Solitary cervical fibrous tumor. Case illustration.

Abstract

This 49-year-old woman with a 1-year history of deteriorating quadriparesis visited our clinic in November 1999. She required a cane to walk and presented with a large elastic mass in the neck posteriorly. Neurological examination showed exaggerated deep tendon reflexes in the upper and lower extremities bilaterally as well as positive Hoffmann and Babinski reflexes bilaterally. Sensory disturbance and diffuse muscle weakness (Grades 2/5 on the right side and 4/5 on the left) below C-5 were also present. Magnetic resonance (MR) imaging revealed an 8� 5 � 8–cm extradural tumor (Fig. 1). Angiography demonstrated an intense hypervascular tumor fed by the bilateral ascending cervical and vertebral arteries. Following embolization, we resected the tumor, first separating the posterior extraspinal portion of the tumor in the muscular layer from surrounding tissues and excising it at the surface of the laminae, where severe bleeding was encountered. After hemostasis, we conducted a C2–5 laminectomy, and completely removed the tumor. The bilateral facet joints remained intact during laminectomy, making fusion unnecessary. The tumor had a gray pseudocapsule and was easily separated from the dura mater. Histological examination was compatible with a solitary fibrous tumor (Fig. 2). At 1-year follow-up examination, the patient suffered no neck pain or neurological deficits except for slightly exaggerated lower-extremity deep tendon reflexes. Radiography revealed no cervical instability or malalignment. No residual or recurrent tumor was found on MR imaging. Solitary fibrous tumors were first differentiated from diffuse mesothelioma by Klemperer and Rabin.4 These lesions are most commonly found in the visceral pleura but are considered to arise from mesenchymal rather than mesothelial tissue. Those occurring in the spinal canal are so rare that only 12 cases have been reported to date. 1–3,5,6 Of these, four harbored tumors in the cervical and thoracic spine and three in the lumbar spine. On the axial plane, tumors were intradural–extramedullary in seven, extradural in four, and intramedullary in one. Diagnosis of solitary fibrous tumors is based on characteristic pathological findings. Because CD34 staining, however, is also positive in other tumors such as hemangioma, fibroma, and epithelioma, the final diagnosis should be made on the basis of hematoxylin and eosin and CD34 staining together. Solitary fibrous tumors of the spine are usually benign, and marginal resection is considered to be sufficient. One case in which the tumor recurred after partial resection has been reported, indicating that complete resection and careful follow-up examination are mandatory. 2