An unusual presentation of solitary fibrous tumor

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.

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.

Recurrent solitary fibrous tumor of lumbar spine with vertebral body involvement: imaging features and differential diagnosis with report of a case

Solitary fibrous tumors (SFTs) of the spine are exceedingly rare tumors of mesenchymal origin. Most spinal SFTs arise from the thoracic spine, followed by cervical spine, and last lumbar spine with only 6 cases reported in literature. SFTs represent a wide range of neoplasms, ranging from benign to malignant. These tumors can develop a late recurrence, even after a decade or more of initial presentation, requiring long-term follow-up. We present a case of recurrent SFT of the lumbar spine with vertebral body involvement, presenting more than a decade after initial resection. It was initially misdiagnosed as a paraganglioma. To the best of our knowledge, there have been only 3 previous cases reporting SFT with vertebral body involvement.

Hemorrhagic intramedullary solitary fibrous tumor of the conus medullaris: case report

The differential diagnosis of spinal tumors is guided by anatomical location and imaging characteristics. Diagnosis of rare tumors is made challenging by abnormal features. The authors present the case of a 47-year-old woman who presented with progressive subacute right lower-extremity weakness and numbness of the right thigh. Physical examination further revealed an extensor response to plantar reflex on the right and hyporeflexia of the right Achilles and patellar reflexes. Magnetic resonance imaging of the lumbar spine demonstrated an 8-mm intramedullary exophytic nodule protruding into a hematoma within the conus medullaris. Spinal angiography was performed to rule out an arteriovenous malformation, and resection with hematoma evacuation was completed. Pathological examination of the resected mass demonstrated a spindle cell neoplasm with dense bundles of collagen. Special immunostaining was performed and a diagnosis of solitary fibrous tumor (SFT) was made. SFTs are mesenchymally derived pleural neoplasms, which rarely present at other locations of the body, but have been increasingly described to occur as primary neoplasms of the spine and CNS. The authors believe that this case is unique in its rare location at the level of the conus, and also that this is the first report of a hemorrhagic SFT in the spine. Therefore, with this report the authors add to the literature the fact that this variant of an increasingly understood but heterogeneous tumor can occur, and therefore should be considered in the differential of clinically similar tumors.

Intradural solitary fibrous tumor of the lumbar spine: a distinctive case report

Background. Solitary fibrous tumors are ubiquitous mesenchymal neoplasms of putative fibroblastic origin. They were originally described in the pleura but subsequently have been reported in many extraserosal sites. Solitary fibrous tumors may also occur in the meninges, central nervous system parenchyma, and spinal cord. Case. A 67-year-old male patient with progressive lower extremity weakness, urinary urgency, and sexual dysfunction has been admitted to our hospital. On his lumbar MRI, we detected an intradural lesion posterior to the L3 vertebral corpus. We resected the lesion by L3 total laminectomy. Immunohistological findings revealed strong and diffuse immunopositivity with vimentin, CD34, and bcl-2. Ki-67 proliferation index was 5–8%. We did not detect any recurrence 12 months after his operation. Conclusion. SFT is mostly seen in young and middle-aged patients and should be considered among differential diagnosis in cases suffering from pain, hypoesthesia, and urinary dysfunction. Gross total resection should be primary treatment. Tumors that have high Ki-67 labeling should be followed up for potential recurrences.

Solitary fibrous tumor of the lumbar spine: the great mimicker-report of the fifth case

Solitary fibrous tumor (SFT) is a rare neoplasm occurring in the central nervous system. It rarely occurs in the spine. This paper reports the fifth case of SFT in a 34-year-old female and focusses on differential diagnosis and importance of surgical treatment.

Recurrent solitary fibrous tumour of the thoracic spine. A case-report and literature review

Solitary fibrous tumours (SFTs) are rare tumours originating in the soft tissues. SFT development in the spine is an exceedingly rare event about which little is known. We describe a case of SFT of the thoracic spine in a 56-year-old woman. She presented with neurological deficits that required emergency resection, which was incomplete. Two subsequent local recurrences prompted further surgical procedures. At last follow-up, 12 months after the last procedure, function was satisfactory and there was no evidence of tumour recurrence. The management of SFTs is not well standardised, and no proven adjuvant treatments are available to date. Complete excision is effective in controlling disease progression. Prolonged follow-up is mandatory.

MRI Features of Spinal Solitary Fibrous Tumors

Spinal solitary fibrous tumors (SFT) are very rare neoplasms occurring in the spinal canal, with only 38 cases reported in ten years since the first description. We describe two cases of SFT of the spine and review 33 well-documented cases in the literature to define distinctive radiological and surgical features raising the suspicion of a spinal SFT before histological verification. A 67-year-old man with cervical myeloradiculopathy had a large extramedullary tumor of the cervical spinal canal extending from C4 to C7. On MRI the tumor was isointense on T1-sequences and hypointense on T2-sequences, and had marked contrast enhancement. At surgery, the tumor was intradural extramedullary, with no dural or root attachment, but it was adherent to the cord. Complete tumor removal was achieved with good outcome. A 75-year-old man with progressive thoracic myelopathy had an intramedullary tumor at C6 and C7 level, which was hypointense on T1- and T2-weighted images of MRI. At surgery, the tumor was intramedullary and strongly adherent to the cord; it was successfully removed. Both tumors were composed of elongated cells with a collagen-matrix background. Immunohistochemical staining was positive for vimentin, CD34, and bcl-2, and negative for EMA and S-100 protein. A careful analysis of our own and the other reported cases of spinal SFTs may disclose some peculiar features of this rare tumor. A spinal intramedullary or extramedullary tumor, hypointense on T2-weighted images of MRI, which intraoperatively shows hard consistency, scarce vascularization, no nerve root involvement, no or weak dural attachment, absence of arachnoidal interface, and adherence to the spinal cord may suggest the diagnosis of SFT.

"Hitting all the right markers to save a life" Solitary fibrous tumors of the central nervous system: Case series and review of the literature

Background:

Solitary fibrous tumors (SFTs) of the central nervous system are uncommon. Their biological features remain largely unknown; hence, the clinical management and prognosis is often challenging due to the lack of comprehensive data. For this reason, we present two cases of large SFTs to illustrate a comprehensive review.

Methods:

This was a retrospective analysis of two patients: a 65-year-old male with a left parietooccipital lesion and a 70-year-old female with a right parietal convexity mass.

Results:

Gross total resection was performed in the male patient with no recurrence 30 months after resection. The second patient received stereotactic radiosurgery for what was initially thought to be a parafalcine meningioma; however, continued growth 1 year later prompted an open resection, with pathology indicative of an SFT. The tumor recurred the following year requiring repeat resection. Unfortunately, due to the aggressive nature of the lesion, the patient eventually succumbed to tumor burden a year later.

Conclusion:

Based on the literature review, the sometimes observed aggressive growth pattern, and also, the potential for malignant transformation, we recommend complete resection of SFTs with close sequential follow-up.

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

OBJECTIVE

Central nervous system (CNS) solitary fibrous tumor (SFT) is a rare lesion first identified as a unique entity in 1996. We describe two cases treated at the University of Florida followed by a review of all reported cases of CNS SFT between 1996 and 2010.

METHODS

A review of the literature was performed to identify all reported cases of CNS SFT.

RESULTS

189 cases (including the two presented herein) were discovered, of which 46 were spinal and 143 were intracranial. Demographic, imaging, and pathologic findings are presented. Roughly 6% of reported lesions are malignant. Subtotal resection (STR) was associated with a 16-fold increased odds of recurrence (OR 15.9, 95% CI 5.5-46.1), although mean follow-up was shorter in those cases of GTR without recurrence.

CONCLUSION

CNS SFT is a rare lesion. Six percent of lesions are malignant. GTR is superior to STR although the degree of superiority is not clear.

Solitary Fibrous Tumor With Multiple Intracranial and Spinal Lesions: Case Report

BACKGROUND AND IMPORTANCE:

Solitary fibrous tumor (SFT) has been previously reported for its wide variety of presentations and atypical sites. We report a case of recurrent SFT with multiple intracranial and spinal lesions.

CLINICAL PRESENTATION:

A 45-year-old female with recurrent right frontoparietal SFT was found to have multiple intracranial and spinal lesions. Most of the lesions are asymptomatic. Each of the intracranial and spinal lesions has been confirmed histologically. In 1999 the patient was found to have a single right temporal SFT and had a gross total resection of the lesion. In 2005 the patient underwent a second gross total resection for the recurrence of the right temporal-parietal lesion, followed by radiation therapy. In 2009 she underwent a third and fourth gross total resection of the right frontoparietal lesion, and the L4-5 mass, as well as a cervical laminectomy for an extramedullary spinal lesion causing spinal compression.

CONCLUSION:

This is the first case report of recurrent SFT with multiple intracranial and spinal lesions. This case illustrates the nature of recurrence and multiplicity of SFT and raises the importance of a thorough investigation, especially in the entire neuroaxis, in patients with the diagnosis of SFT. This case also questions the justification of the name that was given to this tumor.

Solitary fibrous tumor in the cervical spine with destructive vertebral involvement: a case report and review of the literature

INTRODUCTION

Recently, solitary fibrous tumors occurring in spine-related lesions have been reported. However, the destruction of vertebral bodies by this type of tumor has not been reported.

MATERIALS AND METHODS

A 71-year-old female presented with pain from a mass on the right side of her neck. Plain radiographs of the cervical spine showed collapse of the C5 vertebral body and dislocation of the C4 vertebral body. The MRI image showed a large mass surrounding C4 and C5, which had low signal intensity in the T1W image and high signal intensity in the T2W image. At first, resection of the tumor and spinal fusion was performed by anterior approach.

RESULTS

Histology revealed a solitary fibrous tumor with proliferating spindle cells. Immunohistochemistry showed positive stains for vimentin and CD34. One year postoperatively, a local recurrence manifested extensive destruction of the C4 and C5 vertebral bodies. Then, palliative surgery with posterior cervical instrumentation and radiation therapy were performed. Because the destruction proceeded and the rods were broken 2 years after, she underwent additional occipito-cervical instrumentation.

CONCLUSIONS

This is the first report of a solitary fibrous tumor that involves the destruction of the spinal structure. An extensive destruction of the vertebral body by the solitary fibrous tumor needs to be aware in treating this tumor with spinal involvement.

A rare case of malignant solitary fibrous tumor of the spinal cord

STUDY DESIGN

Case report.

OBJECTIVE

We present a case of an ambulatory patient with a solitary fibrous tumor of the spinal cord.

SUMMARY OF BACKGROUND DATA

Solitary fibrous tumor (SFT) is an uncommon mesenchymal tumor of the pleural cavity, increasingly recognized at numerous extrathoracic sites, including, among others, prostate, kidney, and thyroid. The spinal cord is an extremely rare localization of SFTs with only 17 cases reported in the literature since 1996. Although SFTs are usually indolent neoplasms that are cured with complete surgical resection, malignant transformation has been described within histologically benign SFTs. However, no cases of malignant dissemination have been described in this localization.

METHODS

Discussion of the patient's clinical and radiologic history with a review of the relevant background literature.

RESULTS

We report the first case of spinal cord SFT with visceral dissemination years after the primary diagnosis, despite benign histologic features of the primary tumor.

CONCLUSION

This finding may indicate that long-term follow-up might be necessary in these patients. In addition, metastatic radical surgery of SFTs should be considered to achieve long-term survival since there are no currently available effective systemic therapies.

Solitary fibrous tumor in the thigh: review of the literature

Solitary fibrous tumors (SFT) of extremities, especially the thighs are very rare. Despite SFTs are generally benign, well-circumscribed soft tissue tumors new cases should be presented and followed up carefully to monitor their biological behavior. In general for tumor classification a biopsy is state of the art. Histological including immunohistochemical patterns for SFTs are defined. MRI and ultrasound are not sufficient for differential diagnosis. Once property identified and defined by size and location, resection with intact tumor capsule may result in full recovery of the patient. Reviewing the literature there are no validated reasons for a wider resection. The current patient was a 41-year-old male. Four years after an arthroscopy of the left knee the patient has been suffering an ongoing swelling of the lateral thigh. Because MRI scan data suggested a synovial sarcoma a biopsy was performed. The tumor was classified as a benign SFT. The diagnosis based on histological findings and the presence of the positive immunohistochemical markers Vimentin, CD34, and CD99. The complete tumor resection with intact capsule was achieved in a final operation. Clinical and in MRI after 54-month outcome period there were no local recurrences.

Recurrent solitary fibrous tumour in the cerebellopontine angle

Solitary fibrous tumours (SFT) of the central nervous system are rare. They resemble meningioma in clinical presentation, imaging features and appearance at surgery. Schwannoma, hemangiopericytoma and other spindle cell mesenchymal neoplasms should also be considered in the differential diagnosis. Although the histogenesis of this tumour is still debated, strong CD34 reactivity of the tumour cells suggests that SFT is mesenchymal. We present the clinical, radiological, and pathological features of an SFT located in the cerebellopontine angle (CPA). A 55-year-old female presented with 6 months of headache. The MRI scan showed a contrast enhancing ovoid mass in the left CPA. At craniotomy, the tumour was completely resected. Histolopathological diagnosis was of meningioma. Three years later, the symptoms recurred and an MRI scan demonstrated tumour recurrence. A repeat craniotomy was performed and the lesion was again completely excised. Tumour morphology on histopathology and immunoreactivity for CD34 of the tumour cells supported the diagnosis of SFT. Review of the original tumour also disclosed immunoreactivity for CD34. Ki67 labeling indices were less than 1% in both tumours.

Spinal Solitary Fibrous Tumors: A Series of Four Patients: Case Report

OBJECTIVE AND IMPORTANCE:

Intraspinal solitary fibrous tumors, which are rare mesenchymal tumors, have previously been reported as case reports. We review our experience and, to our knowledge, the first small institutional series with respect to clinical presentation, diagnosis, surgical management, pathohistological analysis, progression-free survival, and long-term outcome.

CLINICAL PRESENTATION:

In this retrospective review, four patients (three male and one female) ranging in age from 17 to 59 years (mean, 38.5 yr) had spinal solitary fibromas located throughout the spinal canal. Three tumors were located in the thoracic region and one in the cervical spine. All patients presented with pain and paresthesia. Two patients had an associated spinal deformity. All had gross total resection as confirmed by postoperative imaging studies.

INTERVENTION:

All four patients underwent surgical treatment for spinal solitary fibromas. None of these patients underwent irradiation or chemotherapy after surgery at our center; therefore, outcome was attributed to surgery alone. There were no surgical deaths, and the 5-year actuarial survival rate was 100%. At the most recent follow-up examination, neurological function was stable or improved in 90% of patients.

CONCLUSION:

Patients with solitary fibrous tumors have a long survival. These tumors have an indolent course, and radiotherapy or chemotherapy seems to be unnecessary.

Solitary fibrous tumor in the occipitocervical region: a case report

STUDY DESIGN

Case report of a solitary fibrous tumor in the occipitocervical region.

OBJECTIVE

To describe a rare clinical entity and successful management in a patient with solitary fibrous tumor in the occipitocervical region.

SUMMARY OF BACKGROUND DATA

Solitary fibrous tumor is a rare spindle cell neoplasm of adults that arises most commonly in the pleura. Recently, this tumor has been reported in a number of other sites. However, its occurrence in the occipitocervical region is rare.

METHODS

The patient presented with a painless mass in the left posterior neck. Resection of the tumor was performed.

RESULTS

Histopathological study revealed features of a solitary fibrous tumor. Clinical follow-up review for 2.5 years shows no evidence of recurrence or metastasis.

CONCLUSION

A case of extrapleural solitary fibrous tumor in the occipitocervical region was reported. Solitary fibrous tumor should be considered in the differential diagnosis in a tumoral mass of this region.

Recurrent intracranial solitary fibrous tumor with cerebrospinal fluid dissemination

✓ Solitary fibrous tumor (SFT) is a benign and rare neoplasm. To date, only 37 patients with intracranial SFTs have been reported. Although a number of the tumors were recurrent and some later underwent malignant transformation, none of these lesions progressed to cerebrospinal fluid (CSF) dissemination. In this paper the authors report a case of SFT in which the lesion recurred several times and ultimately was disseminated by the CSF. The patient was a 63-year-old woman with multiple intracranial and spinal tumors. Fifteen years before this presentation, at the age of 48 she had been hospitalized for resection of a falcotentorial tumor. During the ensuing 15 years she underwent multiple surgeries and sessions of radiation therapy for recurrent lesions. The exclusive location of her tumors in the subarachnoid space at the end of this 15-year period indicate CSF dissemination of the tumor.

The tumor that was resected when the patient was 48 years old and the latest resected lesion were analyzed by performing immunohistological CD34, epithelial membrane antigen, vimentin, S100 protein, and reticulin staining, and determining the MIB-1 labeling index (LI). Most of the results were identical, and both tumors were diagnosed as SFT according to a staining pattern that showed a strong and diffuse positive reaction for CD34. Nevertheless, the authors noted that the MIB-1 LI increased from less than 1% in the original tumor to 13% in the latest tumor. The increased proliferation of MIB-1 indicates that the malignant transformation could have occurred during tumor recurrence with CSF dissemination.

Intramedullary and extramedullary solitary fibrous tumor of the cervical spine

✓ Solitary fibrous tumor is a spindle cell tumor deriving from mesenchymal cells that arises most commonly in the pleura. Only very recently has this tumor been reported in the spine. A solitary fibrous tumor strongly resembles other spindle cell neoplasms of the spine and may be an unrecognized entity if not routinely considered in the differential diagnosis of spinal neoplasms. The authors report an unusual intra- and extramedullary location for a solitary fibrous tumor of the cervical spine. Findings in this case and a comprehensive review of the literature indicate that solitary fibrous tumors can originate from various spinal anatomical substrates and mimic both intra- and extramedullary tumor types.

Dumbbell-type solitary fibrous tumor in the cervical spine

We report a dumbbell-type solitary fibrous tumor in the cervical spine. Eight spinal solitary fibrous tumors have been reported previously, but the cervical location is rare and this may be the first report of a dumbbell-type tumor. Histopathological examination showed that the tumor was composed of spindle cells in a collagen-rich matrix, although regional variability was noted. Diffuse immunostaining for CD34 and vimentin was noted in the cytoplasm of the tumor cells. This rare tumor should be recognized in the differential diagnosis of cervical spinal tumors.

Solitary fibrous tumors in the central nervous system. A clinicopathologic review of 18 cases and comparison to meningeal hemangiopericytomas

CONTEXT

Solitary fibrous tumors (SFTs) of the central nervous system are rare neoplasms that usually present as dura-based masses and clinically resemble meningiomas. Histologically, they can be similar to fibrous meningioma or hemangiopericytoma (HPC). In particular, densely cellular regions seen in some SFTs can be indistinguishable from HPC. Little is known about the biological behavior of SFTs, although most seem amenable to total resection.

OBJECTIVES

To define the clinicopathologic spectrum of SFTs in the central nervous system and to outline their differences from HPC and meningioma.

DESIGN

We present the clinicopathologic features of 18 patients with SFT and compare them with those of an age- and sex-matched cohort of HPCs.

RESULTS

Eleven SFTs were supratentorial, 3 were infratentorial, and 4 were intraspinal. Four of the 18 tumors were intra-axial (2 in the lateral ventricles and 2 within the spinal cord). Histologically, SFTs were similar to their soft tissue counterparts. Six tumors (6/18) had densely cellular regions, and 1 tumor showed frankly anaplastic features. All but 3 patients underwent gross total resection, and there were no metastases or tumor-related mortalities during the median follow-up of 40 months. In contrast, there were 15 local recurrences (83%), 5 extracranial metastases (27%), and 4 tumor-related deaths (22%) in the HPC cohort.

CONCLUSIONS

Our study presents the clinicopathologic features of SFT as a distinct entity from both meningioma and HPC. We also present unusual examples of anaplastic, intraventricular, and intramedullary spinal SFTs that expand the clinicopathologic spectrum of these uncommon and sometimes diagnostically difficult neoplasms.

Solitary fibrous tumours of the meninges: case series and literature review

We report four new cases of meningeal Solitary Fibrous Tumour (SFT). Two patients presented with raised intracranial pressure from posterior fossa SFT, and the third developed hemiparesis and dysphasia due to a large lesion that originated in the left middle cranial fossa. These were successfully excised and the patients remain well at follow-up of between 1 and 3 years. The fourth patient, a 71-year-old man, suffered an intracerebral haemorrhage and later died from a malignant SFT that had invaded the falx cerebri, superior sagittal sinus, and brain. This is the first description of a locally aggressive meningeal SFT with multiple atypical histological features. The 31 previously reported cases of meningeal SFT are reviewed. They occur at all ages and may be relatively more common in the posterior fossa and spine. Intracranial SFT originate from the dura and are probably indistinguishable from meningiomas on imaging and at surgery. In contrast, approximately two-thirds of spinal SFT have no dural attachment. Histologically, SFT are spindle-cell neoplasms with a characteristic immunohistochemical profile of CD34, vimentin, and bcl-2 positivity. Data on outcome for patients with meningeal SFT are limited. At other sites, however, extent of resection is the most important prognostic factor, and invasion or metastasis can occur with histologically benign SFT. Meningeal SFT should, therefore, be excised as completely as possible and followed carefully in the long-term.