Usuda Daisuke, Yamada Shinya, Izumida Toshihide, Sangen Ryusho, Higashikawa Toshihiro, Nakagawa Ken, Iguchi Masaharu, Kasamaki Yuji
Department of General Medicine, Kanazawa Medical University Himi Municipal Hospital, Himi-shi 935-8531, Toyama-ken, Japan.
Department of Respiratory Medicine, Kanazawa Medical University Himi Municipal Hospital, Himi-shi 935-8531, Toyama-ken, Japan.
World J Clin Cases. 2020 Oct 26;8(20):4844-4852. doi: 10.12998/wjcc.v8.i20.4844.
Solitary fibrous tumor (SFT) is a rare fibroblastic mesenchymal neoplasm that affects spindle cell soft tissues with broad-spectrum biological behavior; it is predominantly benign, and rarely metastasizes. SFT occurs mainly in the tissue structure of the serosa in the pleura and the thorax, and can be found throughout the body, though extra-thoracic localization, including the cephalic region, is un-common. We reported the first case of intracranial malignant SFT metastasized to the chest wall.
An 81-year-old Japanese man was referred to our hospital due to progressive gait disturbance and appetite loss. His medical history included partial resection due to brain tumor, four times, and 50-Gray radiation therapy at another hospital, starting when he was 74 years old. An unenhanced head computed tomography (CT) scan revealed an 8 cm × 5.1 cm × 6.5 cm mixed-density mass at the left frontal lobe, accompanying a midline shift, and an unenhanced chest-abdomen CT scan revealed a 6 cm × 4.1 cm × 6.5 cm low-density mass in the left chest wall. A CT-guided percutaneous lung biopsy was performed, and the pathological findings were SFT corresponding to brain tumor. Finally, the correct diagnosis of his brain tumor in history of past illness revealed to be SFT, and the unremovable tumor, namely present brain lesions enlarged and metastasized to the chest wall. We established a definitive diagnosis of intracranial malignant SFT metastasized to the chest wall. We notified him and his family of the disease, and offered palliative care. He passed away on the 29 hospital day.
This case suggests the need for careful, detailed examination, and careful follow-up when encountering patients presenting with a mass.
孤立性纤维性肿瘤（SFT）是一种罕见的成纤维细胞间叶性肿瘤，可累及具有广泛生物学行为的梭形细胞软组织；它主要为良性，很少发生转移。SFT主要发生于胸膜和胸部浆膜的组织结构中，尽管包括头部区域在内的胸外定位并不常见，但可在全身发现。我们报告了首例颅内恶性SFT转移至胸壁的病例。
一名81岁的日本男性因进行性步态障碍和食欲减退被转诊至我院。他的病史包括因脑肿瘤进行了4次部分切除术，并在74岁时于另一家医院接受了50格雷的放射治疗。头部非增强计算机断层扫描（CT）显示左额叶有一个8 cm×5.1 cm×6.5 cm的混合密度肿块，伴有中线移位，胸部-腹部非增强CT扫描显示左胸壁有一个6 cm×4.1 cm×6.5 cm的低密度肿块。进行了CT引导下经皮肺活检，病理结果为与脑肿瘤相符的SFT。最终，他既往病史中的脑肿瘤经正确诊断为SFT，且不可切除的肿瘤，即目前的脑病变已增大并转移至胸壁。我们确诊为颅内恶性SFT转移至胸壁。我们将病情告知了他及其家人，并提供了姑息治疗。他在住院第29天去世。
该病例提示，在遇到有肿块的患者时，需要进行仔细、详细的检查及密切随访。
