Bifrontal solitary fibrous tumor of the meninges

Abstract

Background: We report the case of a bifrontal solitary fibrous tumor (SFT) arising from the meninges. The points of interest in this case report are the particular imaging appearance, the immunohistochemical findings and the surgical features.

Case description: A 53-year-old Caucasian male presented with a 1-year history of behavioral changes, attention disorders and anterograde memory disorders. Magnetic resonance imaging revealed a bifrontal heterogeneous lesion attached to the anterior falx cerebri with a prominent multicompartmental cystic part. The patient underwent craniotomy for a sub-total resection of the tumor. At surgery, the multicystic component was highly vascularized and encased the anterior cerebral arteries. Neuropathological findings were consistent with a solitary fibrous tumor. Despite the absence of malignant features, there was a focal expression of p53.

Conclusion: SFT is a pathological entity with specific immunohistochemical features; it has frequently been misdiagnosed in the past. The multicystic imaging appearance of this SFT and the particular p53 immunohistochemical staining are features that should be added to the growing data on intracranial SFTs. The surgical features described (high vascularization and partial vessel encasement) may help improve surgical planning.

Keywords: CNS tumors; meningeal tumors; p53; solitary fibrous tumor.

Figure 1

Magnetic resonance imaging of a large frontal interhemispheric heterogeneous lesion; (a) sagittal T1-weighted scan; (b) axial and coronal T2-weighted images showing the important mass-effect and the partial inclusion of both anterior cerebral arteries and their branches in the tumor (arrows); (c) and (d) axial and sagittal gadolinium-enhanced T1-weighted images showing both the anterior solid (asterisk) and the multicystic components of the lesion with the homogenous enhancement of the solid part, as well as the enhancement of the thick cystic walls

Figure 2

Postoperative magnetic resonance imaging showing no signs of tumor growth; (a) sagittal T1-weighted scan; (b) sagittal gadolinium-enhanced T1-weighted scan; (c) axial T2-weighted scan

Figure 3

Histology and immunohistochemical profile of resected tumor (all original magnification at ×200; a+d at ×400): a) Tumor mostly containing spindle cells arranged in fascicles. Hematoxilyn and eosin staining coloration; b) Expression of CD34 in most tumor cells; c) Expression of Bcl-2 in most tumor cells; d) Nuclear expression of p53 in about half of the tumor cells