Hemorrhagic intramedullary solitary fibrous tumor of the conus medullaris: case report

Abstract

<jats:p>The differential diagnosis of spinal tumors is guided by anatomical location and imaging characteristics. Diagnosis of rare tumors is made challenging by abnormal features. The authors present the case of a 47-year-old woman who presented with progressive subacute right lower-extremity weakness and numbness of the right thigh. Physical examination further revealed an extensor response to plantar reflex on the right and hyporeflexia of the right Achilles and patellar reflexes. Magnetic resonance imaging of the lumbar spine demonstrated an 8-mm intramedullary exophytic nodule protruding into a hematoma within the conus medullaris. Spinal angiography was performed to rule out an arteriovenous malformation, and resection with hematoma evacuation was completed. Pathological examination of the resected mass demonstrated a spindle cell neoplasm with dense bundles of collagen. Special immunostaining was performed and a diagnosis of solitary fibrous tumor (SFT) was made. SFTs are mesenchymally derived pleural neoplasms, which rarely present at other locations of the body, but have been increasingly described to occur as primary neoplasms of the spine and CNS. The authors believe that this case is unique in its rare location at the level of the conus, and also that this is the first report of a hemorrhagic SFT in the spine. Therefore, with this report the authors add to the literature the fact that this variant of an increasingly understood but heterogeneous tumor can occur, and therefore should be considered in the differential of clinically similar tumors.</jats:p>

<p>Spinal Intramedullary Solitary Fibrous Tumor: A Rare and Challenging Diagnosis</p>

“…SFTs were initially described in 1931 by Klemperer and Rabin as a mesenchymal tumor arising from the pleura 9. The visceral pleura is the predominant location, while the central nervous system involvement is quite infrequent; SFTs occurring within the spinal cord is extremely rare, with only 18 cases previously reported in the literature 4–8,10-21. The relevant literature review was summarized in Table 1.…”

“…They can occur anywhere in the human body but arise predominantly in the visceral pleura; SFTs in extraserosal sites, especially those involving the central nervous system, are quite infrequent 1–3. SFTs occurring in the spinal intramedullary locations are extremely rare 4–8. Although it may be challenging on neuroimages to offer a specific diagnosis of this rare entity, knowledge of this tumor is vital as it has benign features and a possibly better prognosis than some more malignant tumors in this location 4,7.…”

Solitary fibrous tumors of the spine: a pediatric case report with a comprehensive review of the literature

“…2,10,43,64,65,72,73 One hemorrhagic lesion in the conus was thought to be either a myxopapillary ependymoma or cavernous malformation. 74 Seventy-five of the reported cases contained information regarding treatment. Patients in all of these cases underwent surgery.…”

Primary intrapulmonary solitary fibrous tumours

“…A solitary fibrous tumour (SFT) is a rare, slow-growing, mesenchymal neoplasm arising from the pleura, which is unrelated to asbestos exposure or cigarette smoking ( 1 ) and was initially described in 1931 ( 2 ). Over the past 80 years, SFTs have been identified in numerous extrapleural locations, including the nasal cavity ( 3 ), breast ( 4 ), stomach ( 5 ), bronchus ( 6 ), head and neck ( 7 ), liver ( 8 ), oesophagus ( 9 ), pelvic ( 10 ), pancreas ( 11 ), prostate ( 12 ), orbit ( 13 ), central nervous system ( 14 ), parotid gland ( 15 ), kidney ( 16 ), lung ( 17 ), sella turcica ( 18 ), heart ( 19 ), conus medullaris ( 20 ), omentum ( 21 ), infratemporal fossa ( 22 ), bladder ( 23 ), soft tissues of the extremities ( 24 ), palatine tonsil ( 25 ), diaphragm ( 26 ), mesentery ( 27 ), lumbar spine ( 28 ), thymus ( 29 ), oral cavity ( 30 ), spermatic cord ( 31 ), thyroid ( 32 ), rectum ( 33 ), salivary glands ( 34 ), retroperitoneum ( 35 ), larynx ( 36 ), trachea ( 37 ), adrenal gland ( 38 ), female genital tract ( 39 ), periosteum of bone ( 40 ), mediastinum ( 41 ) and hypopharynx ( 42 ).…”