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Solitary fibrous tumor, case 1

CLINICAL HISTORY:
This 26-year old man complains of intermittent sensory disturbances in the right leg, manifesting as numbness and sleeping sensation. He notes visual disturbances of the right eye.

NEUROLOGICAL EXAMINATION reveals bilateral papilledema and hypoesthesia of the right leg.

CT:
a) NON-CONTRAST CT (IMAGE 1): A spontaneously hyperdense multilobulated tumor is seen in the left frontoparietal region with broad contact with the falx (arrowheads).

b) CONTRAST-ENHANCED CT (IMAGE 2): Intense but inhomogeneous contrast enhancement is noted.

MRI:
a) TRANSAXIAL T2-WEIGHTED SPIN-ECHO (33800/90/1) SEQUENCE (IMAGE 3): A huge mass is seen in the left paramedian frontoparietal region with accompanying edema. The lesion is isointense to brain with evidence of markedly hypointense calcifications (arrow). The tumor is broadly implanted on the surface of the falx (arrowhead). The probable location of the lesion is in the Rolandic region, possibly involving the motor cortex.

b) TRANSAXIAL T1 WEIGHTED SPIN-ECHO (560/15/1) SEQUENCE (IMAGE 4): The lesion is heterogeneous but with overall isointensity to grey matter.

c) TRANSAXIAL (IMAGE 5), CORONAL (IMAGE 6) AND SAGITTAL (IMAGE 7) GADOLINIUM-ENHANCED T1-WEIGHTED SPIN-ECHO SEQUENCE: Intense contrast enhancement of the tumor is noted. The lesion now is clearly multilobulated and is in broad contact with the falx on all sequences. The center of the mass is less enhancing. The corpus callosum and left lateral ventricle are depressed (arrowheads). The superior sagittal sinus cannot be identified over the tumor.

ANGIOGRAPHY: Selective injection of the left internal carotid artery (lateral vein) (IMAGE 8): The tumor is supplied at its periphery by pial branches.
Selective injection of the left internal carotid artery: (venous phase): right anterior oblique projection (IMAGE 9). The superior sagittal sinus (arrowheads) is somewhat irregular over the tumor, but patent.
Selective injection of the left external carotid artery in anteroposterior (IMAGE 10) and lateral (IMAGE 11) projection. There is substantial hypervascularity supplied by the middle meningeal artery.

RADIOLOGICAL DIAGNOSIS is falx meningioma based on the extraaxial location, the broad insertion on the falx and the convexity and the intense enhancement.

SURGICAL INTERVENTION found that the tumor displaced the motor cortex anteriorly. The tumor was highly vascular. It was inserted on the lateral wall of the superior sagittal sinus but does not extend towards the falx. The mass invaded the superior sagittal sinus. For the complete removal of the tumor it was necessary to open the superior sagittal sinus.

ANATOMOPATHOLOGICAL EXAMINATION was consistent with "solitary fibrous tumor".

FOLLOW-UP: One year later there is no tumor recurrence on CT. There is some improvement in vision. He is still receiving anti-epileptic medication.

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Solitary fibrous tumor

 

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Fig. 1

Solitary fibrous tumor, case 1, Fig. 1
Solitary fibrous tumor, case 1, Fig. 2
Solitary fibrous tumor, case 1, Fig. 3
Solitary fibrous tumor, case 1, Fig. 4
Solitary fibrous tumor, case 1, Fig. 5
Solitary fibrous tumor, case 1, Fig. 6
Solitary fibrous tumor, case 1, Fig. 7
Solitary fibrous tumor, case 1, Fig. 8
Solitary fibrous tumor, case 1, Fig. 9
Solitary fibrous tumor, case 1, Fig. 10
Solitary fibrous tumor, case 1, Fig. 11