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Presented by Peter Illei, M.D. and prepared by Priya Banerjee, M.D.
Case 2: The patient is a 42-year-old gentleman who was seen in the emergency room for progressive headaches and photophobia.
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Question 1 of 1
1. Question
Week 371: Case 2
The patient is a 42-year-old gentleman who was seen in the emergency room for progressive headaches and photophobia. Imaging showed a C1-C2 a 2.5 and 2.2 cm intradural extramedullary tumor.images/11_3_08 intradural_sft_1.jpg
images/11_3_08 intradural_sft_2.jpg
images/11_3_08 intradural_sft_3.jpg
images/11_3_08 intradural_sft_4.jpgCorrect
Answer: Solitary fibrous tumor (SFT)
Histology: see below
Discussion: The tumor exhibits variable cellularity and is composed of bland spindle cells that are arranged in poorly formed fascicles that are separated by variable amount of dense collagen. The tumor is well vascularized and contains numerous branching “stag horn” vessels. The mitotic activity is increased and is 5-6 per 10 HPF.
The majority (75%) of central nervous system SFT-s are intracranial. Spinal cord tumors arise mostly in the thoracic and lumbar regions. The tumors are usually not encapsulated but tend to have a well circumscribed pushing border. The histologic appearance is similar to SFTs seen at other sites. The metastatic potential of leptomeningeal solitary fibrous tumors appears to be low. Unlike solitary fibrous tumors that arise outside the CNS, the criteria for malignant SFT in the CNS are not well established. The combination of high cellularity, increased mitotic activity, nuclear atypia and necrosis are indicative of malignant potential. In this recurrent tumor the presence of hypercellular areas and mildly increased mitotic activity may be indicative of malignant potential; nevertheless, the biologic behavior of the tumor cannot be predicted with certainty.
Incorrect
Answer: Solitary fibrous tumor (SFT)
Histology: see below
Discussion: The tumor exhibits variable cellularity and is composed of bland spindle cells that are arranged in poorly formed fascicles that are separated by variable amount of dense collagen. The tumor is well vascularized and contains numerous branching “stag horn” vessels. The mitotic activity is increased and is 5-6 per 10 HPF.
The majority (75%) of central nervous system SFT-s are intracranial. Spinal cord tumors arise mostly in the thoracic and lumbar regions. The tumors are usually not encapsulated but tend to have a well circumscribed pushing border. The histologic appearance is similar to SFTs seen at other sites. The metastatic potential of leptomeningeal solitary fibrous tumors appears to be low. Unlike solitary fibrous tumors that arise outside the CNS, the criteria for malignant SFT in the CNS are not well established. The combination of high cellularity, increased mitotic activity, nuclear atypia and necrosis are indicative of malignant potential. In this recurrent tumor the presence of hypercellular areas and mildly increased mitotic activity may be indicative of malignant potential; nevertheless, the biologic behavior of the tumor cannot be predicted with certainty.
