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McCarty J, Chung C, Samant R, Sitton C, Bonfante E, Chen PR, Raz E, Shapiro M, Riascos R, Gavito-Higuera J. Vascular Pathologic Conditions in and around the Spinal Cord. Radiographics 2024; 44:e240055. [PMID: 39207926 DOI: 10.1148/rg.240055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/04/2024]
Abstract
Diagnosing and differentiating spinal vascular pathologic conditions is challenging. Small structures, lengthy imaging examinations, and overlapping imaging features increase the difficulty. Yet, subtle findings and helpful protocols can narrow the differential diagnosis. The authors aim to help radiologists make accurate and timely diagnoses of spinal vascular pathologic conditions in and around the spinal cord by highlighting spinal vascular anatomy, imaging findings, and three broad categories of abnormalities: infarcts, anomalies, and tumors. ©RSNA, 2024.
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Affiliation(s)
- Jennifer McCarty
- From the Department of Diagnostic and Interventional Imaging, Division of Neuroradiology, UTHealth Houston, 6431 Fannin St, MSB 2.130, Houston, TX (J.M.); Department of Radiology and Neurosurgery, NYU Langone Health, New York, NY (C.C., E.R., M.S.); and Department of Diagnostic and Interventional Imaging, Division of Neuroradiology (R.S., C.S., E.B., R.R., J.G.H.) and Department of Neurosurgery (P.R.C.), UTHealth Houston, Houston, Tex
| | - Charlotte Chung
- From the Department of Diagnostic and Interventional Imaging, Division of Neuroradiology, UTHealth Houston, 6431 Fannin St, MSB 2.130, Houston, TX (J.M.); Department of Radiology and Neurosurgery, NYU Langone Health, New York, NY (C.C., E.R., M.S.); and Department of Diagnostic and Interventional Imaging, Division of Neuroradiology (R.S., C.S., E.B., R.R., J.G.H.) and Department of Neurosurgery (P.R.C.), UTHealth Houston, Houston, Tex
| | - Rohan Samant
- From the Department of Diagnostic and Interventional Imaging, Division of Neuroradiology, UTHealth Houston, 6431 Fannin St, MSB 2.130, Houston, TX (J.M.); Department of Radiology and Neurosurgery, NYU Langone Health, New York, NY (C.C., E.R., M.S.); and Department of Diagnostic and Interventional Imaging, Division of Neuroradiology (R.S., C.S., E.B., R.R., J.G.H.) and Department of Neurosurgery (P.R.C.), UTHealth Houston, Houston, Tex
| | - Clark Sitton
- From the Department of Diagnostic and Interventional Imaging, Division of Neuroradiology, UTHealth Houston, 6431 Fannin St, MSB 2.130, Houston, TX (J.M.); Department of Radiology and Neurosurgery, NYU Langone Health, New York, NY (C.C., E.R., M.S.); and Department of Diagnostic and Interventional Imaging, Division of Neuroradiology (R.S., C.S., E.B., R.R., J.G.H.) and Department of Neurosurgery (P.R.C.), UTHealth Houston, Houston, Tex
| | - Eliana Bonfante
- From the Department of Diagnostic and Interventional Imaging, Division of Neuroradiology, UTHealth Houston, 6431 Fannin St, MSB 2.130, Houston, TX (J.M.); Department of Radiology and Neurosurgery, NYU Langone Health, New York, NY (C.C., E.R., M.S.); and Department of Diagnostic and Interventional Imaging, Division of Neuroradiology (R.S., C.S., E.B., R.R., J.G.H.) and Department of Neurosurgery (P.R.C.), UTHealth Houston, Houston, Tex
| | - Peng Roc Chen
- From the Department of Diagnostic and Interventional Imaging, Division of Neuroradiology, UTHealth Houston, 6431 Fannin St, MSB 2.130, Houston, TX (J.M.); Department of Radiology and Neurosurgery, NYU Langone Health, New York, NY (C.C., E.R., M.S.); and Department of Diagnostic and Interventional Imaging, Division of Neuroradiology (R.S., C.S., E.B., R.R., J.G.H.) and Department of Neurosurgery (P.R.C.), UTHealth Houston, Houston, Tex
| | - Eytan Raz
- From the Department of Diagnostic and Interventional Imaging, Division of Neuroradiology, UTHealth Houston, 6431 Fannin St, MSB 2.130, Houston, TX (J.M.); Department of Radiology and Neurosurgery, NYU Langone Health, New York, NY (C.C., E.R., M.S.); and Department of Diagnostic and Interventional Imaging, Division of Neuroradiology (R.S., C.S., E.B., R.R., J.G.H.) and Department of Neurosurgery (P.R.C.), UTHealth Houston, Houston, Tex
| | - Maksim Shapiro
- From the Department of Diagnostic and Interventional Imaging, Division of Neuroradiology, UTHealth Houston, 6431 Fannin St, MSB 2.130, Houston, TX (J.M.); Department of Radiology and Neurosurgery, NYU Langone Health, New York, NY (C.C., E.R., M.S.); and Department of Diagnostic and Interventional Imaging, Division of Neuroradiology (R.S., C.S., E.B., R.R., J.G.H.) and Department of Neurosurgery (P.R.C.), UTHealth Houston, Houston, Tex
| | - Roy Riascos
- From the Department of Diagnostic and Interventional Imaging, Division of Neuroradiology, UTHealth Houston, 6431 Fannin St, MSB 2.130, Houston, TX (J.M.); Department of Radiology and Neurosurgery, NYU Langone Health, New York, NY (C.C., E.R., M.S.); and Department of Diagnostic and Interventional Imaging, Division of Neuroradiology (R.S., C.S., E.B., R.R., J.G.H.) and Department of Neurosurgery (P.R.C.), UTHealth Houston, Houston, Tex
| | - Jose Gavito-Higuera
- From the Department of Diagnostic and Interventional Imaging, Division of Neuroradiology, UTHealth Houston, 6431 Fannin St, MSB 2.130, Houston, TX (J.M.); Department of Radiology and Neurosurgery, NYU Langone Health, New York, NY (C.C., E.R., M.S.); and Department of Diagnostic and Interventional Imaging, Division of Neuroradiology (R.S., C.S., E.B., R.R., J.G.H.) and Department of Neurosurgery (P.R.C.), UTHealth Houston, Houston, Tex
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Okubo T, Nagoshi N, Tsuji O, Tachibana A, Kono H, Suzuki S, Okada E, Fujita N, Yagi M, Matsumoto M, Nakamura M, Watanabe K. Imaging Characteristics and Surgical Outcomes in Patients With Intraspinal Solitary Fibrous Tumor/Hemangiopericytoma: A Retrospective Cohort Study. Global Spine J 2023; 13:276-283. [PMID: 33691508 PMCID: PMC9972268 DOI: 10.1177/2192568221994799] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
STUDY DESIGN Retrospective cohort study. OBJECTIVES Intraspinal solitary fibrous tumor (SFT)/hemangiopericytoma (HPC) is often misdiagnosed preoperatively as schwannoma or meningioma because its imaging characteristics are not well understood. As postoperative prognosis differs among the 3 lesions, predicting the probability of SFT/HPC preoperatively is essential. Thus, this study investigates the imaging characteristics of SFT/HPC compared with those of schwannoma or meningioma and evaluates surgical outcomes. METHODS The preoperative imaging findings, tumor resection extent, recurrence and regrowth rates, and neurological improvement were compared between 10 patients with SFT/HPC and 42 patients with schwannoma or 40 patients with meningioma. RESULTS Most patients with SFT/HPC showed isointensity on both T1- and T2-weighted images compared with patients with schwannoma (P = 0.011 and 0.029, respectively) and no significant difference compared with patients with meningioma (P = 0.575 and 0.845, respectively). Almost all patients with SFT/HPC showed highly uniformizing enhancement patterns, similar to those with meningioma (P = 0.496). Compared with meningioma, SFT/HPC lacked the dural tail sign and intratumoral calcification and exhibited irregular shape. Of the 5 patients who underwent partial resection, 60% exhibited tumor recurrence and regrowth following surgery. CONCLUSIONS Complete en bloc surgical resection should be attempted in patients with intraspinal SFT/HPC to prevent postoperative recurrence or regrowth. As this tumor is often preoperatively misdiagnosed, we recommend that the imaging findings exhibited in this study should be used to positively suspect SFT/HPC. This will enhance patient outcomes by enabling more appropriate preoperative surgical planning.
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Affiliation(s)
- Toshiki Okubo
- Department of Orthopaedic Surgery, Keio
University School of Medicine, Tokyo, Japan
| | - Narihito Nagoshi
- Department of Orthopaedic Surgery, Keio
University School of Medicine, Tokyo, Japan,Narihito Nagoshi, MD, PhD, Department of
Orthopaedic Surgery, Keio University School of Medicine, 35 Shinanomachi,
Shinjuku-ku, Tokyo 160-8582, Japan.
| | - Osahiko Tsuji
- Department of Orthopaedic Surgery, Keio
University School of Medicine, Tokyo, Japan
| | - Atsuko Tachibana
- Department of Orthopaedic Surgery, Keiyu
Orthopaedic Hospital, Gunma, Japan
| | - Hitoshi Kono
- Department of Orthopaedic Surgery, Keiyu
Orthopaedic Hospital, Gunma, Japan
| | - Satoshi Suzuki
- Department of Orthopaedic Surgery, Keio
University School of Medicine, Tokyo, Japan
| | - Eijiro Okada
- Department of Orthopaedic Surgery, Keio
University School of Medicine, Tokyo, Japan
| | - Nobuyuki Fujita
- Department of Orthopaedic Surgery,
Fujita Health University, Aichi, Japan
| | - Mitsuru Yagi
- Department of Orthopaedic Surgery, Keio
University School of Medicine, Tokyo, Japan
| | - Morio Matsumoto
- Department of Orthopaedic Surgery, Keio
University School of Medicine, Tokyo, Japan
| | - Masaya Nakamura
- Department of Orthopaedic Surgery, Keio
University School of Medicine, Tokyo, Japan
| | - Kota Watanabe
- Department of Orthopaedic Surgery, Keio
University School of Medicine, Tokyo, Japan
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Recurrent Solitary Fibrous Tumor in Intradural Extramedullary Space: Case Report and Review of the Literature. Case Rep Oncol Med 2021; 2021:4559749. [PMID: 34845431 PMCID: PMC8627340 DOI: 10.1155/2021/4559749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 10/28/2021] [Indexed: 11/17/2022] Open
Abstract
Solitary fibrous tumor/hemangiopericytoma (SFT/HPC) is a rare neoplasm arising from spindle cells and most commonly arising from pleura. Spinal SFT/HPC is a rare entity; hence, it is not on the top of the differential diagnosis list when a clinician faces a spinal lesion. In the review of the literature, there exist less than 50 case reports of intradural extramedullary SFT/HPC. Here, we present a 54-year-old female patient who underwent subtotal surgical excision of an intradural extramedullary spinal mass pathologically reported to be SFT/HPC and had symptomatic recurrence in the 3rd year of follow-up. Surgical intervention was unachievable and the patient was given 45 Gy to the surgical cavity followed by a 5.4 Gy boost to visible tumor with external radiotherapy. Patient reported significant relief of her symptoms. We aim to contribute to the formation of a treatment algorithm for this rare entity.
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4
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Wang L, Yu J, Shu D, Huang B, Wang Y, Zhang L. Primary endodermal hemangiopericytoma/solitary fibrous tumor of the cervical spine: a case report and literature review. BMC Surg 2021; 21:405. [PMID: 34837986 PMCID: PMC8626743 DOI: 10.1186/s12893-021-01399-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Accepted: 11/07/2021] [Indexed: 12/18/2022] Open
Abstract
Background Hemangiopericytoma (HPC), also known as solitary fibrous tumor (SFT), is a type of soft tissue sarcoma with a special aggressive behavior. The HPC/SFT is locally aggressive with possibility of late recurrence locally or distant extraneural metastasis. The most common location of this HPC/SFT is the lower extremities. The HPC/SFT in the central nervous system (CNS) is very rare, and compared with the brain, it is rarer in the spinal region. However, clinicians also lack an overall understanding of the diagnosis of HPC/SFT in the spinal cord. Case presentation In this study, we report a rare case of primary cervical spine HPC/SFT in a 53-year-old woman. Two to three weeks before admission, she experienced pain and numbness in her left upper extremity. After computerized tomography (CT) and magnetic resonance imaging (MRI), a gross total resection was performed. Obvious neurological improvement was observed postoperatively. The pain and numbness in the patient's left upper limb were relieved subsequently. We then reviewed the literature on HPC/SFT, such as its clinical presentation, imaging characteristics, treatment, and follow-up. Conclusions Diagnosis of HPC/SFT relies on magnetic resonance spectroscopy, enhanced CT, and MRI. Postoperative radiotherapy is strongly recommended to reduce the HPC/SFT recurrence. Immunohistochemical analysis can also help in the differential diagnosis. However; early and long-term follow-up is necessary for patients.
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Affiliation(s)
- Liyun Wang
- Department of Neurosurgery, Shengzhou People's Hospital (the First Affiliated Hospital of Zhejiang University Shengzhou Branch), Shengzhou, China
| | - Jianbo Yu
- Department of Neurosurgery, First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Dongping Shu
- Department of Neurosurgery, Shengzhou People's Hospital (the First Affiliated Hospital of Zhejiang University Shengzhou Branch), Shengzhou, China
| | - Bin Huang
- Department of Neurosurgery, Xinchang Hospital of Traditional Chinese Medicine, Shaoxing, China
| | - Yumin Wang
- Department of Otolaryngology Head and Neck Surgery, Xiangya Hospital, Central South University, Changsha, China.
| | - Luyuan Zhang
- Department of Neurosurgery, First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China.
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Olmsted ZT, Tabor J, Doron O, Hosseini H, Schneider D, Green R, Wahl SJ, Sciubba DM, D'Amico RS. Intradural Extramedullary Solitary Fibrous Tumor of the Thoracic Spinal Cord. Cureus 2021; 13:e18613. [PMID: 34765368 PMCID: PMC8572645 DOI: 10.7759/cureus.18613] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/08/2021] [Indexed: 01/04/2023] Open
Abstract
Solitary fibrous tumors (SFTs) are rare soft tissue neoplasms that can impact the central nervous system (CNS). SFTs comprise <1% of all primary CNS tumors. Here, we describe a rare case of intradural, extramedullary SFT arising within the thoracic spine that was treated with surgical resection. Histological features were evaluated and revealed a highly cellular tumor with positive expression of BCL2, CD34, CD99, and STAT6 proteins that are consistent with a diagnosis of SFT. We discuss the use of surgical intervention for long-term disease control of spinal SFT and evaluate the role of postoperative radiation therapy in management strategies. Lastly, we review the literature reports of intradural, extramedullary SFTs in the thoracic spine. The importance of molecular characterization by histopathology to properly determine diagnosis and prognosis is emphasized.
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Affiliation(s)
| | - Joanna Tabor
- Neurological Surgery, Northwell Health, New York, USA
| | - Omer Doron
- Neurological Surgery, Northwell Health, New York, USA
| | - Hossein Hosseini
- Pathology and Laboratory Medicine, Northwell Health, New York, USA
| | | | - Ross Green
- Neurological Surgery, Lenox Hill Hospital, New York, USA
| | - Samuel J Wahl
- Pathology and Laboratory Medicine, Northwell Health, New York, USA
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Yamada CAF, Narvaez EDO, Yamaki VN, Pfann RZ, Neville IS, Amaral LLFD. Cervical solitary fibrous tumor: case report and literature review. BJR Case Rep 2021; 7:20210058. [PMID: 35300229 PMCID: PMC8906161 DOI: 10.1259/bjrcr.20210058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 06/29/2021] [Accepted: 07/02/2021] [Indexed: 11/17/2022] Open
Abstract
Solitary fibrous tumors (SFTs) are rare neoplasms in the spinal canal. There are few studies addressing SFT/hemangiopericytomas with no distinctive clinical characteristics, no conclusive radiological findings or even a well-defined best treatment strategy. We described a rare case of cervical SFT/hemangiopericytomas in a young patient with spinal cord compression. There are many differential diagnoses for spinal dural-based masses of which meningiomas are the most common. Surgeons and oncologists should be aware of differentials of dural-based masses in the spinal cord for surgical decision making and to guide treatment.
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Affiliation(s)
- Camilla Akemi Felizardo Yamada
- Departament of Oncology, Hospital BP, São Paulo, Brazil
- Latin American Cooperative Oncology Group - LACOG, Sao Paulo, Brazil
| | | | - Vitor Nagai Yamaki
- Department of Neurosurgery, Universidade de São Paulo, São Paulo, Brazil
| | | | - Iuri Santana Neville
- Department of Neurosurgery, Universidade de São Paulo, São Paulo, Brazil
- Instituto do Cancer do Estado de São Paulo – Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
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7
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Singla R, Singh PK, Khanna G, Suri V, Agarwal D, Chandra PS, Kale SS, Mahapatra AK. An institutional review of 10 cases of spinal hemangiopericytoma/solitary fibrous tumor. Neurol India 2021; 68:448-453. [PMID: 32415022 DOI: 10.4103/0028-3886.284374] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background Spinal hemangiopericytoma is very rare tumors with only a few case reports and one case series. We have treated ten patients between 2004 and 2017 and, thus, present a retrospective review of our patients with a focus on clinical presentation, radiological features, management, pathology, and outcome. Materials and Methods Histopathological data were reviewed in all the cases and clinical and follow-up details were collected from data available in our department. Results There were five males and five females, including one pediatric patient. The mean age of the patients was 34.7 years (Range 12-52 years). Dorsal, cervical, and lumbar spine involvement were found in five, four, and one patient, respectively. Intradural extramedullary tumor was the most common tumor and all patients presented motor weaknesses. Gross total resection of the tumor was done in seven patients and six patients received postoperative radiotherapy. Histopathology showed anaplastic tumor in two cases with high MIB-1 labelling index. Most patients were positive for CD34, vimentin, mic-2, and bcl-2. While the seven patients who underwent gross total resection improved significantly and were self-ambulatory in the follow-up period, two patients who underwent subtotal resection expired due to tumor metastasis. Conclusion Spinal hemangiopericytoma is a very rare tumor. We present a series of cases treated at our institute for the same. Gross total resection is the goal and radiotherapy should be given in case of residual tumor or high-grade tumors. Prognosis is good after gross total excision and functional recovery can be expected in most patients.
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Affiliation(s)
- Raghav Singla
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | - Pankaj K Singh
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | - Gaurav Khanna
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
| | - Vaishali Suri
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
| | - Deepak Agarwal
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | - P S Chandra
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | - S S Kale
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | - A K Mahapatra
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
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8
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Chunyang L, Huiqin Z, Mo S, Yubo W, Xianfeng Z. Case Report: A Review of the Literature on Spinal Intradural Hemangiopericytoma With Spinal Cord Infiltration and a Case Report. Front Surg 2020; 7:600563. [PMID: 33392244 PMCID: PMC7772210 DOI: 10.3389/fsurg.2020.600563] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Accepted: 11/25/2020] [Indexed: 11/13/2022] Open
Abstract
Purpose: Primary spinal intradural hemangiopericytoma (HPC) with spinal cord infiltration is rare. The purposes of this study were to investigate the clinical features of intradural HPC with spinal cord infiltration and to explore the related factors affecting tumor recurrence. Methods: We report a case of intramedullary HPC with intramedullary infiltration of the thoracic spine. The relevant literature was searched for with PubMed, and clinical data were extracted from the included studies. Clinical patient data were described and statistically analyzed. Then, Kaplan-Meier (KM) curves were used to describe the relapse-free survival (RFS) of patients in different groups, and the log-rank test was used for evaluation. Results: A total of 11 cases of spinal intradural HPC with spinal cord infiltration were included (including the case described in this report). Further data analysis showed that sex (P = 0.249), age (P = 0.876), tumor location (P = 0.524), and postoperative radiotherapy (P = 0.12) had no significant influence on RFS. The range of tumor resection (P = 0.004) and the WHO grade (P = 0.014) significantly affect the patient RFS. Conclusion: RFS was higher in patients with total tumor resection than in patients with subtotal tumor resection. The patients with lower WHO grade have better RFS. Total tumor resection is the primary objective of surgical treatment of spinal intradural HPC with spinal infiltration. Long-term postoperative follow-up is considered necessary.
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Affiliation(s)
- Liu Chunyang
- Department of Neurosurgery, First Hospital of Jilin University, Jilin, China
| | - Zhu Huiqin
- Department of Respiratory Medicine, First Hospital of Jilin University, Jilin, China
| | - Sun Mo
- Department of Pathology, First Hospital of Jilin University, Jilin, China
| | - Wang Yubo
- Department of Neurosurgery, First Hospital of Jilin University, Jilin, China
| | - Zhang Xianfeng
- Department of Neurosurgery, First Hospital of Jilin University, Jilin, China
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Primary intra and extradural solitary fibrous tumor/hemangiopericytoma of thoracic spine with paravertebral intrathoracic spread: Case report and review of the literature. INTERDISCIPLINARY NEUROSURGERY 2020. [DOI: 10.1016/j.inat.2020.100746] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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10
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Giordan E, Marton E, Wennberg AM, Guerriero A, Canova G. A review of solitary fibrous tumor/hemangiopericytoma tumor and a comparison of risk factors for recurrence, metastases, and death among patients with spinal and intracranial tumors. Neurosurg Rev 2020; 44:1299-1312. [PMID: 32556679 DOI: 10.1007/s10143-020-01335-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 06/03/2020] [Accepted: 06/08/2020] [Indexed: 12/21/2022]
Abstract
Meningeal solitary fibrous tumors (SFTs) and hemangiopericytomas (HPCs) had been combined into a single classification until 2016. Recurrence and metastases rates are still understudied, especially for spinal SFT/HPCs. Here, we describe CNS SFT/HPCs and predictors for recurrence, metastases, and death, in spinal and intracranial SFT/HPCs, separately. We collected data from studies with patient-level data available on primary SFT/HPCs from multiple online databases. Clinico-demographic data, surgical outcomes, recurrence, metastases, and death rates were abstracted. We used logistic and Cox regression models to identify predictors for recurrence, metastases, and death for spinal and intracranial SFT/HPCs. Twenty-nine studies (368 patients) were included. Higher histological grade and subtotal resection were associated with recurrence (p values < 0.05), while higher histological grade and recurrence (p values < 0.005) were associated with metastases formation. Time to recurrence (p < 0.005) and metastases (p < 0.001) formation were shorter for spinal SFT/HPCs. Death rates were higher among intracranial SFT/HPC patients (p value = 0.001). Among patients with higher histological grade, rates of metastases formation were different between intracranial and spinal SFT/HPCs. Risk of metastases was higher in the first 5 years from surgery for both intracranial and spinal SFT/HPCs. Meningeal SFT/HPCs patients have high rates of recurrence and metastasis, which occur mostly within the first 5 years after diagnosis. Spinal and intracranial SFT/HPCs show similar behavior, but spinal SFT/HPCs tend to develop metastases and recurrences in a shorter interval of time. Careful follow-up for spinal SFT/HPCs should be considered because spinal cases seem to be slightly more aggressive and require more attention.
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Affiliation(s)
- Enrico Giordan
- Department of Neurosurgery, Aulss 2 Marca Trevigiana, Via Piazzale 1, Treviso, Italy.
| | | | - Alexandra M Wennberg
- Department of Neuroscience, University of Padova and Padova Neuroscience Center, Padova, Italy
| | - Angela Guerriero
- Department of Pathology, Aulss 2 Marca Trevigiana, Treviso, Italy
| | - Giuseppe Canova
- Department of Neurosurgery, Aulss 2 Marca Trevigiana, Via Piazzale 1, Treviso, Italy
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How to differentiate spinal cord hemangiopericytoma from common spinal cord tumor? Neurochirurgie 2020; 66:53-55. [PMID: 31953073 DOI: 10.1016/j.neuchi.2019.10.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Revised: 09/25/2019] [Accepted: 10/13/2019] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Tumors of the spinal cord are rare and some can be confused with each other. We report a rare spinal cord solitary fibrous tumor/hemangiopericytoma (SFT/HPC), and propose keys to differentiate spinal cord tumors from each other. CASE REPORT A 67-year-old man presented weakness with recent diffuse sensory disorders in the right lower limb. Spinal MRI revealed a T8-T9 intradural extramedullary mass with spinal cord compression. Gross total resection of a poorly vascularized intradural tumor was achieved. It was an encapsulated extramedullary tumor, which was difficult to separate from the spinal cord due to the presence of pial adhesions. Definitive diagnosis was grade 1 SFT/HPC of the spinal cord. One-year follow-up MRI revealed complete excision without any evidence of residual tumor. CONCLUSION SFT/HPC is a very rare spinal tumor that can be extramedullary, intramedullary or both. It may perfectly mimic meningioma. The maximal resection is the best treatment, but can be challenging because of the tumor's firm consistency and pial adherences to the spinal cord. Outcome is good in case of gross total resection, but there is a risk of very late recurrence, requiring long-term follow-up.
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12
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Abstract
The management of patients harboring central nervous system (CNS) hemangiopericytomas (HPCs) is a partially answered challenge. These are rare locally aggressive lesions, with potential for local recurrence, distal neural metastasis (DNM), and extraneural metastasis (ENM). Resection, when feasible, remains the initial treatment option, providing histological diagnosis and immediate relief of tumor-related mass effect. Patients receiving surgery alone or surgery and external beam radiotherapy (EBRT) show improved overall survival (OS) and progression-free survival as compared to those undergoing a biopsy alone (p = 0.01 and p = 0.02, respectively). Yet, in many instances, patient and tumor-related parameters preclude complete resection. EBRT or stereotactic radiosurgery (SRS) shares a significant role in achieving local tumor control, not shown to impact OS in HPC patients. The benefits of SRS/EBRT are clearly limited to improved local tumor volume control and neurologic function, not affecting DNM or ENM development. SRS provides acceptable rates of local tumor volume control coupled with treatment safety and a patient-friendly apparatus and procedure. Single-session SRS is most effective for lesions measuring <2 cm in their largest diameter (10 cm3 volume), with prescription doses of at >15 Gy. Systemic HPC disease is managed with various chemotherapeutic, immunotherapeutic, and anti-angiographic agents, with limited success. We present a short discussion on CNS HPCs, focusing our discussion on available evidence regarding the role of microsurgical resection, EBRT, SRS, chemotherapy, and immunotherapy for upfront, part of adoptive hybrid surgery approach or for recurrent HPCs.
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A DSTYK mutation activates ERK1/2 signaling to promote intraspinal dissemination in a case of solitary fibrous tumor/hemangiopericytoma. J Transl Med 2019; 99:1501-1514. [PMID: 31201369 DOI: 10.1038/s41374-019-0274-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2019] [Revised: 04/20/2019] [Accepted: 04/23/2019] [Indexed: 12/18/2022] Open
Abstract
Intracranial solitary fibrous tumors/hemangiopericytomas (SFT/HPCs) are vascular tumors that have a high rate of local recurrence and extracranial metastases. Intradural extramedullary spinal dissemination of intracranial SFT/HPC is extremely rare. There is a paucity of data available to elucidate the molecular mechanisms of intraspinal dissemination of intracranial SFT/HPC. Herein, we presented a case of intracranial SFT/HPC with intraspinal metastasis. The resected tumor specimens were enrolled in a clinical sequencing program, including whole-exome and transcriptome sequencing. By comparing genomic sequencing data of the intracranial tumors with intraspinal metastasis, we established the somatic mutational profiles of these tumors. Clonality analysis revealed a distinct subclonal structure in the intracranial tumor and its intraspinal metastasis, which might reflect the possibility of intratumoral clonal selection and evolution during the process of tumor dissemination. Through bioinformatics analysis and Sanger sequencing validation, a DSTYK mutation (Met296Ile) was identified as a candidate driver of intraspinal metastasis in this SFT/HPC case. Further, an intracranial tumor-derived SFT/HPC cell line, HPC3, was established to explore the mechanisms of the DSTYK mutation in promoting SFT/HPC metastasis. Based on the HPC3 cell model, we found that the DSTYK mutation promoted cell migration and invasion of HPC3 cells via activation of ERK1/2 signaling, which was inhibited by the MEK/ERK inhibitor AZD6244. The DSTYK mutation was also shown to upregulate the expression of two metastasis-related molecules: MMP2 and MMP9 in HPC3 cells; however, this effect was attenuated by AZD6244 treatment. Therefore, the DSTYK mutation may activate ERK1/2/MMP2/9 signaling to promote tumor cell metastasis in SFT/HPC. In conclusion, our study revealed the potential role of DSTYK mutation in the regulation of intraspinal metastasis of SFT/HPC, which might provide new biological insights into this rare disease.
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Primary epidural hemangiopericytoma of the thoracic spine: Case report and literature review. J Clin Neurosci 2018; 60:142-147. [PMID: 30352760 DOI: 10.1016/j.jocn.2018.10.057] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Accepted: 10/06/2018] [Indexed: 01/23/2023]
Abstract
Hemangiopericytoma (HPC) is a rare tumor originating from pericapillary cells. Rarely found in the central nervous system, it is extremely rare in the spinal canal. Because of the low incidence of this tumor, its radiographic features and clinical manifestations have not been extensively studied and reported, therefore, it is often misdiagnosed as a schwannoma or spinal meningioma. We describe an unexpected HPC in a 35-year-old woman who was admitted to the Peking Union Medical College Hospital with a severe backache, sensory abnormalities, and muscle weakness. Magnetic resonance imaging showed an enhancing lesion at T6-7 with severe compression of the spinal cord. Gross total resection was achieved, and subsequently, a marked neurologic improvement was observed. The diagnosis of primary extradural HPC in our patient was confirmed based on postoperative histopathology and immunohistochemistry. Neither recurrence nor metastasis of the tumor was found during the 14-month follow-up, which did not include radiotherapy. To describe the demography, radiologic features, treatment, and prognosis of spinal HPC, a comprehensive literature review was performed and 105 cases of primary spinal HPC from 1958 to 2017 were collected from 39 articles. Although rare, HPC should be considered in the differential diagnosis of intraspinal lesions. Immunohistologic examination is of decisive importance in making the diagnosis. Adequate surgical resection, when feasible, is the first choice of treatment for all cases of HPC; however, the outcomes of radiotherapy and chemotherapy have yet to be determined. Individualized treatment combined with long-term follow-up for each patient is recommended.
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Mashaly H, Zhang Z, Shaw A, Youssef P, Mendel E. Intraoperative Transpedicular Onyx Injection to Reduce Vascularity of a Thoracic Hemangiopericytoma After Unsuccessful Preoperative Endovascular Embolization: a Technical Report. Oper Neurosurg (Hagerstown) 2018; 14:E17-E22. [PMID: 29351687 DOI: 10.1093/ons/opx102] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2016] [Accepted: 04/05/2017] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND AND IMPORTANCE Hemangiopericytoma is a rare vascular tumor with central nervous system involvement representing only 1% of central nervous system tumors. They rarely affect the vertebral column. Complete surgical resection is the treatment of choice for hemangiopericytoma given their high rates of local recurrence. However, the high vascularity of such tumors with the risk of massive bleeding during surgery represents a significant challenge to surgeons. Therefore, preoperative endovascular embolization via the transarterial route has been advocated. CLINICAL PRESENTATION In the current study, we present a case of a T12 hemangiopericytoma that was managed by a 2-stage surgical resection, with the use of intraoperative transpedicular onyx injection to reduce intraoperative blood loss following an unsuccessful trial of preoperative endovascular embolization. CONCLUSION Preoperative endovascular embolization is not feasible in some cases due to the location of the segmental or radiculomedullary arteries in relation to tumor feeders and, rarely, small size of these arterial feeders. Percutaneous injection of onyx is an option. In this case report, we discuss direct intraoperative injection via a transpedicular route as a safe and effective method for decreasing the vascularity of some lesions and improving intraoperative blood loss.
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Affiliation(s)
- Hazem Mashaly
- Department of Neurological Surgery, The Ohio State University, Wexner Medical Center Columbus, Ohio.,Department of Neurological Surgery, Ain Shams University, Cairo, Egypt
| | - Zoe Zhang
- Department of Neurological Surgery, The Ohio State University, Wexner Medical Center Columbus, Ohio
| | - Andrew Shaw
- Department of Neurological Surgery, The Ohio State University, Wexner Medical Center Columbus, Ohio
| | - Patrick Youssef
- Department of Neurological Surgery, The Ohio State University, Wexner Medical Center Columbus, Ohio
| | - Ehud Mendel
- Department of Neurological Surgery, The Ohio State University, Wexner Medical Center Columbus, Ohio
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Surgical management of spinal solitary fibrous tumor/hemangiopericytoma: a case series of 20 patients. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2017; 27:891-901. [DOI: 10.1007/s00586-017-5376-0] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/15/2017] [Revised: 10/29/2017] [Accepted: 10/31/2017] [Indexed: 12/20/2022]
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Chew LS, Han XJ, Tan KK, Bundele MM. Hemangiopericytoma of the thoracic spine: a case report. J Surg Case Rep 2017; 2017:rjx121. [PMID: 28690777 PMCID: PMC5495936 DOI: 10.1093/jscr/rjx121] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2017] [Accepted: 06/10/2017] [Indexed: 11/20/2022] Open
Abstract
Hemangiopericytoma (HPC) has been described to be aggressive and potentially a malignant tumour. We report a rare case of a 63-year-old Chinese male who presented with primary intradural extramedullary HPC of the thoracic spine. The main presenting complaint was gradual progression of back pain, associated with paraparesis and sensory deficit of lower limbs. He had MRI thoracolumbar with contrast which showed T9 lesion compressing on spinal cord and oedema, he was then operated upon and histopathology report confirmed a thoracic spine HPC. A T8/9 laminectomy and excision of intradural extramedullary lesion was performed, tumour section was sent for frozen section study, and more tissue was sent for paraffin studies and additional immunohistochemical staining. Surgical resection is most commonly performed, radiotherapy remains debatable. In this report, we discussed another rare case of primary spinal HPC to be added into the literature.
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Affiliation(s)
- Luen Shaun Chew
- Department of Neurosurgery, National Neuroscience Institute Singapore, Singapore 308433, Singapore
| | - Xinguang Julian Han
- Department of Neurosurgery, National Neuroscience Institute Singapore, Singapore 308433, Singapore
| | - Kheng Kooi Tan
- Department of Neurosurgery, National Neuroscience Institute Singapore, Singapore 308433, Singapore
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Rapid Neurological Recovery Following Partial Surgical Resection of Spinal Glioblastoma Multiforme in a Pediatric Patient Presenting With Complete Paraplegia. J Pediatr Hematol Oncol 2016; 38:e286-e290. [PMID: 27403775 DOI: 10.1097/mph.0000000000000637] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Pediatric spinal cord glioblastoma multiforme is a rare entity with a poor prognosis often presenting with lower extremity weakness or paralysis. Previous literature suggests that aggressive surgical resection may provide overall survival benefit; however, there is limited concurrent analysis demonstrating neurological recovery following surgical resection. We report the case of a 9-year-old boy who presented with complete paraplegia and regained the ability to ambulate independently following subtotal surgical resection, radiation, and chemotherapy. The case demonstrates the balance between meaningful neurological recovery and overall survival when deciding on the extent of resection in cases of pediatric spinal glioblastoma multiforme.
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