Intracranial solitary fibrous tumor/hemangiopericytoma - A case series

Abstract

Background: Intracranial solitary fibrous tumor/hemangiopericytoma (HPC) is a rare and aggressive tumor. We conducted this retrospective study to investigate the outcome of patients after treatment, the efficacy of postoperative adjuvant radiotherapy, and the factors not conducive to total resection.

Methods: We conducted a retrospective review of the medical records of patients harboring fresh intracranial solitary fibrous tumor/HPC treated from January 2009 to December 2019 in our hospital. We reviewed their clinical presentations, radiologic appearances, tumor size and location, extent of resection, estimate intraoperative blood loss, treatment modalities and results, and duration of follow-up.

Results: There were seven consecutive patients (three males and four females). The ages of the patients at the time of diagnosis ranged from 35 to 77 years (mean: 52.86 years). Five patients (71.43%) got tumor bigger than 5 cm in dimension and only 1 patient (14.29%) underwent gross total tumor resection in the first operation without complication. Five patients (71.43%) underwent postoperative adjuvant radiotherapy. Follow-up period ranged from 4.24 to 123.55 months and the median follow-up period was 91.36 months. Three patients had favorable outcome with Glasgow Outcome Scale (GOS) equal to 4; four patients had unfavorable outcome with GOS equal to 2 or 3. No mortality was happened.

Conclusion: Gross total tumor resection in the initial surgery is very important to achieve a better outcome. Massive intraoperative bleeding and venous sinus or major vessels adjoining are factors not conducive to total resection. Radiotherapy can be administered as adjuvant therapy for cases showing an aggressive phenotype or not treated with gross total resection.

Keywords: Intracranial solitary fibrous tumor/hemangiopericytoma; Massive intraoperative bleeding; Postoperative adjuvant radiotherapy.

Figure 1:

Preoperative brain MRI of case 2. Axial T1-weighted image (a) and axial T2-weighted image (b) showing a large tumor in the right side frontotemporal region, abutting the sphenoid ridge and right cavernous sinus, extension to the right basal ganglion and right side periventricular region with relative isosignal intensity on T1WI and T2WI. Axial T1-weighted image postgadolinium enhancement (c) showing good enhancement. MRA (d) partial encasement of the right middle cerebral artery and right supraclinoid internal carotid artery (black arrows).

Figure 2:

Preoperative brain MRI of case 3. Coronal axial T2-weighted image (a) and coronal T1-weighted image (b) showing a large tumor in right fronto-occipital-parietal region, abutting the posterior cerebral falx and right-sided tentorium and invading right occipital bone, isointense with cortical gray matter on T1-weighted image but hyperintense on T2-weighted image. Coronal T1-weighted image postgadolinium enhancement (c) showing heterogeneous enhancement.

Figure 3:

Preoperative brain MRI of case 7. Axial T1-weighted image (a) and axial T2-weighted image (b) showing a large extra-axial well-circumscribed mass lesion in the right frontal-temporal convexity, abutting the skull bone, isointense with cortical gray matter on both T1-weighted and T2-weighted image. Axial T1-weighted image postgadolinium enhancement (c) showing good enhancement. MRA (d) showing a small aneurysm in bifurcation of the right middle cerebral artery (black arrow).