Fourth ventricular solitary fibrous tumor: a case report and review of the literature

Abstract

Introduction Solitary fibrous tumors of the central nervous system usually present as dura-based masses and clinically resemble meningiomas. There are very few reported cases of intra-ventricular solitary fibrous tumors, particularly in the fourth ventricle. Case presentation Our patient was a 52-year-old African-American man, who presented to our facility with a two-month history of progressive weakness and numbness in all extremities. A computed tomography scan and brain magnetic resonance imaging scan revealed a homogeneous, avidly enhancing 4.5 × 3.7 × 2.7cm fourth ventricular mass, with compression of adjacent medulla and cerebellum and extension into the foramen of Luschka. Our patient underwent a suboccipital craniotomy and resection of the tumor. A histological examination showed a spindle cell neoplasm with prominent collagenized stroma. The neoplastic cells were strongly and diffusely positive for CD34, vimentin and Bcl-2, and negative for S-100, CD99 and epithelial membrane antigen. The molecular immunology Borstel-1 (MIB-1) proliferation index was low (1%). CD31 immunostain highlighted the endothelial cells but the spindle cells were negative. Reticulin stain demonstrated a moderate reticulin network but individual cells were not invested by reticulin fibers. The histological features and immunoprofile was consistent with a solitary fibrous tumor. Conclusions In the central nervous system, solitary fibrous tumors are usually indolent tumors, with only rare examples showing hypercellularity and increased mitotic activity; features that were absent in our patient’s case. We present an uncommon central nervous system neoplasm in a rare location. Although uncommon, solitary fibrous tumors should be included in the differential diagnosis of intra-ventricular tumors in adults.

Magnetic resonance features of meningeal solitary fibrous tumors

“…However, the results were slightly different from the 'usually solid lesions' described in the study by Wang et al (24). There were large cystic regions in the certain tumors of the present study (5/12 cases, 41.67%), and there were small cystic areas in others (3/12 cases, 25.00%).…”

“…Another literature review reported a median age of 44.5-55.0 years (23). The ages of other reported cases have been within this range (24)(25)(26)(27). In the present study, the ages of the patients ranged between 20 and 71 years, with a mean age of 48.8 years.…”

“…The MR findings of I-SFT were described in the study by Wang et al (24). It was reported that I-SFT was usually a solid lesion with clear edges, which exhibited a medium T1WI signal, a low T2WI signal and was significantly enhanced upon contrast-enhanced scanning.…”

“…Spindled fibroblast-like cells have been reported in the SFT pathology (24). The tumors contain a significant amount of collagen fiber and scar tissue.…”

Solitary Fibrous Tumor: An Uncommon Cause of Paraparesis and Sciatic Pain

“…They are initially reported by Klemperer et al [1]. It is a mesenchymal tumor that appears to exhibit fibroblastic differentiation, classically described in the pleura, but extrathoracic SFT has also been reported [2].…”