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Solitary fibrous tumor, case 2

CLINICAL HISTORY:
This 47-year old man has a long history of occipital headache. Recently the headache worsened. He complains of tinnitus and memory disturbances. He mentions one episode of "drop attack", due to weakness in the legs.

NEUROLOGICAL EXAMINATION is normal.

CT:
a) NON-CONTRAST SCAN (IMAGE 1): In the right frontal region, a huge mass (arrowheads) is seen, broadly implanted on the frontal convexity and on the falx. The mass has overall high density, with some calcification at the medial border. Some edema is present in the frontal lobe.

b) CONTRAST-ENHANCED SCAN (IMAGE 2): Intense and homogeneous enhancement (arrowheads).

MRI:
a) TRANSAXIAL T2-WEIGHTED (5000/128/1) SPIN-ECHO SEQUENCE (IMAGES 3 AND 4): The mass demonstrates overall hypointense signal. Substantial compression of the right frontal horn and the corpus callosum (arrow) is noted as is edema.

b) TRANSAXIAL T1-WEIGHTED (560/14/1) SPIN-ECHO SEQUENCE (IMAGES 5 AND 6): Tumor (arrowheads) is isointense to grey matter, but with some intralesional inhomogenity.

c) TRANSAXIAL (IMAGES 7 AND 8), CORONAL (IMAGE 9) AND SAGITTAL (IMAGE 10) GADOLINIUM-ENHANCED SPIN-ECHO SEQUENCES: Intense and slightly inhomogeneous enhancement. The tumor has broad contact with the frontal convexity and with the falx in all directions. Notice the small dural tail (arrowhead image 9).

ANGIOGRAPHY: Selective injection of right internal carotid artery. Early (IMAGE 11) and late (IMAGE 12) phase. The tumor is supplied by anterior falcine branches (arrows), originating from the ophthalmic artery, and is markedly vascular. No external carotid artery supply is identified

RADIOLOGICAL DIAGNOSIS: Falx meningioma based on the extraaxial location, the broad implantation on the falx, the intense and homogeneous enhancement and the dural tail.

SURGICAL FINDINGS: At surgery the tumor was found to be extremely hypervascular. The tumor appeared not to be inserted at all at the level of the convexity or the falx, but showed only a limited region of insertion on the lateral wall of the superior sagittal sinus.

ANATOMOPATHOLOGY(IMAGES 13 - 14 - 15) is fibrous tumor.

COMMENT: 6 months after surgery, the patient is still receiving anti-epileptic therapy.

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Solitary fibrous tumor

 

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Fig. 1

Solitary fibrous tumor, case 2, Fig. 1
Solitary fibrous tumor, case 2, Fig. 2
Solitary fibrous tumor, case 2, Fig. 3
Solitary fibrous tumor, case 2, Fig. 4
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Solitary fibrous tumor, case 2, Fig. 6
Solitary fibrous tumor, case 2, Fig. 7
Solitary fibrous tumor, case 2, Fig. 8
Solitary fibrous tumor, case 2, Fig. 9
Solitary fibrous tumor, case 2, Fig. 10
Solitary fibrous tumor, case 2, Fig. 11
Solitary fibrous tumor, case 2, Fig. 12
Solitary fibrous tumor, case 2, Fig. 13
Solitary fibrous tumor, case 2, Fig. 14
Solitary fibrous tumor, case 2, Fig. 15