Work

Case Report: Solitary fibrous tumor of the right temporal skull base with bone destruction and postoperative recurrence

Year: 2026

Type: article

Abstract: Background: Solitary fibrous tumor (SFT) is a rare fibroblastic mesenchymal neoplasm of the central nervous system, and temporal skull-base lesions with destructive osseous change and extension toward the middle-ear region are uncommon. Case presentation: A 60-year-old woman presented with acute right peripheral facial weakness. CT demonstrated expansile mixed lytic-sclerotic destruction of the right temporal bone and middle cranial fossa floor, and MRI showed a 46 × 38 × 36 mm lobulated mass with heterogeneous signal, irregular peripheral and nodular enhancement, central nonenhancing necrotic or cystic change, and adjacent temporal-lobe edema. Right frontotemporal microsurgical resection achieved gross-total macroscopic removal, although piecemeal resection rendered microscopic margins unassessable. Histology and immunohistochemistry supported SFT, with 4 mitoses/10 high-power fields, focal necrosis, nuclear STAT6 expression, weak partial CD34 expression, MDM2 immunoreactivity, and a Ki-67 labeling index of approximately 40%. Review of the available sections showed no morphologically distinct high-grade sarcomatous component. Under the 2021 CNS WHO framework, the documented mitotic count corresponds most closely to grade 1. Postoperative radiotherapy was recommended but declined. Telephone follow-up indicated that outside-hospital MRI reportedly showed tumor recurrence at 18 months and further enlargement at 27 months. The patient also reported that outside examinations showed no metastatic disease in the lungs, liver, or skeleton. During later follow-up, the family expressed concern that the patient might not tolerate another major surgical intervention, and continued clinical and imaging follow-up was recommended. Conclusion: This case illustrates that a documented mitotic count within the CNS WHO grade 1 range does not exclude clinically significant local recurrence. In skull-base SFT, formal pathologic grading should be interpreted together with anatomic extent, margin assessability, proliferative features, and the certainty of local control when planning postoperative management and surveillance.

Source: Frontiers in Surgery

DOI: 10.3389/fsurg.2026.1955012