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|LETTER TO EDITOR
|Year : 2017 | Volume
| Issue : 1 | Page : 192-193
Intracranial fibrous xanthoma mimicking a falcine meningioma
Zhiqin Lin, Zongze Li, Meng Zhao, Yongzhi Wang, Zhongli Jiang
Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
|Date of Web Publication||12-Jan-2017|
Dr. Zhongli Jiang
Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, No. 6 TiantanXili, Dongcheng District, Beijing - 100050
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Lin Z, Li Z, Zhao M, Wang Y, Jiang Z. Intracranial fibrous xanthoma mimicking a falcine meningioma. Neurol India 2017;65:192-3
A 25-year-old female patient was admitted to a local hospital with a history of several episodes of seizures. Computed tomography (CT) scan of the brain revealed an isodense mass in the left frontal region with prominent perilesional brain edema and marked midline shift. Three weeks later, she was transferred to the Beijing Tiantan hospital with a radiological diagnosis of intracranial space-occupying lesion. Neurological examination revealed papilledema. Magnetic resonance (MR) images of the brain revealed an irregularly-shaped solid lesion beside the cerebral falx with compression of the left frontal brain parenchyma. The lesion showed isointense T1 and hypointense T2 signals as well as homogeneous enhancement [Figure 1]. Thus, a preoperative diagnosis of a falxine meningioma was made according to the characteristics of the lesion. Total removal of the tumor was performed through the left frontal craniotomy. During the operation, the tumor was found to be a gray-white, hard, mass-like lesion. In addition, it was found that the tumor was not attached to the dura mater or the cerebral falx, and was almost well-demarcated. Postoperative pathology confirmed the diagnosis of fibrous xanthoma with positivity for vimentin, CD68, neuron-specific enolase, periodic acid Schiff, local positivity for S100, myelin-basic protein, and Ki-67 (<5%), and negativity for glial fibrillary acidic protein, progesterone receptor, synaptophysin, SMA, desmin, CD34, nestin, creatine kinase, and epithelial membrane antigen [Figure 2]. The patient was discharged 16 days after the surgery without any neurological deterioration. She was followed-up for 4 years, and no recurrence was found.
|Figure 1: MRI showing an irregularly shaped lesion showing T1 isointense (a) and T2 hypointense (b) signals in the left frontal region with homogeneous enhancement (c, d and e). A cerebrospinal fluid cleft between the neoplasm and brain parenchyma was seen on T2-weighted images (b)|
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|Figure 2: Pathological examination revealed a diagnosis of fibrous xanthoma (a, b) with negativity for epithelial membrane antigen (c) on immunohistochemical analysis|
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Fibrous xanthoma (fibrous histiocytoma) is commonly found in the extracranial soft tissue; its intracranial occurrence is extremely rare. Moreover, there remains limited data focusing on the morbidity and clinical characteristics of intracranial fibrous xanthomas among primary brain tumors [Table 1].
|Table 1: Review of the literature of intracranial fibrous xanthoma (fibrous histiocytoma)|
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Radiologically, the present case showed isointensity on T1-weighted images and hypointensity on T2-weighted images. The soft tissue tumors showing hypointensity on T2-weighted images have certain histological features (i.e., rich fibrous collagen and poor cellular elements). In addition, a cerebrospinal fluid cleft between the neoplasm and brain parenchyma was seen on T2-weighted images [Figure 1]b, confirming the extra-axial location of the tumor.
Meningiomas are the most frequently reported intracranial extra-axial tumors, accounting for nearly 30% of all primary brain neoplasms,, and the falx cerebri is one of the most frequent sites of its occurrence. On nonenhanced T1-weighted images, most meningiomas have no signal intensity difference compared with cortical gray matter. Fibromatous meningiomas may be more hypointense than the cerebral cortex. On T2-weighted images, the signal produced is variable. T2-weighted signal intensity is best correlated with both the histology and the consistency of the meningioma. In general, low-intensity portions of the tumor indicate a more fibrous and harder character (e.g., fibroblastic meningiomas).
The similarity of location and the imaging characteristics in our patient with a fibrous xanthoma suggests that this entity should be considered as a rare differential diagnosis of a falcine meningioma.
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[Figure 1], [Figure 2]