, a piecemeal resection was completed, achieving radiographic gross total resection. Pathology was consistent with a hemangiopericytoma. He was treated adjunctively with 60 Gy of local radiation. At 6-month follow-up, the patient had resolution of his aphasia and improvement in his headaches, with no signs of recurrence or metastasis on imaging.

CONCLUSIONS

Standard treatment for central nervous system hemangiopericytoma includes aggressive surgical resection. The role of adjuvant radiation is less well defined but is commonly pursued postoperatively. Regardless of extent of resection or adjuvant treatment, close follow-up to evaluate for evidence of local recurrence and distant metastasis is essential.

Intracranial solitary fibrous tumors: A report of two cases and a review of the literature

Solitary fibrous tumors (SFTs) are uncommon, with the pleura as a site of predilection. Central nervous system SFTs, particularly intracranial SFTs, are extremely rare. The lesions are generally benign and localized, and surgery is the main therapeutic solution. The current study reports the cases of a patient who presented with right haunch pain, right leg weakness and paresthesias for several months, and a patient with a history of unexpected loss of consciousness. Magnetic resonance imaging revealed the presence of lesions, with a spindle cell morphology evident on pathological examination. The immunohistochemical examination demonstrated a strong immunoreaction for cluster of differentiation 34, which supported the diagnosis of an SFT. Following a near-total resection, the patients had a good neural prognosis. The present study also provides a literature review, discussing the imageological and pathological characteristics of SFT, and the diagnostic methods that aid in distinguishing the entity from other spindle-cell central nervous system tumors.