Solitary fibrous tumour of the dura

Case contributed by RMH Neuropathology

Presentation

Unwitnessed seizure, severe headache, photophobia and neck stiffness.

Patient Data

Age: 35
Gender: Male
CT

CT Brain

There is a 23mm x 21mm x 20mm vividly enhancing, lobulated lesion, left of midline and likely extra-axial in origin within the anterior cranial fossa. No vessels are seen to feed into or drain from this lesion. Surrounding hypoattenuation consistent with oedema. It is difficult to appreciate whether there is a dural tail associated with this lesion. No other intra or extra-axial abnormality.

Conclusion: Findings are most consistent with a solid tumour and in this location a meningioma (olfactory groove) is by far the most likely. An aneurysm is considered unlikely. The findings are not consistent with an abscess or infective process. The patient will proceed to MRI for further characterisation.

MRI

MRI Brain

The study is complete as it was terminated due to patient movement. 

Findings:

Vividly enhancing 3cm lobulated extra axial mass in the left olfactory groove with no abnormal diffusion restriction. Surrounding oedema is again demonstrated. No other intra or extra-axial abnormality, mass, or collection identified. Ventricles and basal cisterns are normal in appearance. The cribriform plate beneath is remodelled but not obviously breached within the limitations of the images and there is no involvement of nasal cavity or ethmoid sinuses to suggest esthesioneuroblastoma.

Conclusion: Incomplete study. The lobulated mass in the left olfactory groove is favoured to represent a meningioma.

Pathology

MICROSCOPIC DESCRIPTION: 1-4. Paraffin sections show a moderately hypercellular tumour. This consists of spindle and epithelioid cells with a loose fascicular and storiform architectural arrangement. A vague whorling architecture is also noted in some areas. Tumour cells show mild nuclear and cellular pleomorphism. Occasional mitotic figures are identified (2/10 HPF). No areas of necrosis are seen. There is no evidence of brain invasion. Immunohistochemistry shows strong staining in tumour cells for CD34 and bcl-2. No staining for epithelial membrane antigen (EMA), progesterone receptor (PgR) or ALK-1 is seen. The features are of solitary fibrous tumour (WHO Grade II). The topoisomerase labelling index is approximately 3%.

DIAGNOSIS: 1-4. Olfactory groove tumour: Solitary fibrous tumour (WHO Grade II).

Case Discussion

Solitary fibrous tumours of the dura are rare dural masses, histologically identical to solitary fibrous tumours found elsewhere, and composed of spindle cells thought to be of mesenchymal origin. 

The radiographic appearances are those of a well circumscribed mass arising from the dura (supratentorial convexity, falx and tentorium and posterior fossa). Unlike solitary fibrous tumours of the spinal cord, which most frequently arise from the cord itself and not the theca, parenchymal tumours of the brain are very rare. 

PlayAdd to Share

Case information

rID: 38521
Case created: 22nd Jul 2015
Last edited: 10th Sep 2015
Inclusion in quiz mode: Included

Updating… Please wait.
Loadinganimation

Alert accept

Error Unable to process the form. Check for errors and try again.

Alert accept Thank you for updating your details.