Recurrence of solitary fibrous tumor of the cervical spinal cord

Abstract

Solitary fibrous tumor (SFT) mostly originates from the pleura because of proliferation of fibroblast cells. It is extremely rare for the tumor to originate from the spinal cord. Here, we report a rare case of SFT in the spinal cord that recurred repeatedly and progressed from intramedullary to extramedullary. A 40-year-old man underwent C4-5 intramedullary and extramedullary tumor resection in another hospital. Eighteen years later, he experienced symptoms of myelopathy because of tumor recurrence; therefore, he consulted with our hospital and underwent tumor resection again. During surgery, we found that the tumor had an intramedullary and extramedullary location. Only partial resection was possible because of intraoperative deterioration in the compound motor action potential (CMAP). After resection, the pathological diagnosis was SFT. The postoperative course was good. However, two years later, a third tumor resection was required because of dysuria and tumor growth. In this surgery, total resection of the tumor was possible without intraoperative deterioration of the CMAP. The tumor has not subsequently recurred. However, SFT recurrence is relatively common and careful follow-up is required for early detection of recurrence, even after successful removal of the tumor.

Fig. 1

Magnetic resonance imaging at the time of the initial consultation with our hospital. Sagittal T1-weighted (A) and T2-weighted (B) of the cervical cord gave isointense and iso- to hyperintense signals due to a intradural tumor at the C4–5 level. Sagittal T1 gadolinium-enhanced (C) and axial (D) images showed homogenous enhancement.

Fig. 2

Sagittal T2-weighted (A) and axial (B) imaging showed recurrence of the tumor six months after surgery at our hospital. Sagittal T2-weighted (C) and axial (D) imaging revealed tumor growth two years after surgery at our hospital.

Fig. 3

Postoperative sagittal T1-weighted (A) and T2-weighted (B) images showing the absence of a residual tumor at the present time.

Fig. 4

Microscopic examination of the tumor specimen after hematoxylin and eosin staining showed a well circumscribed, partially encapsulated tumor along with bland spindle cells with somewhat vesicular nuclei (A). In immunocytochemical analysis, the tumor cells exhibited strong positivity for vimentin (B) and CD34 (C). The Ki-67 proliferation index was low (approximately 1%) (D). (A-D:×400).