A malignant solitary fibrous tumour arising from the first lumbar vertebra and mimicking an osteosarcoma: a case report

World Journal of Surgical Oncology

Case Report

Tetsuo Hotta¹  Naoki Oike¹  Akira Ogose¹  Toru Hirano¹  Tetsuro Yamagishi¹  Hiroyuki Kawashima¹  Takashi Ariizumi¹  Naoto Endo¹  Hajime Umezu²  Shoichi Inagawa³ 

[1] Division of Orthopedic Surgery, Graduate School of Medical and Dental Sciences, Niigata University, 1-757 Asahimachi-dori, 951-8510, Niigata, Japan;Division of Pathology, Graduate School of Medical and Dental Sciences, Niigata University, Niigata, Japan;Division of Radiology, Graduate School of Medical and Dental Sciences, Niigata University, Niigata, Japan;

关键词: Malignant solitary fibrous tumour;    Osteosarcoma;    Lumbar vertebra;    Anterior spinal fusion;    Fusion gene;   

DOI  :  10.1186/s12957-017-1161-0

 received in 2016-12-09, accepted in 2017-04-23,  发布年份 2017

来源: Springer

【 摘 要 】

BackgroundA solitary fibrous tumour (SFT) is an unusual neoplasm typically found in soft tissues. Although SFTs can arise in the bones, they very rarely arise in the vertebral arch. Here, we describe a case of a SFT that arose in the vertebral arch of the first lumbar (L1) spinal vertebrae and mimicked osteosarcoma.Case presentationA 49-year-old woman presented with a 2-month history of lower back pain and a lumbar region mass. Magnetic resonance imaging demonstrated a heterogeneously enhanced mass in the L1 vertebral arch. The patient received neoadjuvant chemotherapy, followed by a surgical procedure comprising an anterior spinal fusion and en bloc resection. Histologically, our initial diagnosis was osteosarcoma. The postoperative course was uneventful, and the patient received adjuvant chemotherapy. However, the tumour metastasised to the lung 5 years after the first surgery, and a second surgery was performed for lung tumour resection. The histology of the metastatic lung tumour appeared similar to that of the malignant SFT, and the specimen from the first surgery was re-examined. Immunohistochemically, the tumour was positive for STAT6. Reverse transcription-polymerase chain reaction revealed a NAB2-STAT6 fusion gene, thus confirming our final diagnosis of malignant SFT. The patient died of disease progression 8 years after the first surgery; however, there was no evidence of local recurrence.ConclusionsMalignant SFT in the vertebral arch is extremely rare and very difficult to distinguish histologically an osteoid from lace-like collagen. STAT6 immunostaining is useful for distinguishing malignant SFTs from other neoplasms. Although it is difficult to completely resect a SFT arising from the spine, we demonstrated the feasibility of an en bloc resection of spinal tumours arising from posterior elements, without local recurrence.

【 授权许可】

CC BY   
© The Author(s). 2017