- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, King Abdulaziz Medical City, National Guard Health Affairs, Jeddah, Saudi Arabia
- Department of Neurosurgery, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
- Department of Neurosurgery, Fakeeh College for Medical Science, Jeddah, Saudi Arabia
- Department of Neurosurgery, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Jeddah, Saudi Arabia
Correspondence Address:
Hussam Kutub, Department of Neurosurgery, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Jeddah, Saudi Arabia.
DOI:10.25259/SNI_538_2024
Copyright: © 2024 Surgical Neurology International This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-Share Alike 4.0 License, which allows others to remix, transform, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.How to cite this article: Osama A. Alkulli1, Omar Abdulrahman Albaradie1, Khalid Talal Alghamdi2, Layan Hussam Kutub3, Hussam Kutub4. A case of lumbar spinal solitary fibrous tumor or hemangiopericytomas. 23-Aug-2024;15:301
How to cite this URL: Osama A. Alkulli1, Omar Abdulrahman Albaradie1, Khalid Talal Alghamdi2, Layan Hussam Kutub3, Hussam Kutub4. A case of lumbar spinal solitary fibrous tumor or hemangiopericytomas. 23-Aug-2024;15:301. Available from: https://surgicalneurologyint.com/surgicalint-articles/13053/
Abstract
Background: Solitary fibrous tumors (SFTs) account for 3.7% of all soft-tissue sarcomas, with an annual incidence of 0.35/100,000 individuals. Notably, although 20% involve the central nervous system, only one in 10 occurs in the spine versus the brain.
Case Description: A 46-year-old female presented with 18 months of left lower extremity sciatica. On examination, she had a 60° limitation of straight leg raising but was otherwise neurologically intact. The lumbar magnetic resonance revealed a dumbbell tumor at the L4–L5 level filing the canal, causing cauda equina compression and extending into the left L45 foramen. The patient successfully underwent a L4 left hemi-laminectomy for tumor resection. The postoperative World Health Organization (WHO) histopathology was consistent with a SFT/WHO Grade I hemangiopericytoma (HPC).
Conclusion: A 46-year-old female with a lumbar L4 SFT with the left L45 foraminal extension successfully underwent a left hemilaminectomy for GTR of an SFT/WHO Grade I HPC.
Keywords: Hemangiopericytoma, Lumbar solitary fibrous tumor, Solitary fibrous tumor, Spinal solitary fibrous tumor, Spinal tumor
INTRODUCTION
Solitary fibrous tumors (SFT) or hemangiopericytomas (HPCs) account for 3.7% of all soft-tissue sarcomas with an annual incidence of 0.35/100,000 individuals.[
CASE PRESENTATION
Clinical data
A 46-year-old female presented with 18 months of left lower extremity pain and positive left-sided straight leg at 60°; otherwise, she was neurologically intact. The lumbar magnetic resonance revealed a dumbbell-shaped, L4 extradural, and solid mass (i.e., 2.2 × 2.1 cm axial diameter) compressing the cauda equina and extending into the left L4–L5 neural foramen [
Surgery and postoperative course
The patient underwent a L4 left hemilaminectomy. A clear plane was created between the tumor and the thecal sac; ultimately, the tumor was removed using the cavitron ultrasonic surgical aspirator, dissecting it free from a somewhat adherent nerve root. The frozen section revealed a moderately vascular lesion. No intraoperative complications occurred, and once postoperatively, the radicular symptoms improved significantly. Day-1 postoperatively, gadolinium-enhanced magnetic resonance imaging demonstrated no evidence of residual tumor [
Histopathology
The specimen aggregates included 3.5 × 2.5 × 0.3 cm fragments of heterogeneous tan soft-tissue ranging in color from gray to red. The microscopic examination revealed neoplastic proliferation with spindled to ovoid monomorphic cells arranged in an arbitrary manner, interspersed with hyalinized and dilated, thin-walled, branching blood vessels (i.e., staghorn appearance). The mitosis rates were below 5/10 per high-power field, and there was no accompanying necrosis. Target cells were immunohistochemically positive for STAT6 (nuclear), CD34, and B-Catenin (membranous) but negative for EMA, S100, SOX10, SMA, Desmin, CK PAN, P63, chromogranin, synaptophysin, and neurofilaments.
DISCUSSION
SFT/HPCs account for 3.7% of all soft-tissue sarcomas. An annual incidence is 0.35/100,000 individuals.[
Treatment options
Gross-total SFT/HPC resection is the “gold standard.” Notably, adjuvant chemotherapy and/or radiotherapy therapy are typically unnecessary for patients with low-grade SFT undergoing GTR. In Apra et al., 29 patients had either GTR or subtotal SFT tumor resections (i.e., due to spinal cord invasion and/or excessive hemorrhage).[
CONCLUSION
A 46-year-old female with a lumbar L4 SFT with the left L45 foraminal extension successfully underwent a left hemilaminectomy for GTR of an SFT/WHO Grade I HPC.
Ethical approval
The Institutional Review Board approval is not required.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
Use of artificial intelligence (AI)-assisted technology for manuscript preparation
The authors confirm that there was no use of artificial intelligence (AI)-assisted technology for assisting in the writing or editing of the manuscript and no images were manipulated using AI.
Disclaimer
The views and opinions expressed in this article are those of the authors and do not necessarily reflect the official policy or position of the Journal or its management. The information contained in this article should not be considered to be medical advice; patients should consult their own physicians for advice as to their specific medical needs.
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