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Solitary fibrous tumor of the central nervous system: a clinicopathologic study of 24 cases

  • Clinical Article
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Abstract

Objective

Solitary fibrous tumor is a rare, spindle-cell benign mesenchymal neoplasm and has a high recurrence rate. In this study, we reviewed our experience in the diagnosis and treatment of 24 patients with central nervous system solitary fibrous tumors.

Methods

Clinical data were retrieved from the medical records. Prognosis was assessed by clinic service and telephone interview. The specimens were stained with hematoxylin and eosin. Immunohistochemistry for CD34, CD99, EMA, HMB-45, Bcl-2, vimentin, GFAP, S-100, MBP, CK and MIB-1 was performed in all cases. Distributions of time to progression and recurrence were estimated using the Kaplan­Meier method and compared using the log-rank test.

Results

The 24 patients included 13 men and 11 women with a median age of 49.0 years. The most frequent initial symptoms were headache, dizziness, unstable walk and hearing loss. The most common location was cerebellar pontine angle (n = 6). Surgery reached gross total removal for 18 patients but subtotal removal for six patients on initial operation. Histopathologic examination showed spindle to oval cells were disposed in wavy fascicles between prominent, eosinophilic bands of collagen. Dense bands of collagen appeared in cross section as minute nodules that separated individual tumor cells. Cellular areas with a partial hemangiopericytoma pattern were noted in six cases. Atypical presentations were shown on initial operation in three cases. CD34, CD99 and vimentin were 100% positive; but EMA, CK, MBP, HBM-45 and GRAP were 100% negative. The positive in Bcl-2, RF and S-100 was 89%, 85% and 26%, respectively. Follow-up information was available for 23 patients. The median follow-up period was 36.0 months. Nine patients recurred and one patient died from the progression. Incomplete surgical resection was significantly associated with recurrence (p = 0.010). MIB-1 labeling index in recurrence was higher than in no recurrence (6.0% versus 3.4%, p = 0.029). All treated with subtotal removal only had subsequent tumor recurrence or progression; however, the two patients who were administered adjuvant radiosurgery after subtotal removal did not recur or progress. Adjuvant radiosurgery seemed to improve the prognosis (p = 0.028).

Conclusions

Solitary fibrous tumor is a rare mesenchymal tumor with a propensity to recur. The most affected area is the cerebellopontine angle. Immunohistochemistry should be used to differentiate solitary fibrous tumor from other tumors. The extent of resection, MIB-1 labeling index and some anaplastic features might be predictive for recurrence. Postoperative radiosurgery might be an option in incompletely resected solitary fibrous tumor. Regular and long-term follow-up remains mandatory to monitor recurrence.

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Acknowledgments

We thank Professor Liang-Fu Zhou, Professor Ying Mao, Professor Feng-Ping Huang, Professor Xiao-Ming Che, Professor Ye Gong, Professor Rong Zhang, Professor Wei Zhu and Professor Zhi-Yong Qin for providing patients’ information. We thank Professor Timir Banerjee of Louisville, KY, USA for reading the manuscript and editing it. We also thank Professor Jian-Kang Shen for expert opinions during the development of this manuscript. This work is supported by grants from China Postdoctoral Science Foundation (No. 20100480568)

Conflicts of interest

None.

Author information

Authors and Affiliations

  1. Department of Neuropathology, Huashan Hospital, Fudan University, Shanghai, 200040, China

    Hong Chen & Yin Wang

  2. Department of Neurosurgery, Affiliated Hospital, Weifang Medical University, Shandong, 261053, China

    Xian-Wei Zeng

  3. Department of Neurosurgery, Huashan Hospital, Fudan University, Shanghai, 200040, China

    Jin-Song Wu, Ping Zhong, Rong Xu, Cheng-Chuan Jiang & Xiao-Qiang Wang

  4. Department of Radiology, Huashan Hospital, Fudan University, Shanghai, 200040, China

    Ya-Fang Dou

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  1. Hong Chen
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  5. Yin Wang
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Corresponding authors

Correspondence to Ping Zhong or Xiao-Qiang Wang.

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Comment

Neurosurgery at Huashan Hospital, Shanghai, is at its own level of magnitude [1]. In 9 years (2002–10), they operated on 6,700 meningiomas, 183 hemangiopericytomas (rare) and 28 solitary fibrous tumors (very rare) of the CNS. Their 28 solitary fibrous tumours make obviously the largest published series to date - but that is only secondary here. The most important point is the change of times. China and its megacities allow the creation of huge neurosurgical units compared with our European ones, and such units (1) may produce series of patients five- to ten-times larger than published from Europe, (2) may allow subspecialization with tens of neurosurgeons and dedicated instrumentation into a much deeper level that in standard European units, and (3) may at best represent the frontline of neurosurgical decidation and innovation.

Young neurosurgeons, look East!

Juha E Jääskeläinen

Kuopio Finland

1. Mao Y, Shi ZF, Zhou LF, Zhao Y (2011) Huashan Hospital affiliated to Fudan University: spanning a century of history. World Neurosurg 75(3–4):369–376

Hong Chen and Xian-Wei Zeng contributed equally to this study

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Chen, H., Zeng, XW., Wu, JS. et al. Solitary fibrous tumor of the central nervous system: a clinicopathologic study of 24 cases. Acta Neurochir 154, 237–248 (2012). https://doi.org/10.1007/s00701-011-1160-9

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  • DOI: https://doi.org/10.1007/s00701-011-1160-9

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