Intraventricular Hemangiopericytoma: A Case Report and Literature Review

A Single-Center Retrospective Analysis of Intracranial and Spinal Solitary Fibrous Tumor/Hemangiopericytoma Clinical Outcomes: Sex Association With Aggressiveness

BACKGROUND

Solitary fibrous tumor/hemangiopericytoma (SFT/HPCT) is a rare tumor characterized by high recurrence rate and metastatic potential, even after surgical resection. We report on the clinical outcomes and risk factors for metastasis and progression-free survival (PFS) of patients diagnosed with SFT/HPCT.

METHODS

We retrospectively identified patients with intracranial or spinal SFT/HPCT who underwent surgical resection and/or radiation therapy at our institution between 1995 and 2021. Baseline demographics, tumor characteristics, and outcome data were collected, and factors associated with PFS and metastasis were analyzed.

RESULTS

Thirty-four subjects (mean age, 46.4 years; 44% female) with a histopathologically proven diagnosis of SFT/HPCT were included; the median follow-up was 89.7 months. Twenty-two tumors were supratentorial (67%), 6 (18%) were infratentorial, and 5 (15%) were spinal. Eleven patients had documented occurrence of metastasis (32%). Detailed preoperative and postoperative data were available for 25 patients (74%) who received treatment at our institution after their initial diagnosis. Of those, 20 (80%) underwent gross total resection (GTR), and 12 (48%) received either adjuvant or salvage radiotherapy. Univariate analyses revealed that males had a shorter mean PFS compared with females (25 months vs. 78 months; P = 0.01), and that patients who underwent GTR had a longer mean PFS compared with those who underwent subtotal resection (54 months vs. 23 months; P = 0.02). Male sex was the sole risk factor for metastasis (odds ratio, 6.75; 95% confidence interval, 1.19-38.02).

CONCLUSIONS

Our data demonstrate a strong association between male sex and the outcomes of shorter PFS and higher risk for metastases. Further research is warranted to understand the clinical characteristics and outcomes of this rare tumor.

The Role of Adjuvant Radiation in the Management of Solitary Fibrous Tumors of the Central Nervous System: A National Cancer Database Analysis of 155 Patients

Solitary fibrous tumors (SFT) are a rare neoplasm of mesenchymal origin. There is limited evidence on the epidemiology, treatment, and outcomes of SFT in the central nervous system (CNS). The National Cancer Database (NCDB) was queried for patients diagnosed with an SFT in the CNS as their only tumor diagnosis between 2003 and 2011. The final cohort included 155 patients who received surgery and had adequate information for analysis. Descriptive statistics, logistic regression, and Kaplan-Meier survival analyses were performed. Significance was calculated using a t-test, Fisher’s exact test, chi-square, log-rank test, or Cox model. Twenty-three patients (15%) underwent both surgery and adjuvant radiation while 132 (85%) underwent surgery alone. The treatment groups had comparable demographics and tumor size; median age 53 (range 25-80) and 11 females (48%) in the surgery and adjuvant radiation group, compared to 55 (20-89) and 71 (54%) in the surgery alone group, respectively. Radiotherapy methods included conventional and stereotactic dose and fractionations schemes. Information on margin status and re-resection rates was not available. No variables were significantly associated with receipt of adjuvant radiation. In single (p = 0.78) and multivariable (p = 0.86) survival analyses, the addition of adjuvant radiation did not significantly affect overall survival. Five-year overall survival was 88% with surgery alone versus 93% with adjuvant radiation. SFTs are rare neoplasms, especially in the CNS. Our study did not demonstrate an overall survival benefit for adjuvant radiation. The role of adjuvant radiation is still unclear and warrants further investigation.

Atypical epidural hemangiopericytoma presenting with visual disturbance

Background:

Hemangiopericytomas are a rare entity commonly presenting as subdural tumors.

Case Description:

A 57-year-old man presented with a progressive visual disturbance over a period of 3 weeks. Cranial computed tomography scans revealed an isodense mass at the tip of the left middle fossa, extending into the orbital apex, and accompanying bony erosions in the sphenoid ridge. On magnetic resonance imaging, the lesion appeared isointense both on T1- and T2-weighted sequences, and intensely enhanced on contrast examinations. A frontotemporal craniotomy revealed a dura-based, capsulized tumor located entirely in the epidural space. A gross total resection was achieved for the tumor and histologically verified as hemangiopericytoma.

Conclusion:

Hemangiopericytoma should be assumed in a differential diagnosis when encountering epidural tumors, and total resection should be attempted when possible.