Yoshida Masafumi, Moriyoshi Koki, Doi Kento, Yamao Yukihiro, Kishida Natsue, Uemura Hiroya, Fukuda Shunichi
Department of Neurosurgery, National Hospital Organization Kyoto Medical Center, Kyoto, Kyoto, Japan.
Department of Diagnostic Pathology, National Hospital Organization Kyoto Medical Center, Kyoto, Kyoto, Japan.
NMC Case Rep J. 2025 Apr 25;12:181-188. doi: 10.2176/jns-nmc.2024-0284. eCollection 2025.
Intracranial solitary fibrous tumor is a rare tumor accounting for 0.4% of intracranial tumors, with a high local recurrence rate and a tendency toward metastasis outside the central nervous system. We experienced a case of distant metastasis to the soft tissues and the kidney without local recurrence after gross total resection of the primary intracranial tumor. A 58-year-old male with cognitive impairment and right hemianopsia had a tumor of 5 cm maximum diameter in the left occipitotemporal convexity. Magnetic resonance imaging examinations showed a tumor with a slightly high signal on T1-weighted images, a low signal on T2-weighted images, and uniform and prominent contrast-enhanced images. Intratumoral flow voids were markedly observed. A head computed tomography performed 3 years earlier showed no mass lesions in the same region. Following tumor embolization, a gross total tumor resection was performed. The pathological diagnosis was grade-1 solitary fibrous tumor according to the 2021 World Health Organization central nervous system 5 criteria. A total of 45 Gy of postoperative local radiation therapy was administered. The patient recovered from his cognitive impairment and his right hemianopsia also improved. Although subsequent imaging studies showed no local recurrence, over 8 years after surgery, distant metastases were found in the subcutaneous soft tissue of the medial right femur and the left kidney, all of which were surgically removed. In a literature review, we identified 213 cases of intracranial solitary fibrous tumor having distant metastases with or without local recurrence from 18 reports and found that ours was the ninth case of distant metastasis despite gross total resection without local recurrence.
颅内孤立性纤维瘤是一种罕见肿瘤，占颅内肿瘤的0.4%，局部复发率高，且有向中枢神经系统外转移的倾向。我们遇到一例原发性颅内肿瘤全切术后无局部复发但发生远处软组织和肾脏转移的病例。一名58岁男性，有认知障碍和右侧偏盲，左侧枕颞叶凸面有一个最大直径5 cm的肿瘤。磁共振成像检查显示，该肿瘤在T1加权图像上呈稍高信号，在T2加权图像上呈低信号，增强图像均匀且明显强化。瘤内明显可见血流空信号。3年前进行的头部计算机断层扫描显示同一区域无占位性病变。在肿瘤栓塞后，进行了肿瘤全切术。根据2021年世界卫生组织中枢神经系统肿瘤分类标准，病理诊断为1级孤立性纤维瘤。术后给予45 Gy的局部放射治疗。患者的认知障碍得到恢复，右侧偏盲也有所改善。尽管随后的影像学检查未显示局部复发，但术后8年多，在右股骨内侧皮下软组织和左肾发现远处转移，均进行了手术切除。在文献综述中，我们从18篇报告中确定了213例有或无局部复发的颅内孤立性纤维瘤发生远处转移的病例，发现我们的病例是第九例尽管全切但无局部复发却发生远处转移的病例。
