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

Yamaguchi, 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. Due to 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 three months prior to visiting the hospital. Head MRI 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 one 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

Medulla oblongata

Personal Characteristics

55-year-old woman

Clinical Characteristics

Presented with gait disturbance and numbness in bilateral upper limbs from 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. Head MRI revealed homogeneously high intensity on the t2-weighted image, low intensity on the t1-weighted image, and a gadolinium-enhanced 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 and aqueduct were compressed. The bilateral posterior inferior cerebellar arteries were the main feeders of this enhancing tumor. Tumor resection was planned. The patient underwent a midline suboccipital craniotomy and tumor resection. Histologic examination revealed proliferation of spindle cells lacking an atypical nucleus, immunohistochemical was consistent with intracranial solitary fibrous tumor.

Remission Characteristics

While waiting for surgery, her symptoms had gradually improved. Surprisingly, regression of the lesion was revealed in the second head MRI scan performed 1 month after.

Treatment & Mechanisms

Clinical Treatment

Midline suboccipital craniotomy and tumor resection. Dexamethasone, concentrated glycerin