Solitary Fibrous Tumor of the Posterior Fossa: case report and literature review

Tumor Fibroso Solitário da Fossa Posterior: relato de caso e revisão da literatura

• Rafael Harter Tomaszeski    
• Manuella Giusti Fin    
• Talita Siara Almeida Baptista    
• João Pedro Einsfeld Britz    
• Eduardo Cambruzzi    
• Marcos Dalsin    
• Gerson Evandro Perondi    
• Samir Cezimbra dos Santos    
• Felipe Lourezon Schiavo    

• https://doi.org/10.22290/jbnc.2025.20081117
• J Bras Neurocirur 36 (4):533-540, 2025

Resumo

O tumor fibroso solitário (TFS) é um tumor intracraniano raro sendo classificado em graus I, II e III, conforme sua agressividade. Relatamos um caso de um paciente masculino, 50 anos, com quadro de cefaleia, náuseas e alteração de marcha há três meses com piora progressiva. A tomografia de crânio evidenciou lesão expansiva hiperdensa cerebelar a direita. A ressonância magnética revelou uma lesão sólida com realce homogêneo pelo gadolínio com pequena área cística, caracterizada por hipossinal em T1 e hipersinal heterogêneo em T2, sugestivo de meningioma. Foi realizada ressecção cirúrgica e o anatomopatológico indicou TFS grau I pela Organização Mundial da Saúde (OMS). O tumor fibroso solitário é frequentemente confundido com o meningioma devido a características de neuroimagem semelhantes. Por esse motivo, a confirmação diagnóstica com anatomopatológico associado a painel imuno-histoquímico é de extrema importância para o diagnóstico preciso de neoplasias intracranianas.

Palavras-chave

Palavras-Chave: Neoplasia infratentorial; Fossa posterior; Tumor fibroso solitário

Abstract

Solitary fibrous tumor (SFT) is an uncommon intracranial tumor that is classified into grades I, II and III to its aggressiveness. The following case report details the case of a 50-year-old male patient who had been suffering from headaches, nausea, and gait alterations for a period of three months, with a progressive exacerbation of these symptoms. A CT scan of the skull revealed an expansive hyperdense cerebellar lesion on the right. Magnetic resonance imaging revealed a solid lesion with homogeneous gadolinium enhancement, accompanied by a small cystic area, characterized by hyposignal on T1 and heterogeneous hypersignal on T2, suggesting a diagnosis of meningioma. Surgical resection was performed, and the anatomopathological analysis indicated SFT grade I according to the World Health Organization (WHO) classification system. Solitary fibrous tumors are frequently misdiagnosed as meningiomas due to the presence of comparable neuroimaging characteristics. For this reason, it is imperative to employ a meticulous diagnostic approach that incorporates an anatomopathological examination and an immunohistochemical panel to ensure an accurate diagnosis of intracranial neoplasms.

Keywords

Infratentorial neoplasms; Cranial fossa, posterior; Solitary fibrous tumors

References

1. Nhung TH, Minh VL, Lam NL, Lien ND, Duc NM. Malignant intracranial solitary fibrous tumor: a case report and literature review. Radiol Case Rep. 2023;18(5):2014-8. http://doi.org/10.1016/j.radcr.2023.02.064. PMid:37033688.

2. Fargen KM, Opalach KJ, Wakefield D, Jacob RP, Yachnis AT, Lister JR. The central nervous system solitary fibrous tumor: a review of clinical, imaging and pathologic findings among all reported cases from 1996 to 2010. Clin Neurol Neurosurg. 2011;113(9):703-10. http:// doi.org/10.1016/j.clineuro.2011.07.024. PMid:21872387.

3. Carneiro SS, Scheithauer BW, Nascimento AG, Hirose T, Davis DH. Solitary fibrous tumor of the meninges: a lesion distinct from fibrous meningioma. A clinicopathologic and immunohistochemical study. Am J Clin Pathol. 1996;106(2):217-24. http://doi.org/10.1093/ ajcp/106.2.217. PMid:8712177.

4. Louis DN, Perry A, Reifenberger G, et al. The 2016 World Health Organization classification of tumors of the central nervous system: a summary. Acta Neuropathol. 2016;131(6):803-20. http://doi.org/10.1007/ s00401-016-1545-1. PMid:27157931.

5. Louis DN, Perry A, Wesseling P, et al. The 2021 WHO classification of tumors of the central nervous system: a summary. Neuro-oncol. 2021;23(8):1231-51. http://doi.org/10.1093/neuonc/noab106. PMid:34185076.

6. Al Armashi AR, Alkrekshi A, Al Zubaidi A, et al. Grade III solitary fibrous tumor/hemangiopericytoma: an enthralling intracranial tumor - a case report and literature review. Radiol Case Rep. 2022;17(10):3792-6. http://doi.org/10.1016/j.radcr.2022.07.007. PMid:35965927.

7. Gengler C, Guillou L. Solitary fibrous tumour and haemangiopericytoma: evolution of a concept. Histopathology. 2006;48(1):63-74. http://doi.org/10.1111/j.1365-2559.2005.02290.x. PMid:16359538.

8. Sun Z, Li F, Cai X, Jiang Z. Intracranial primary malignant solitary fibrous tumor/hemangiopericytoma masquerading as meningioma: report of a rare case. Int J Gen Med. 2020;13:963-7. http://doi.org/10.2147/IJGM.S279483. PMid:33149660.

9. Cheng L, Ni H, Dai Y. Intracranial solitary fibrous tumor mimicking meningioma: a case report. Medicine. 2020;99(50):e23504. http:// doi.org/10.1097/MD.0000000000023504. PMid:33327290.

10. Wu Z, Yang H, Weng D, Ding Y. Rapid recurrence and bilateral lungs, multiple bone metastasis of malignant solitary fibrous tumor of the right occipital lobe: report of a case and review. Diagn Pathol. 2015;10(1):91. http://doi.org/10.1186/s13000-015-0318-9. PMid:26155787.

11. Liu J, Wu S, Zhao K, Wang J, Shu K, Lei T. Clinical features, management, and prognostic factors of intracranial solitary fibrous tumor. Front Oncol. 2022;12:915273. http://doi.org/10.3389/fonc.2022.915273. PMid:35712477.

12. Gubian A, Ganau M, Cebula H, et al. Intracranial solitary fibrous tumors: a heterogeneous entity with an uncertain clinical behavior. World Neurosurg. 2019;126:e48-56. http://doi.org/10.1016/j.wneu.2019.01.142. PMid:30716501.

13. Chikasue T, Uchiyama Y, Tanoue S, Komaki S, Sugita Y, Abe T. Intracranial solitary fibrous tumor/hemangiopericytoma mimicking cystic meningioma: a case report and literature review. Radiol Case Rep. 2021;16(7):1637-42. http://doi.org/10.1016/j.radcr.2021.04.008. PMid:34007374.

14. Buerki RA, Horbinski CM, Kruser T, Horowitz PM, James CD, Lukas RV. An overview of meningiomas. Future Oncol. 2018;14(21):2161-77. http://doi.org/10.2217/fon-2018-0006. PMid:30084265.

15. Watts J, Box G, Galvin A, Brotchie P, Trost N, Sutherland T. Magnetic resonance imaging of meningiomas: a pictorial review. Insights Imaging. 2014;5(1):113-22. http://doi.org/10.1007/s13244-013-0302-4. PMid:24399610.

16. Sardaro A, Mammucci P, Pisani AR, et al. Intracranial solitary fibrous tumor: a “new” challenge for PET Radiopharmaceuticals. J Clin Med. 2022;11(16):4746. http://doi.org/10.3390/jcm11164746. PMid:36012988.

17. Wu Z, Yang H, Weng D, Ding Y. Rapid recurrence and bilateral lungs, multiple bone metastasis of malignant solitary fibrous tumor of the right occipital lobe: report of a case and review. Diagn Pathol. 2015;10(1):91. http://doi.org/10.1186/s13000-015-0318-9. PMid:26155787.

18. Kasper E, Lam FC, Anderson M, Boruchow S, Zinn PO, Mahadevan A. “Hitting all the right markers to save a life” Solitary fibrous tumors of the central nervous system: case series and review of the literature. Surg Neurol Int. 2012;3(1):83. http://doi.org/10.4103/2152-7806.99173. PMid:22937483.

19. Doyle LA, Vivero M, Fletcher CD, Mertens F, Hornick JL. Nuclear expression of STAT6 distinguishes solitary fibrous tumor from histologic mimics. Mod Pathol. 2014;27(3):390-5. http://doi.org/10.1038/ modpathol.2013.164. PMid:24030747.

20. Schweizer L, Koelsche C, Sahm F, et al. Meningeal hemangiopericytoma and solitary fibrous tumors carry the NAB2-STAT6 fusion and can be diagnosed by nuclear expression of STAT6 protein. Acta Neuropathol. 2013;125(5):651-8. http://doi.org/10.1007/s00401-013-1117-6. PMid:23575898.

21. Bouvier C, Bertucci F, Métellus P, et al. ALDH1 is an immunohistochemical diagnostic marker for solitary fibrous tumours and haemangiopericytomas of the meninges emerging from gene profiling study. Acta Neuropathol Commun. 2013;1:10. http://doi.org/10.1186/20515960-1-10. PMid:24252471.

22. Macagno N, Figarella-Branger D, Mokthari K, et al. Differential diagnosis of meningeal SFT-HPC and meningioma: which immunohistochemical markers should be used? Sou J Surg Pathol. 2016;40:270-8. http:// doi.org/10.1097/PAS.0000000000000526.

23. Ahmad Z, Tariq MU, Din NU. Meningeal solitary fibrous tumor/ hemangiopericytoma: emphasizing on STAT 6 immunohistochemistry with a review of literature. Neurol India. 2018;66(5):1419-26. http:// doi.org/10.4103/0028-3886.241365. PMid:30233017.

24. Yamashita D, Suehiro S, Kohno S, et al. Intracranial anaplastic solitary fibrous tumor/hemangiopericytoma: immunohistochemical markers for definitive diagnosis. Neurosurg Rev. 2021;44(3):1591-600. http:// doi.org/10.1007/s10143-020-01348-6. PMid:32671693.

25. Zhang R, Yang Y, Hu C, et al. Comprehensive analysis reveals potential therapeutic targets and an integrated risk stratification model for solitary fibrous tumors. Nat Commun. 2023;14(1):7479. http:// doi.org/10.1038/s41467-023-43249-4. PMid:37980418.

26. Yamamoto Y, Hayashi Y, Murakami I. Recurrence of solitary fibroustumor/hemangiopericytoma could be predicted by Ki-67 regardless of its origin. Acta Med Okayama. 2020;74(4):335-43. PMid:32843765.

27. El-Abtah ME, Murayi R, Lee J, Recinos PF, Kshettry VR. Radiological differentiation between intracranial meningioma and solitary fibrous tumor/hemangiopericytoma: a systematic literature review. World Neurosurg. 2023;170:68-83. http://doi.org/10.1016/j.wneu.2022.11.062. PMid:36403933.

28. Ohba S, Murayama K, Nishiyama Y, et al. Clinical and radiographic features for differentiating solitary fibrous tumor/hemangiopericytoma from meningioma. World Neurosurg. 2019;130:e383-92. http:// doi.org/10.1016/j.wneu.2019.06.094. PMid:31233926.

29. Tariq MU, Din NU, Abdul-Ghafar J, Park YK. The many faces of solitary fibrous tumor; diversity of histological features, differential diagnosis and role of molecular studies and surrogate markers in avoiding misdiagnosis and predicting the behavior. Diagn Pathol. 2021;16(1):32. http://doi.org/10.1186/s13000-021-01095-2.

PMid:33879215.

30. Usuda D, Yamada S, Izumida T, et al. Intracranial malignant solitary fibrous tumor metastasized to the chest wall: A case report and review of literature. World J Clin Cases. 2020;8(20):4844-52. http:// doi.org/10.12998/wjcc.v8.i20.4844. PMid:33195652.

---

1Neurosurgery Service, Hospital Cristo Redentor, Grupo Hospitalar Conceição, Porto Alegre, RS, Brazil.

2Universidade Luterana do Brasil, Canoas, RS, Brazil.

 

Received Jul 13, 2025

Accepted Jul 29, 2025