Malignant solitary fibrous tumor of tandem lesions in the skull and spine

Abstract

A Solitary Fibrous Tumor (Sft) Is A Rare Neoplasm Originated From The Pleura, But They Can Occur In A Variety Of Extrathoracic Regions. Although Many Cases Of Primary Sft Have Been Reported, There Are Extremely Rare Repots To Date Of A Malignant Sft In The Spine Or Skull. A 54-year-woman Visited Our Hospital Due To Low Back Pain And Both Leg Radiating Pain. Several Imaging Studies Including Magnetic Resonance Imaging And Computed Tomography Revealed Expansive Enhanced Lesions In The Occipital Bone, T8, S1-2, And Ilium, With Neural Tissue Compression. We Performed Surgical Resection Of The Tumor In Each Site, And Postoperative Radiosurgery And Chemotherapy Were Performed. However, After Six Months, Tumors Were Recurred And Metastasized In Multiple Regions Including Whole Spine And Lung. The Authors Report Here The First Case Of Patient With Malignant Sft Of Tandem Lesions In The Various Bony Structures, Including Skull, Thoracic Spine, And Sacral Spine, With A Rapid Recurrence And Metastasis. Although Malignant Sft Is Extremely Rare, It Should Be Considered In The Differential Diagnosis And Carful Follow-up Is Needed.

Keywords: Metastasis; Skull; Solitary fibrous tumors; Spine.

Fig. 1

Image findings on admission. A : Sagittal lumbar enhanced MRI shows strongly enhanced lesion in S1, S2, and epidural space with encroachment of the bilateral nerve root of L5, S1, and S2. B : Sagittal thoracic enhanced MRI shows an extraosseous mass formation in the posterior element of T8. C : Enhanced neck CT shows heterogeneous enhancing extraosseous mass with occipital bone destruction and prominent collateral feeding vessels.

Fig. 2

Photomicrographs of the malignant solitary fibrous tumor. A : Hemangiopericytoma-like perivascular pattern (H&E, ×100). B : Patternless pattern with intervening irregular hyalinzed collagen bundles (H&E, ×100). C : Tumor shows high cellularity and marked cellular atypia (H&E, ×400). D : Tumor cells are positive for CD34 (immunostain, ×400).

Fig. 3

Follow-up enhanced thoracic MRI at postoperative one month. Sagittal enhanced MRI reveals a recurred expansive posterior epidural mass with cord compression at T8.