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Open Access Case report

Fourth ventricular solitary fibrous tumor: a case report and review of the literature

Congli Wang1*, Varsha Manucha1, Scott Faro2, Michael Weaver3 and Abir L Mukherjee1

Author Affiliations

1 Department of Pathology and Laboratory Medicine, Temple University Hospital, 3401 North Broad Street, Philadelphia, PA, 19140, USA

2 Department of Radiology, Temple University Hospital, Philadelphia, PA, USA

3 Department of Neurosurgery, Temple University Hospital, Philadelphia, PA, USA

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Journal of Medical Case Reports 2012, 6:205  doi:10.1186/1752-1947-6-205

Published: 17 July 2012

Abstract

Introduction

Solitary fibrous tumors of the central nervous system usually present as dura-based masses and clinically resemble meningiomas. There are very few reported cases of intra-ventricular solitary fibrous tumors, particularly in the fourth ventricle.

Case presentation

Our patient was a 52-year-old African-American man, who presented to our facility with a two-month history of progressive weakness and numbness in all extremities. A computed tomography scan and brain magnetic resonance imaging scan revealed a homogeneous, avidly enhancing 4.5 × 3.7 × 2.7cm fourth ventricular mass, with compression of adjacent medulla and cerebellum and extension into the foramen of Luschka. Our patient underwent a suboccipital craniotomy and resection of the tumor. A histological examination showed a spindle cell neoplasm with prominent collagenized stroma. The neoplastic cells were strongly and diffusely positive for CD34, vimentin and Bcl-2, and negative for S-100, CD99 and epithelial membrane antigen. The molecular immunology Borstel-1 (MIB-1) proliferation index was low (1%). CD31 immunostain highlighted the endothelial cells but the spindle cells were negative. Reticulin stain demonstrated a moderate reticulin network but individual cells were not invested by reticulin fibers. The histological features and immunoprofile was consistent with a solitary fibrous tumor.

Conclusions

In the central nervous system, solitary fibrous tumors are usually indolent tumors, with only rare examples showing hypercellularity and increased mitotic activity; features that were absent in our patient’s case. We present an uncommon central nervous system neoplasm in a rare location. Although uncommon, solitary fibrous tumors should be included in the differential diagnosis of intra-ventricular tumors in adults.

Keywords:
Fourth ventricle; Intraventricular; Solitary fibrous tumor