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Spontaneous Tumor Regression Of Intracranial Solitary Fibrous Tumor Originating From The Medulla Oblongata: A Case Report And Literature Review

Yamaguchy, J. 2019Brain tumor

Yamaguchi, J., Motomura, K., Ohka, F., Aoki, K., Tanahashi, K., Hirano, M., Nishikawa, T., Shimizu, H., Wakabayashi, T., & Natsume, A. (2019). Spontaneous Tumor Regression of Intracranial Solitary Fibrous Tumor Originating From the Medulla Oblongata: A Case Report and Literature Review. World neurosurgery, 130, 400–404. https://doi.org/10.1016/j.wneu.2019.07.052

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Abstract

BACKGROUND: Intracranial solitary fibrous tumor (SFT) is a rare occurrence and involvement of the fourth ventricle rarely reported. Because of its rarity, some characteristics of intracranial SFT seem to still remain uncertain. CASE DESCRIPTION: This study describes a very rare case of intracranial SFT in a 55-year-old woman who presented with gait disturbance and numbness in bilateral upper limbs from 3 months before visiting the hospital. Head magnetic resonance imaging scan revealed a homogeneously enhancing mass lesion located primarily in the fourth ventricle extending into the spinal canal and left foramen of Luschka, with a maximum diameter of 60 mm. Notably, this tumor presented spontaneous partial regression during waiting planned surgery without therapy, including chemotherapy and radiotherapy. This patient underwent a midline suboccipital craniotomy and resection of the tumor. Interestingly, there was no attachment to the dura mater of the posterior cranial fossa and the lesion was only attached to the dorsal part of the medulla oblongata. CONCLUSIONS: Although the location of the SFT in the fourth ventricle is rare, SFT should be considered as 1 of the differential diagnosis of fourth ventricle tumors. In addition, this case indicates that SFT in the fourth ventricle may regress on occasion spontaneously without a precisely known cause for this spontaneous partial regression.

Case Details

Disease Location

Brain

Personal Characteristics

55-year-old woman

Clinical Characteristics

Presented with gait disturbance and numbness in bilateral upper limbs for 3 months before visiting the hospital. Neurological examination revealed numbness in the upper limbs bilaterally, paresis in the 4 limbs, and bilateral dysmetria. Her gait was slow with a wider base than normal. MRI revealed a mass lesion located primarily in the fourth ventricle, extending to the spinal canal and to the left foramen of luschka, with a maximum diameter of 60 mm. The brainstem was compressed. The bilateral posterior inferior cerebellar arteries were the main feeders of this enhancing tumor. After surgery, histologic findings were consistent with an intracranial solitary fibrous tumor (sft).

Remission Characteristics

Regression of the lesion was revealed in the second head MRI scan performed 1 month after the initial preoperative assessment

Treatment & Mechanisms

Proposed Remission Mechanisms

There might be a possibility that the immune response was triggered for some reasons

Clinical Treatment

Dexamethasone, concentrated glycerin, head computed tomography (CT) scan, head MRI, positron emission tomography, and digital subtraction angiography (dsa).

Non-Clinical Treatment

None reported