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Abstract
BACKGROUND Intracranial fibrosarcoma is an extremely rare neoplasm in the central nervous system. Insofar there were only sporadic case reports describing its features. The purpose of this study is to review the clinical and surgical features of cases who were treated in our department. METHOD The authors retrospectively reviewed and detailed the clinical and surgical data obtained from 5 patients with fibrosarcoma who underwent treatment at our institute between January 2009 and January 2019. RESULTS There were 3 males and 2 females including 2 juvenile and 3 senior patients. The most frequent sign was intermittent pain and vomiting. The location of the tumor included middle fossa, thalamus and midbrain, sellar and suprasellar region and right parietal-occipital lobe. Surgical observation demonstrated the consistency of the tumor was tenacious with abundant blood supply. Gross total resection was achieved in 2 cases. Pathological analysis showed spindle cells in a herringbone form with positive Vimentin staining in all 5 cases, with the absence of GFAP or S-100. All 5 patients were deceased eventually after a varied period of time after the first surgery. CONCLUSION Intracranial fibrosarcoma was a highly malignant entity presented in the central nervous system. Surgery still remains the first-line treatment followed by radiotherapy, however, the prognostic outcome was very poor. Future studies should be more focused on accumulation of the relevant information on this disease thus hopefully in assisting to developing more optimized treatment.
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Ma XJ, Li D, Li H, Wang L, Hao SY, Zhang LW, Zhang JT, Wu Z. The clinicoradiological features and surgical outcomes of primary intracranial fibrosarcoma: a single-institute experience with a systematic review. Neurosurg Rev 2020; 44:543-553. [PMID: 32036505 DOI: 10.1007/s10143-020-01249-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2019] [Revised: 01/15/2020] [Accepted: 01/20/2020] [Indexed: 12/01/2022]
Abstract
Primary intracranial fibrosarcoma (PIF) was a rare tumor with a high relapse rate and dismal survival rate. This study aimed to delineate the clinical characteristics of primary intracranial fibrosarcoma (PIF) and the risk factors for outcomes. We reviewed 15 PIF patients, who underwent surgical treatment at our institution from January 2009 to December 2018. Meanwhile, 36 cases from the prior literature between November 1962 and December 2019 were also retrieved and pooled to identify the risk factors. In our cohort, while cystic component (46.7%), perilesional edema (83.3%), and vascular flow void (66.7%) were commonly observed, no patient was accurately diagnosed. The 2-year relapse-free survival (RFS) and overall survival (OS) were 12.2% and 30.2%, respectively. Based on the pooled data, tumor size (p = 0.006), Ki-67 index (p = 0.004), and radiotherapy dose (p = 0.029) were prognostic factors for RFS in univariate analysis. In the univariate analysis, tumor size (p = 0.002), NGTR (p = 0.049), and high Ki-67 index (p = 0.019) were significant predictors for OS; and further multivariate analysis (n = 18) showed that large tumor size (≥ 5 cm; HR 14.613, p = 0.022) and high Ki-67 index (≥ 30%; HR 5.879, p = 0.020) were the independent risk factors for OS. Due to the rarity and nonspecific clinicoradiological features, the correct diagnosis of PIF before surgery was challenging. The outcomes of PIF were poor, and GTR plus radiotherapy (at least 60 Gy) might benefit to the outcomes and were recommended. Future study with a large cohort was needed to verify our findings.
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Affiliation(s)
- Xiu-Jian Ma
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Nansihuanxilu 119, Fengtai District, Beijing, People's Republic of China.,Division of Molecular Neurogenetics, German Cancer Research Center (DKFZ), DKFZ-ZMBH Alliance, Im Neuenheimer Feld 280, 69120, Heidelberg, Germany
| | - Da Li
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Nansihuanxilu 119, Fengtai District, Beijing, People's Republic of China
| | - Huan Li
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Nansihuanxilu 119, Fengtai District, Beijing, People's Republic of China
| | - Liang Wang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Nansihuanxilu 119, Fengtai District, Beijing, People's Republic of China
| | - Shu-Yu Hao
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Nansihuanxilu 119, Fengtai District, Beijing, People's Republic of China
| | - Li-Wei Zhang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Nansihuanxilu 119, Fengtai District, Beijing, People's Republic of China
| | - Jun-Ting Zhang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Nansihuanxilu 119, Fengtai District, Beijing, People's Republic of China
| | - Zhen Wu
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Nansihuanxilu 119, Fengtai District, Beijing, People's Republic of China.
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Zhang N, Guo L, Kuang H, Ji Y, Zeng X. Primary Intracranial Fibrosarcoma: Case Report and Systematic Review of Literature. World Neurosurg 2018; 123:251-255. [PMID: 30579028 DOI: 10.1016/j.wneu.2018.12.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Revised: 12/04/2018] [Accepted: 12/05/2018] [Indexed: 10/27/2022]
Abstract
Primary intracranial fibrosarcoma (PIF) is an exceedingly rare tumor. Only about 50 cases have been reported in the literature. Here, we present a case of a 20-year-old male who presented with a sudden-onset headache. Magnetic resonance imaging of the brain showed a hemorrhagic extra-axial space-occupying mass. The mass was surgically resected, and biopsy was consistent with PIF. The patient was lost to follow-up and presented with recurrence 3 months later. He expired from complications of the tumor. PIF is a diagnosis of exclusion: More common intracranial tumors should first be excluded. Biopsy is necessary to diagnose PIF.
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Affiliation(s)
- Ning Zhang
- Department of Radiology, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China.
| | - Linghong Guo
- Department of Radiology, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Hongmei Kuang
- Department of Radiology, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Yuqiang Ji
- Department of Radiology, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Xianjun Zeng
- Department of Radiology, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
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Guerrini F, Franzin AB, Grimod G, Cesana C, Vismara D, Verlotta M, Parolin M, Mazzeo LA, Crespi M. A meningeal fibrosarcoma on the same site of osteodural decompression: a pure coincidence? J Neurosurg Sci 2017. [PMID: 28643506 DOI: 10.23736/s0390-5616.17.04086-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Francesco Guerrini
- Department of Neurosurgery, Hospital A. Manzoni, Lecco, Italy - .,Unit of Neurosurgery, Department of Clinical Surgical Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy -
| | | | - Gianluca Grimod
- Department of Neurosurgery, Hospital A. Manzoni, Lecco, Italy
| | - Carlo Cesana
- Department of Neurosurgery, Hospital A. Manzoni, Lecco, Italy
| | - Daniela Vismara
- Department of Neurosurgery, Hospital A. Manzoni, Lecco, Italy
| | | | - Michele Parolin
- Department of Neurosurgery, Hospital A. Manzoni, Lecco, Italy
| | - Lucio A Mazzeo
- Department of Neurosurgery, Hospital A. Manzoni, Lecco, Italy
| | - Marta Crespi
- Department of Neurosurgery, Hospital A. Manzoni, Lecco, Italy
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New Software for Preoperative Diagnostics of Meningeal Tumor Histologic Types. World Neurosurg 2016; 90:123-132. [PMID: 26926798 DOI: 10.1016/j.wneu.2016.02.084] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2015] [Revised: 02/17/2016] [Accepted: 02/18/2016] [Indexed: 11/23/2022]
Abstract
OBJECTIVE Meningeal tumors are neoplasms with different histologic manifestations of both benign and malignant types that determine the prognosis of tumor recurrence and its consistency. The risk of surgical treatment depends on the location, size, and consistency of the tumor. Magnetic resonance imaging (MRI) sequences can be used to identify the features of tumors, but these MRI characteristics are not well understood. The present study describes an advanced mathematical algorithm to analyze MRI data and distinguish histologic types of meningeal tumors before surgery. METHODS Forty-eight patients underwent surgical removal of meningeal brain tumor. All patients had preoperative MRI with a 1.5-T scanner. One radiologist and 2 neurosurgeons evaluated MRI histogram peaks of the whole tumor volume using the advanced computer algorithm. RESULTS Three specialists received the following mean value of histogram peaks: 15.99 ± 0.23 (± standard error of the mean [SEM]) for meningoteliomatous meningiomas; 21.24 ± 0.3 (±SEM) for fibroplastic meningiomas; 19.0 ± 0.28 (±SEM) for transitional meningiomas; 10.7 ± 0.27 (±SEM) for anatypical, anaplastic meningiomas, 11.03 ± 0.51 (±SEM) for primary intracranial fibrosarcomas and 25.72 ± 0.29 (±SEM) for meningeal hemangiopericytomas. A one-way analysis of variance test proved the difference between group means: F = 70.138, P < 0.01. The Tukey test and the Games-Howell test indicated that the difference between the tumor groups was significant. Mean deviation in agreement index between specialists was 0.98 ± 0.007 (±SEM). CONCLUSIONS The advanced algorithm proved high specificity, sensitivity, and interoperator repeatability.
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Giridhar P, Mallick S, Haresh KP, Gupta S, Julka PK, Rath GK. Intracranial fibrosarcoma treated with adjuvant radiation and temozolomide: Report of a case and review of all published cases. J Egypt Natl Canc Inst 2015; 28:111-6. [PMID: 26248975 DOI: 10.1016/j.jnci.2015.07.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2015] [Revised: 07/03/2015] [Accepted: 07/04/2015] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Fibrosarcoma is a rare brain tumour with 33 cases reported so far. However, there is no clear consensus about the nature of the disease and treatment as well as outcome. METHODS A MEDLINE search was carried out using MESH terms like intracranial fibrosarcoma, intraspinal fibrosarcoma, fibrosarcoma meninges and fibrosarcoma brain. A total of 22 case reports and series reporting a total of 33 cases were identified. We here also report a case treated in our institute with adjuvant radiation and concurrent and maintenance temozolomide. RESULTS The age of presentation ranged from 2months to 75years (Median=17years). The gender ratio was found to be M:F of 1.75-1. Treatment modalities were described for 17 cases. Surgery was part of treatment in all cases while radiation was a part of treatment in 59% of cases (n=10) and chemotherapy in 29% cases (n=5). Survival data were available only for 8 cases and ranged from 1day to 8years (Median=15.5months). CONCLUSION Fibrosarcoma is a rare disease with dismal prognosis. Surgery remains the cornerstone of therapy. Radiation confers long term disease control and survival. Chemotherapy needs to be evaluated for these tumours to improve survival.
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Affiliation(s)
- Prashanth Giridhar
- Department of Radiation Oncology, All India Institute of Medical Sciences, New Delhi, India
| | - Supriya Mallick
- Department of Radiation Oncology, All India Institute of Medical Sciences, New Delhi, India.
| | - K P Haresh
- Department of Radiation Oncology, All India Institute of Medical Sciences, New Delhi, India
| | - Subhash Gupta
- Department of Radiation Oncology, All India Institute of Medical Sciences, New Delhi, India
| | - P K Julka
- Department of Radiation Oncology, All India Institute of Medical Sciences, New Delhi, India
| | - G K Rath
- Department of Radiation Oncology, All India Institute of Medical Sciences, New Delhi, India
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Giant cranial and cerebellar hemangioma treated with propranolol. Childs Nerv Syst 2015; 31:805-8. [PMID: 25472450 DOI: 10.1007/s00381-014-2603-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2014] [Accepted: 11/26/2014] [Indexed: 01/14/2023]
Abstract
INTRODUCTION Infantile hemangiomas are the most common benign tumors in children. However, cranial involvement of such lesions is rare. Current treatment options for hemangiomas in various locations that would be endangering or disfiguring include follow-up, surgical removal, or administration of corticosteroids, interferon-α, thalidomide, vincristine, propranolol, and laser therapy. METHODS We describe an infant who presented with an extensive cranial hemangioma (proven by a biopsy). The child was treated with propranolol. RESULTS Clinical and radiological follow-up for over a year showed significant reduction in tumor size without adverse clinical symptoms. CONCLUSION Propranolol is a valid treatment for large cranial hemangiomas, avoiding the risks involved in surgeries.
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