Late recurrence and histological progression of a cervical intradural extramedullary solitary fibrous tumor after gross total resection: a case report
Source: PubMed Central Open Access, NCBI / U.S. National Library of Medicine
Background Solitary fibrous tumor/hemangiopericytoma (SFT) is a rare mesenchymal neoplasm of the central nervous system characterized by unpredictable biological behavior, including delayed recurrence and metastatic potential. Spinal localization is uncommon, while cervical intradural extramedullary involvement remains exceptionally rare. Long-term outcomes and optimal postoperative management strategies are not well established. Case presentation A 39-year-old male presented with progressive cervical myelopathy caused by an intradural extramedullary tumor at the C4–C5 level. The patient underwent microsurgical gross total resection (GTR) with intraoperative neurophysiological monitoring. Histopathological and immunohistochemical evaluation demonstrated a CNS WHO grade 2 solitary fibrous tumor with diffuse CD34 and STAT6 positivity. Postoperative recovery was uneventful, and serial contrast-enhanced magnetic resonance imaging (MRI) demonstrated no evidence of recurrence during a 5-year surveillance period. Results In 2026, the patient developed recurrent cervical pain and sensory disturbances. Follow-up MRI revealed a localized recurrent intradural extramedullary lesion at the previous surgical site. Systemic staging showed no evidence of metastatic disease. Repeat microsurgical gross total resection was performed. Histopathological examination of the recurrent lesion demonstrated increased mitotic activity (>5 mitoses per 10 high-power fields), tumor necrosis, and an elevate
Abstract
Background Solitary fibrous tumor/hemangiopericytoma (SFT) is a rare mesenchymal neoplasm of the central nervous system characterized by unpredictable biological behavior, including delayed recurrence and metastatic potential. Spinal localization is uncommon, while cervical intradural extramedullary involvement remains exceptionally rare. Long-term outcomes and optimal postoperative management strategies are not well established. Case presentation A 39-year-old male presented with progressive cervical myelopathy caused by an intradural extramedullary tumor at the C4–C5 level. The patient underwent microsurgical gross total resection (GTR) with intraoperative neurophysiological monitoring. Histopathological and immunohistochemical evaluation demonstrated a CNS WHO grade 2 solitary fibrous tumor with diffuse CD34 and STAT6 positivity. Postoperative recovery was uneventful, and serial contrast-enhanced magnetic resonance imaging (MRI) demonstrated no evidence of recurrence during a 5-year surveillance period. Results In 2026, the patient developed recurrent cervical pain and sensory disturbances. Follow-up MRI revealed a localized recurrent intradural extramedullary lesion at the previous surgical site. Systemic staging showed no evidence of metastatic disease. Repeat microsurgical gross total resection was performed. Histopathological examination of the recurrent lesion demonstrated increased mitotic activity (>5 mitoses per 10 high-power fields), tumor necrosis, and an elevated Ki-67 proliferative index (10–12%), consistent with progression to CNS WHO grade 3 solitary fibrous tumor. Postoperative MRI confirmed complete tumor removal. Following multidisciplinary evaluation, close radiological surveillance was recommended. Conclusion This case highlights the potential for delayed recurrence and histological progression of spinal solitary fibrous tumors despite apparently curative gross total resection and prolonged disease-free survival. Long-term, potentially lifelong radiological follow-up should be considered even for initially low-grade lesions. Recurrent or higher-grade tumors may require multidisciplinary evaluation regarding adjuvant treatment strategies and systemic surveillance.