title: Rapid recurrence and bilateral lungs, multiple bone metastasis of malignant solitary fibrous tumor of the right occipital lobe: report of a case and review.
abstract: BACKGROUND
  Intracranial malignant solitary fibrous tumor (MSFT) is extremely rare. The authors report a case of MSFT of the right occipital lobe with a rapid recurrence and bilateral lung, multiple bone metastasis.
  
  
  METHODS
  The patient was a 25-year-old male presenting with headache, nausea and visual disturbances without obvious cause. Three times right-side occipital craniotomies were performed and two times postoperative conformal radiotherapy were administered within one year. 4 months after the third time of right-side occipital craniotomy, the patient felt right chest pain and neck pain. Positron emission tomography/computed tomography (PET/CT) showed tumor recurrence of the right occipital lobe and bilateral lung metastasis, multiple bone metastasis including: vertebrae, libs, the left iliac wing, sacrum, the right ischium and upper parts of both femurs. Ultrasound guided puncture biopsy of left-side back of the neck and CT guided puncture biopsy of the third lumbar vertebra were performed. General sample showed grayish white or grayish red with irregular shape. Histopathologically, the tumor was composed of areas of alternating hypercellularity and hypocellularity with spindle-shaped cells, which arranged as fascicular, storiform pattern or patternless pattern, with intervening irregular eosinophilic collagen bundles. Some areas showed hemangiopericytoma-like perivascular pattern and perivascular hyalinization. Tumor cells were pleomorphic with mitotic counts of more than 4 per 10 high power fields and showed coagulative necrosis. Immunohistochemically, tumor cells were diffusely positive for vimentin and CD99, focal positive for CD34, bcl-2 and Actin. Ki-67 labelling index was more than 40%. The final pathological diagnosis was MSFT of the right occipital lobe, metastatic MSFT of left-side back of the neck and the third lumbar vertebra.
  
  
  CONCLUSIONS
  The MSFT of the right occipital lobe with recurrence and bilateral lung, multiple bone metastasis is extremely rare. Although intracranial MSFT is extremely rare, it should be considered in the differential diagnosis. Definite diagnosis depended mainly on pathological morphology and immunohistochemistry. The prognosis of MSFT is poor due to recurrence and metastasis. Complete resection of intracranial MSFT is difficult, and carful follow-up is needed.
authors.affiliation: Department of Pathology, School of Basic Medical Sciences; Department of Pathology, Nan Fang Hospital, Southern Medical University, Guangzhou, 510515, China. wuzr813@163.com.
authors.forename: Zhengrong
authors.initials: Z
authors.lastname: Wu
authors.affiliation: Department of Pathology, School of Basic Medical Sciences; Department of Pathology, Nan Fang Hospital, Southern Medical University, Guangzhou, 510515, China. pathyang@smu.edu.cn.
authors.forename: Hongjun
authors.initials: H
authors.lastname: Yang
authors.affiliation: State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, 510060, China. wengdsh@sysucc.org.cn.
authors.forename: Desheng
authors.initials: D
authors.lastname: Weng
authors.affiliation: Department of Pathology, School of Basic Medical Sciences; Department of Pathology, Nan Fang Hospital, Southern Medical University, Guangzhou, 510515, China. dyq@fimmu.com.
authors.forename: Yanqing
authors.initials: Y
authors.lastname: Ding
mesh_terms: D000328:Adult; D014408:Biomarkers, Tumor / Q000032:analysis; D001707:Biopsy, Needle; D001859:Bone Neoplasms / Q000737:chemistry / Q000556:secondary*; D001932:Brain Neoplasms / Q000737:chemistry / Q000473:pathology* / Q000601:surgery; D003937:Diagnosis, Differential; D006801:Humans; D007150:Immunohistochemistry; D008175:Lung Neoplasms / Q000737:chemistry / Q000556:secondary*; D008297:Male; D064847:Multimodal Imaging / Q000379:methods; D009364:Neoplasm Recurrence, Local; D009778:Occipital Lobe / Q000737:chemistry / Q000473:pathology* / Q000601:surgery; D049268:Positron-Emission Tomography; D011237:Predictive Value of Tests; D054364:Solitary Fibrous Tumors / Q000737:chemistry / Q000556:secondary* / Q000601:surgery; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
chemical_list: D014408:Biomarkers, Tumor