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LETTER TO EDITOR
Year : 2017  |  Volume : 65  |  Issue : 1  |  Page : 192-193

Intracranial fibrous xanthoma mimicking a falcine meningioma


Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China

Date of Web Publication12-Jan-2017

Correspondence Address:
Zhongli Jiang
Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, No. 6 TiantanXili, Dongcheng District, Beijing - 100050
China
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0028-3886.198204

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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

How to cite this URL:
Lin Z, Li Z, Zhao M, Wang Y, Jiang Z. Intracranial fibrous xanthoma mimicking a falcine meningioma. Neurol India [serial online] 2017 [cited 2017 Mar 25];65:192-3. Available from: http://www.neurologyindia.com/text.asp?2017/65/1/192/198204


Sir,

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.[1] 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).[4] 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,[2],[3] 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.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.[11]

 
  References Top

1.
Yamataki A, Chiba Y, Tokoro K, Ide K, Yagishita S, Wakabayashi Y, et al. Multicentric intracranial fibrous xanthoma: Case report. Neurol Med Chir 1990;30:759-62.  Back to cited text no. 1
    
2.
Claus EB, Bondy ML, Schildkraut JM, Wiemels JL, Wrensch M, Black PM. Epidemiology of intracranial meningioma. Neurosurgery 2005;57:1088-95.  Back to cited text no. 2
    
3.
Ostrom QT, Gittleman H, Farah P, Ondracek A, Chen Y, Wolinsky Y, et al. CBTRUS statistical report: Primary brain and central nervous system tumors diagnosed in the United States in 2006–2010. Neuro Oncol 2013;15(Suppl 2):ii1–56.  Back to cited text no. 3
    
4.
Sundaram M, McGuire HM, Schajowicz F. Soft tissue masses: Histologic basis for decreased signal (short T2) on T2-weighted MR images. AJR Am J Roentgenol 1987;148:1247-50.  Back to cited text no. 4
    
5.
Funakoshi T, Yamada H, Miwa Y, Takada M, Okuma A, Shimokawa K, et al. A case of intracranial multiple fibrous histiocytoma. Case report and review of literature. No Shinkei Geka 1984;12:641-8.  Back to cited text no. 5
    
6.
Kamiryo T, Abiko S, Orita T, Aoki H, Watanabe Y, Hiraoka K. Bilateral intracranial fibrous xanthoma. Surg Neurol 1988;29:27-31.  Back to cited text no. 6
    
7.
Ohmori Y, Kubo S, Yasukouchi K, Takemi K, Ikeda M, Ibayashi N. Intracranial fibrous xanthoma (xanthofibroma) in an infant: A case report. No Shinkei Geka 1991;19:267-71.  Back to cited text no. 7
    
8.
Baehring JM, Alemohammed S, Croul SE. Malignant fibrous histiocytoma presenting as an intraventricular mass five years after incidental detection of a mass lesion. J Neurooncol 2001;52:157-60.  Back to cited text no. 8
    
9.
Pimentel J, Fernandes A, Tavora L, Miguens J, Lobo Antunes J. Benign isolated fibrohistiocytic tumor arising from the central nervous system. Considerations about two cases. Clin Neuropathol 2002;21:93-8.  Back to cited text no. 9
    
10.
Moliterno JA, Sood S, Zambrano E, Kim JH, Piepmeier JM, Baehring JM. Intracranial benign fibrous histiocytomas: A case report and review. J Neurooncol 2009;92:203-9.  Back to cited text no. 10
    
11.
Chen H, Li P, Liu Z, Xu J, Hui X. Benign fibrous histiocytoma of the fronto-temporo-parietal region: A case report and review of the literature. Int J Clin Exp Pathol. 2015;8:15356-62e.  Back to cited text no. 11
    


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