Surgical and radiation treatment of a paravertebral malignant solitary fibrous tumor: a case report and literature review

Abstract

Malignant solitary fibrous tumors (MSFT) are rare neoplasms, and typically exhibit an aggressive course. While complete surgical resection is the primary treatment modality, the role of adjuvant radiation treatment in larger tumors is not well-established. Despite limited reported cases which demonstrated extended disease-free periods with adjuvant radiation, its utilization is conflictingly both recommended or discouraged across the literature due to the absence of high-quality published data. This is a report to add to the slowly growing body of literature to support the use of adjuvant radiation in these tumors. Specifically, a case of a 64-year-old man who developed rash and mild back pain after a total hip arthroplasty. He was found to have a large paravertebral MSFT, and was treated with surgical resection followed by adjuvant radiation due to size and focally positive margins. He has continued to have no evidence of disease 21 months after treatment. This case of successful treatment and continued disease-free interval with resection and adjuvant radiation contributes valuable supporting data to the management of this rare disease entity. Furthermore, a review of available literature on MSFT treatment is conducted to illustrate the inconsistency in post-surgical management, and demonstrate the necessity of additional detailed reports from a radiation treatment perspective.

Keywords: Solitary fibrous tumor; case report; pleura; radiation; surgery.

Figure 1

Axial CT pulmonary angiography image of a 5.2 cm ×4.0 cm ×4.0 cm right paraspinal mass with small areas of calcification.

Figure 2

Axial thoracic spine MRI with gadolinium contrast image of a partially calcified, enhancing, right paravertebral mass measuring 5.4 cm at the level of T2–3, without spinal canal invasion.

Figure 3

Low power image of the tumor with zone of necrosis and dystrophic calcification (H&E, 20× magnification).

Figure 4

Graphical representation of timeline of workup, treatment, and follow-up.