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）.由于不清楚成像fi之间的联系ndings 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.1Given propensity for extracranial metastasis, systemic imaging should be obtained on establishing tissue diagnosis.2
Postcontrast T1-weighted MRI axial demonstrating lesions involving the right cerebellum (A), right tentorial leaflet (B), and left anterior falx (C). (D) Postcontrast T1-weighted MRI axial demonstrating increased size of right tentorial lesion. (E) PET-CT demonstrating lesion in the superior posterior right hepatic lobe. (F) MRI demonstrating hepatic metastasis.
Author Contributions
M.J. Webb: drafting/revision of the manuscript for content, including medical writing for content, analysis or interpretation of data. J.L. Campian: major role in the acquisition of data. U. Sener: drafting/revision of the manuscript for content, including medical writing for content; major role in the acquisition of data; study concept or design; analysis or interpretation of data.
Study Funding
The authors report no targeted funding.
Disclosure
The authors report no relevant disclosures. Go toNeurology.org/Nfor full disclosures.
Footnotes
Go toNeurology.org/Nfor full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.
Submitted and externally peer reviewed. The handling editor was Resident and Fellow Section Editor Whitley Aamodt, MD, MPH.
Teaching slideslinks.lww.com/WNL/C595
- ReceivedAugust 8, 2022.
- Accepted in final formDecember 2, 2022.
- © 2022 American Academy of Neurology
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