Mariniello G, Napoli M, Russo C, Briganti F, Giamundo A, Maiuri F, Del Basso De Caro M L
Chair of Neurosurgery, Department of Neurological Sciences, "Federico II" University of Naples; Naples, Italy -
Neuroradiol J. 2012 Nov;25(5):610-6. doi: 10.1177/197140091202500516. Epub 2012 Nov 9.
Spinal solitary fibrous tumors (SFT) are very rare neoplasms occurring in the spinal canal, with only 38 cases reported in ten years since the first description. We describe two cases of SFT of the spine and review 33 well-documented cases in the literature to define distinctive radiological and surgical features raising the suspicion of a spinal SFT before histological verification. A 67-year-old man with cervical myeloradiculopathy had a large extramedullary tumor of the cervical spinal canal extending from C4 to C7. On MRI the tumor was isointense on T1-sequences and hypointense on T2-sequences, and had marked contrast enhancement. At surgery, the tumor was intradural extramedullary, with no dural or root attachment, but it was adherent to the cord. Complete tumor removal was achieved with good outcome. A 75-year-old man with progressive thoracic myelopathy had an intramedullary tumor at C6 and C7 level, which was hypointense on T1- and T2-weighted images of MRI. At surgery, the tumor was intramedullary and strongly adherent to the cord; it was successfully removed. Both tumors were composed of elongated cells with a collagen-matrix background. Immunohistochemical staining was positive for vimentin, CD34, and bcl-2, and negative for EMA and S-100 protein. A careful analysis of our own and the other reported cases of spinal SFTs may disclose some peculiar features of this rare tumor. A spinal intramedullary or extramedullary tumor, hypointense on T2-weighted images of MRI, which intraoperatively shows hard consistency, scarce vascularization, no nerve root involvement, no or weak dural attachment, absence of arachnoidal interface, and adherence to the spinal cord may suggest the diagnosis of SFT.
脊柱孤立性纤维瘤（SFT）是发生于椎管内的极为罕见的肿瘤，自首次描述以来的十年间仅报道了38例。我们描述了两例脊柱SFT病例，并复习文献中33例记录完整的病例，以确定在组织学确诊之前提示脊柱SFT的独特影像学和手术特征。一名67岁患有颈段脊髓神经根病的男性，其颈段椎管内有一个从C4延伸至C7的巨大髓外肿瘤。在MRI上，该肿瘤在T1序列上呈等信号，在T2序列上呈低信号，并具有明显的对比增强。手术时，肿瘤位于硬脊膜内髓外，无硬脊膜或神经根附着，但与脊髓粘连。肿瘤完整切除，预后良好。一名75岁患有进行性胸段脊髓病的男性，在C6和C7水平有一个髓内肿瘤，在MRI的T1加权和T2加权图像上呈低信号。手术时，肿瘤位于髓内且与脊髓紧密粘连；肿瘤被成功切除。两个肿瘤均由具有胶原基质背景的细长细胞组成。免疫组化染色波形蛋白、CD34和bcl - 2呈阳性，上皮膜抗原（EMA）和S - 100蛋白呈阴性。对我们自己的病例以及其他报道的脊柱SFT病例进行仔细分析，可能会揭示这种罕见肿瘤的一些特殊特征。脊柱髓内或髓外肿瘤，在MRI的T2加权图像上呈低信号，术中表现为质地硬、血管少（血运不丰富）、无神经根受累、无或仅有薄弱的硬脊膜附着、无蛛网膜界面且与脊髓粘连，可能提示SFT的诊断。
