Korean J Radiol.  2009 Aug;10(4):402-406. 10.3348/kjr.2009.10.4.402.

Intracranial Fibroxanthoma in an Infant: a Case Report

• Chung IH
• Lee YS
• Myong NH
• Lee MJ
• Lee SK
• Ko JH

• KMID: 1777270
• DOI: http://doi.org/10.3348/kjr.2009.10.4.402

Abstract

A primary fibroxanthoma of the central nervous system is very rare. We present a case of an infantile fibroxanthoma that arose from the cranial dura mater in a six-month-old girl with US, MRI and PET/CT features that mimicked a meningioma. The tumor appeared as a large, well-circumscribed echogenic mass in the right parieto-occipital area on US. The tumor was seen as isoattenuated to slightly hypoattenuated on pre-contrast CT scan and as hypometabolic on PET/CT. As seen on T2-weighted image, the mass was heterogeneously hyperintense to the gray matter. The mass was isointense on T1-weighted image and homogeneously strongly enhanced on contrast enhanced T1-weighted image.

Keyword

Fibroxanthoma; Infantile brain tumor; Meningioma

MeSH Terms

*Dura Mater
Female
Histiocytoma, Benign Fibrous/*diagnosis
Humans
Infant
Magnetic Resonance Imaging
Meningeal Neoplasms/*diagnosis
Positron-Emission Tomography
Tomography, X-Ray Computed

Figure

• 

  Fig. 1 Findings for 6-month-old girl with large intracranial mass in right parieto-occipital area are presented. A. Semiaxial US scan with use of low frequency probe (2-5 MHz) reveals large echogenic mass in right parieto-occipital area, and mild dilatation of both lateral ventricles. B-E. Axial and sagittal MR scans show large well-circumscribed, extra-axial tumor in right parieto-occipital area that is isointense with cortex on T1-weighted image (B), slightly hyperintense on T2-weighted image (C) and showing strong homogeneous enhancement on contrast-enhanced T1-weighted image (D, E). Note "tree ring" like appearance (arrowhead in C) and cerebrospinal fluid cleft (arrow in C) and focal leptomeningeal enhancement along anterior aspect of tumor (arrowhead in D). F-G. On PET/CT scan, right parieto-occipital tumor appears as hypometabolic mass (F), and as isoattenuated to slightly hypoattenuated mass relative to adjacent brain parenchyma (G). H. Histopathologic findings of tumor show vaguely fascicular growth of polygonal to spindled tumor cells in relatively delicate fibrous stroma (Hematoxylin & Eosin staining, ×200). I. Immunohistochemically, tumor cells show diffuse cytoplasmic immunopositivity for CD68, histiocytic marker.

Reference

1. Enzinger MG, Weiss SW. Enzinger MG, Weiss SW, editors. Benign fibrohistiocytic tumors. Soft tissue tumors. 2008. 5th ed. St. Louis: CV Mosby;331–342.

2. Miyazono M, Nishio S, Morioka T, Hamada Y, Fukui M, Yanai S. Fibroxanthoma arising from the cranial dura mater. Neurosurg Rev. 1999. 22:215–218.

3. Kim DS, Kim TS, Choi JU. Intradural extramedullary xanthoma of the spine: a rare lesion arising from the dura mater of the spine: case report. Neurosurgery. 1996. 39:182–185.

4. Usul H, Kuzeyli K, Cakir E, Caylan R, Sayin OC, Peksoylu B, et al. Giant cranial extradural primary fibroxanthoma: a case report. Surg Neurol. 2005. 63:281–284.

5. Greenberg SB, Schneck MJ, Faerber EN, Kanev PM. Malignant meningioma in a child: CT and MR findings. AJR Am J Roentgenol. 1993. 160:1111–1112.

6. Osborn AG. Osborn AG, editor. Meningiomas and other nonglial neoplasms. Diagnostic neuroradiology. 1994. St Louis, Mo: Mosby;584–603.

7. Chapman PR, Judd CD, Felgenhauer JL, Gruber DP, Mornin D. Infantile myofibromatosis of the posterior fossa. AJR Am J Roentgenol. 2005. 184:1310–1312.

8. Breidahl WH, Robbins PD, Ives FJ, Wong G. Intracranial plasma cell granuloma. Neuroradiology. 1996. 38:S86–S89.

9. de Ribaupierre S, Meagher-Villemure K, Agazzi S, Rilliet B. Meningeal solitary fibrous tumour in a child. Childs Nerv Syst. 2006. 22:619–622.

10. Büttner A, Pfluger T, Weis S. Primary meningeal sarcomas in two children. J Neurooncol. 2001. 52:181–188.