Primary meningeal fibrosarcoma: a particular neuroradiological presentation

Clinical Characteristics and Surgical Features of Intracranial Fibrosarcoma

BACKGROUND

Intracranial fibrosarcoma is an extremely rare neoplasm in the central nervous system. Insofar there were only sporadic case reports describing its features. The purpose of this study is to review the clinical and surgical features of cases who were treated in our department.

METHOD

The authors retrospectively reviewed and detailed the clinical and surgical data obtained from 5 patients with fibrosarcoma who underwent treatment at our institute between January 2009 and January 2019.

RESULTS

There were 3 males and 2 females including 2 juvenile and 3 senior patients. The most frequent sign was intermittent pain and vomiting. The location of the tumor included middle fossa, thalamus and midbrain, sellar and suprasellar region and right parietal-occipital lobe. Surgical observation demonstrated the consistency of the tumor was tenacious with abundant blood supply. Gross total resection was achieved in 2 cases. Pathological analysis showed spindle cells in a herringbone form with positive Vimentin staining in all 5 cases, with the absence of GFAP or S-100. All 5 patients were deceased eventually after a varied period of time after the first surgery.

CONCLUSION

Intracranial fibrosarcoma was a highly malignant entity presented in the central nervous system. Surgery still remains the first-line treatment followed by radiotherapy, however, the prognostic outcome was very poor. Future studies should be more focused on accumulation of the relevant information on this disease thus hopefully in assisting to developing more optimized treatment.

The clinicoradiological features and surgical outcomes of primary intracranial fibrosarcoma: a single-institute experience with a systematic review

Primary intracranial fibrosarcoma (PIF) was a rare tumor with a high relapse rate and dismal survival rate. This study aimed to delineate the clinical characteristics of primary intracranial fibrosarcoma (PIF) and the risk factors for outcomes. We reviewed 15 PIF patients, who underwent surgical treatment at our institution from January 2009 to December 2018. Meanwhile, 36 cases from the prior literature between November 1962 and December 2019 were also retrieved and pooled to identify the risk factors. In our cohort, while cystic component (46.7%), perilesional edema (83.3%), and vascular flow void (66.7%) were commonly observed, no patient was accurately diagnosed. The 2-year relapse-free survival (RFS) and overall survival (OS) were 12.2% and 30.2%, respectively. Based on the pooled data, tumor size (p = 0.006), Ki-67 index (p = 0.004), and radiotherapy dose (p = 0.029) were prognostic factors for RFS in univariate analysis. In the univariate analysis, tumor size (p = 0.002), NGTR (p = 0.049), and high Ki-67 index (p = 0.019) were significant predictors for OS; and further multivariate analysis (n = 18) showed that large tumor size (≥ 5 cm; HR 14.613, p = 0.022) and high Ki-67 index (≥ 30%; HR 5.879, p = 0.020) were the independent risk factors for OS. Due to the rarity and nonspecific clinicoradiological features, the correct diagnosis of PIF before surgery was challenging. The outcomes of PIF were poor, and GTR plus radiotherapy (at least 60 Gy) might benefit to the outcomes and were recommended. Future study with a large cohort was needed to verify our findings.

En Plaque Meningiomas: A Narrative Review

Background  En plaque meningiomas are a rare subtype of meningiomas that are frequently encountered in the spheno-orbital region. Characterized by a hyperostotic and dural invasive architecture, these tumors present unique diagnostic and treatment considerations. Objective  The authors conduct a narrative literature review of clinical reports of en plaque meningiomas to summarize the epidemiology, clinical presentation, diagnostic criteria, and treatment considerations in treating en plaque meningiomas. Additionally, the authors present a case from their own experience to illustrate its complexity and unique features. Methods  A literature search was conducted using the MEDLINE database using the following terminology in various combinations: meningioma , meningeal neoplasms, en plaque , skull base , spheno-orbital, and sphenoid wing . Only literature published in English between 1938 and 2018 was reviewed. All case series were specifically reviewed for sufficient data on treatment outcomes, and all literature was analyzed for reports of misdiagnosed cases. Conclusion  En plaque meningiomas may present with a variety of symptoms according to their location and degree of bone invasion, requiring a careful diagnostic and treatment approach. While early and aggressive surgical resection is generally accepted as the optimal goal of treatment, these lesions require an individualized approach, with further investigation needed regarding the role of new therapies.

Primary Intracranial Fibrosarcoma: Case Report and Systematic Review of Literature

Primary intracranial fibrosarcoma (PIF) is an exceedingly rare tumor. Only about 50 cases have been reported in the literature. Here, we present a case of a 20-year-old male who presented with a sudden-onset headache. Magnetic resonance imaging of the brain showed a hemorrhagic extra-axial space-occupying mass. The mass was surgically resected, and biopsy was consistent with PIF. The patient was lost to follow-up and presented with recurrence 3 months later. He expired from complications of the tumor. PIF is a diagnosis of exclusion: More common intracranial tumors should first be excluded. Biopsy is necessary to diagnose PIF.

Intracranial fibrosarcoma treated with adjuvant radiation and temozolomide: Report of a case and review of all published cases

INTRODUCTION

Fibrosarcoma is a rare brain tumour with 33 cases reported so far. However, there is no clear consensus about the nature of the disease and treatment as well as outcome.

METHODS

A MEDLINE search was carried out using MESH terms like intracranial fibrosarcoma, intraspinal fibrosarcoma, fibrosarcoma meninges and fibrosarcoma brain. A total of 22 case reports and series reporting a total of 33 cases were identified. We here also report a case treated in our institute with adjuvant radiation and concurrent and maintenance temozolomide.

RESULTS

The age of presentation ranged from 2months to 75years (Median=17years). The gender ratio was found to be M:F of 1.75-1. Treatment modalities were described for 17 cases. Surgery was part of treatment in all cases while radiation was a part of treatment in 59% of cases (n=10) and chemotherapy in 29% cases (n=5). Survival data were available only for 8 cases and ranged from 1day to 8years (Median=15.5months).

CONCLUSION

Fibrosarcoma is a rare disease with dismal prognosis. Surgery remains the cornerstone of therapy. Radiation confers long term disease control and survival. Chemotherapy needs to be evaluated for these tumours to improve survival.

Primary intracranial fibrosarcoma presenting with hemorrhage

Primary intracranial fibrosarcomas (PIFs) are extremely rare and the origin of these tumors is still controversial. The rarity of primary intracranial fibrosarcomas makes it difficult to diagnose them correctly and establish a standard treatment. The pathologic diagnosis is made by distinguishing findings from light microscopic and immunohistochemistry analysis. PIFs have been known to be very aggressive neoplasms. The extra-axial location of the tumor could provide an opportunity to perform a total resection even if it does not mean a cure. We present a case of PIFs mimicking a falx meningioma in a 17-year-old man.

Convexity en plaque meningioma manifesting as subcutaneous mass: case report

A 67-year-old woman sensed a slowly growing, painless hard mass in the left parietal region. Cranial computed tomography showed focal bony erosion and homogeneous sclerotic change at the affected site. Magnetic resonance (MR) imaging revealed an enhanced subcutaneous mass and irregularly thickened dura mater. Intraoperatively, the subcutaneous tumor was found to be strongly adhered to the temporalis muscle. The outer table was eroded adjacent to the subcutaneous tumor, whereas the bony structures of the inner table were intact. The dura mater underneath had irregular-shaped, yellowish convolutions both on the outer and inner surfaces. The patient underwent total tumor resection with sufficient normal margins. The histological diagnosis was World Health Organization (WHO) grade I meningioma, with finger-like outward extensions through the dura mater and overlying skull, and infiltration among into the temporalis muscle fibers. Meningiomas may form a subcutaneous mass without intracranial growth.

Solitary fibrous tumor of the central nervous system: a 15-year literature survey of 220 cases (August 1996-July 2011)

We reviewed the world literature on solitary fibrous tumors of the central nervous system from August 1996 to July 2011, focusing on both clinicopathological features and diagnostic findings. The anatomical distribution of the 220 cases reported so far reveals that most are intracranial and just over one-fifth are intraspinal. In decreasing frequency, intracranial tumors involve the supratentorial and infratentorial compartments, the pontocerebellar angle, the sellar and parasellar regions, and the cranial nerves. Intraspinal tumors are mainly located in the thoracic and cervical segments. Although most solitary fibrous tumors of the central nervous system are dural based, a small subset presents as subpial, intraparenchymal, intraventricular, or as tumors involving the nerve rootlets with no dural connection. Preoperative imaging and intraoperative findings suggest meningioma, schwannoma or neurofibroma, hemangiopericytoma, or pituitary tumors. Immunohistochemistry is critical to establish a definitive histopathological diagnosis. Vimentin, CD34, BCL2, and CD99 are the most consistently positive markers. The usual histologic type generally behaves in a benign manner if complete removal is achieved. Recurrence is anticipated when resection is subtotal or when the tumor exhibits atypical histology. The proliferative index as assessed by MIB1 labeling is of prognostic significance. Occasionally, tumors featuring conventional morphology may recur, perhaps because of minimal residual disease left behind during surgical extirpation. Rare extracranial metastases and tumor-related deaths are on record. Surgery is the treatment of choice. Stereotactic and external beam radiation therapy may be indicated for postsurgical tumor remnants and for unresectable recurrences. Long-term active surveillance of the patients is mandatory.

Solitary Fibrous Tumor of the Central Nervous System

Solitary fibrous tumor (SFT) of the central nervous system was first described in 1996. A number of cases have been reported since. The authors present 5 new cases: 4 intracranial and 1 intraspinal. All patients were adults (age range, 47 to 75 years); 4 were male and 1 female; 4 cases were primary tumors; and 1 was a second tumor recurrence. All patients were surgically treated with gross total removal. All cases were histologically examined with immunohistochemical confirmation; 2 tumors exhibited diffuse classic histology, 1 tumor was a cellular variant, 1 tumor was myxoid, and 1 was predominantly classic with focal myxoid features and focally pleomorphic. The postoperative course was uneventful in all. The patient with the cellular variant experienced 2 local recurrences and eventually died of disease 10 years after the initial diagnosis. The patient with the myxoid variant—the tumor studied—which was the second recurrence of a previously misdiagnosed fibrous meningioma surgically treated 15 years earlier, had a recurrence after 2 years for the third time and eventually died of disease. Three patients are alive and well 11.6, 6, and 4 years after surgery. SFT is a rare tumor that needs to be differentiated from some mimickers, mainly fibrous meningioma, hemangiopericytoma, and with regard to the myxoid variant, also adult-onset myxochordoid meningioma and myxoid peripheral nerve sheath tumor. Immunohistochemistry is crucial for the correct diagnosis of SFT. The authors also performed a review of the literature and found a little more than 200 cases on record.

Fibrosarcoma of the meninges

Meningeal fibrosarcomas are rare tumors. Only 41 cases have been reported in the literature to date. Primary central nervous system fibrosarcomas are very aggressive neoplasms and have a poor prognosis. Hence they need to be correctly diagnosed. This is a case of a 13-year old boy with intracranial space occupying lesion. The mass was completely removed and histological examination was characteristic of meningeal fibrosarcoma. The pathological diagnosis is usually made on routine light microscopic examination; however, occasionally these may be difficult to distinguish from other malignant neoplasms such as gliomas, meningiomas and metastases. The diagnosis of fibrosarcoma is based on the identification of a predominant herringbone architectural pattern, the overall uniformity of the spindle cell population, the prominent vimentin positivity, and the presence of pericellular reticulin fibre network. IHC helps to exclude other diagnoses.

Secondary fibrosarcoma of the brain stem treated with cyclophosphamide and Imatinib

Radiation-induced midbrain fibrosarcoma is a rare, highly aggressive tumor, which is associated with poor prognosis. We present the case of a 48-year old man with brainstem fibrosarcoma 20 years following radiation therapy received for a pituitary tumor. We discuss this case in the context of the diagnostic criteria for these tumors, and previous reports of secondary and primary sarcomas of the central nervous system.

A report of primary brain fibrosarcoma with literature review

Primary fibrosarcoma of the central nervous system (CNS) is an extremely rare tumor. To the best of our knowledge, only 40 cases have been reported in the literature. We document such a case in a 9-year-old child who presented with a short history of headache and vomiting. A mass was completely removed and histologic examination revealed a primary fibrosarcoma with features resembling solitary fibrous tumor, meningioma, and malignant fibrous histiocytoma. In addition, the tumor was associated with meningioangiomatosis. A primary CNS fibrosarcoma with these features is most unusual and rendered a precise diagnosis difficult.