Teaching NeuroImage: Intracranial Solitary Fibrous Tumor With Liver Metastasis

A 65-year-old woman presented with nausea, headache, and visual changes. MRI of the brain identified dural-based lesions involving the right cerebellum, right tentorium, and left anterior falx believed to be consistent with meningiomas (Figure, A-C). Owing to unclear association between imaging findings and clinical symptoms, surveillance was recommended. Follow-up was inadvertently delayed. Repeat imaging at 7 months revealed enlarging tentorial lesion, treated with gamma knife radiosurgery (GKRS) (Figure, D). Further growth prompted resection of the cerebellar lesion. Tumor cells were positive for STAT6 on immunohistochemistry, establishing solitary fibrous tumor (SFT) as the diagnosis. PET-CT identified fluorodeoxyglucose-avid hepatic lesion, with biopsy confirming STAT6, CD34, and synaptophysin-positive metastatic SFT (Figure, E-F). After additional GKRS, systemic therapy with sunitinib was started. SFTs are mesenchymal neoplasms predominantly affecting young adults that should be included in the differential of durally based lesions.(1) Given propensity for extracranial metastasis, systemic imaging should be obtained on establishing tissue diagnosis.(2)

Automated summary

A 65-year-old woman presented with symptoms of nausea, headache, and visual changes. Imaging revealed dural-based lesions suspected to be meningiomas. However, further evaluation and delayed follow-up showed enlargement of the lesions, leading to a diagnosis of solitary fibrous tumor (SFT) with metastasis. Systemic therapy with sunitinib was initiated due to extracranial involvement. This case highlights the importance of considering SFT as a differential diagnosis for dural-based lesions and the need for comprehensive imaging for tissue diagnosis.