Elsevier

Surgical Neurology

Volume 51, Issue 6, June 1999, Pages 636-640
Surgical Neurology

Neoplasm
Solitary fibrous tumor of the meninges: two new cases and review of the literature

https://doi.org/10.1016/S0090-3019(98)00115-3Get rights and content

Abstract

BACKGROUND

Solitary fibrous tumor (SFT), a mesenchymal neoplasm originally described in the pleura has been more recently reported to arise in a number of other sites, including the meninges. Nowadays immunohistochemistry facilitates the otherwise problematic differential diagnosis with regard to other benign and malignant spindle cell neoplasms of the central nervous system.

METHODS

Two recently treated cases of meningeal SFT (one craniospinal, one spinal) are presented and discussed in the light of the present knowledge and a review of the literature.

RESULTS

Total resection was followed by complete recovery and both patients are presently asymptomatic and without evidence of disease. The microscopic and immunohistochemical profiles (CD 34, vimentin positive; S-100, EMA negative) were consistent with those of previously reported cases.

CONCLUSIONS

The majority of SFTs behave in a benign fashion and do not recur unless subtotally resected. Malignant variants may account for up to 37% of SFTs in other locations but have never been reported to occur in the meninges. Meningeal SFTs are to be considered a new pathological entity. Wider use of immunohistochemical screening should enable the determination of their real incidence; larger series and longer follow-up will provide conclusions about their treatment and prognosis.

Section snippets

Case 1

This 18-year-old male patient came to our attention reporting a 1-year history of left arm paresthesias, limb weakness, and urinary retention. Magnetic resonance imaging (MRI) disclosed a large (9 × 3 × 4.7 cm) transdural (intra-extradural) extramedullary tumor extending from the lower clivus down to C3, with predominant left posterolateral growth (Figure 1, left). The homogeneously enhancing mass displayed regular rounded margins and expansive-type growth without erosion of bony structures.

Case 2

A 46-year-old female presented with an 8-month history of left sciatalgia with no sphynteric disturbances. MRI disclosed an intradural-extramedullary spinal tumor localized at T12-L1 level (Figure 3). A T12-L1 laminectomy was performed and an intradural tumor was totally removed.

Macroscopically, the tumor presented as a well delimited, whitish nodule of 1.6 cm in maximum diameter, with a fasciculated cut surface. The postoperative course was uneventful and when the patient was discharged on

Histology

Both cases had similar histology and immunohistochemical profile. The tumors showed spindle cell proliferation with areas of collagenization and a rich vascular component, more abundant in Case 1 (Figure 2). No cellular whorls or psammoma bodies, except rare entrapped leptomeningeal ones, were observed (Figure 2). Minimal lymphoid infiltrate was present. The vascular network showed irregular vascular lumina with “hemangiopericytoma-like” pattern (Figure 4). Mitoses were rare (less than 1/10

Discussion

Solitary fibrous tumor (SFT) was first differentiated from diffuse mesothelioma in 1931 by Klemperer and Rabin [17]. Although challenged [25], their proposal of a mesenchymal rather than mesothelial origin of the tumor is nowdays generally accepted on the base of sound immunohistochemical, ultrastructural, and cell culture evidence 2, 9, 16, 30. SFT consists of monomorphous sheets of spindle cells in straight, gently curving or somewhat undulating fascicles embedded in a conspicuous fibrous

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