Figure 1: T1WI Post-contrast image showing a large, well-defined extra-axial solid lesion with lobulated margins in the right fronto-temporal region, appearing predominantly isointense to white matter with patchy areas of hypointensity with associated dural thickening and mass effect as described already above.
Then the patient underwent surgery in the form of a right frontotemporal parietal craniotomy with near total excision of the space-occupying lesion, and the tissue was sent for histopathological examination, in which it came out to be a solitary fibrous tumor of grade 3. Just after surgery, the patient starts developing a bullous lesion on the bilateral foot at the Achilles tendon, which gradually increases in size and bursts after 3 days, following which the patient has had a chronic ulcer for 1 month.
On post-op NCCT head, an ill-defined hypodense area with blood attenuating density interspersed multiple extra-axial and intra-axial foci in the right lateral ventricle along with mild surrounding edema, resulting in a mass effect in the form of an effacement of nearby sulcal spaces and the right lateral ventricle. A contralateral midline shift of 13.6mm was also seen. Subsequent adjuvant therapy in the form of whole-brain external beam radiotherapy (54Gy/30#@1.8Gy/#@5#/wk) was given to the patient.
On the Doppler of the bilateral lower limb, a few enlarged necrotic lymph nodes are seen in the left inguinal region, with the largest measuring approximately 2.5x2 cm in size. Arterial systems, venous systems, superficial venous systems, and perforators seem to be completely normal. The patient did not complain of inguinal lymph nodes. On USG-guided Fnac, it was cited that previous inguinal lymph nodes were likely reactive.
The right FTP mass excision biopsy specimen underwent immunohistochemistry analysis since SFT is challenging to properly identify using imaging. Lesional cells exhibited immunoreactivity for S100 with a score of 1+, CD34 with a score of 3+, and STAT 6 with a score of 3+. In the cells of the lesions, there was immunoreactive patchy positivity for CK. In 6–7% of the lesional cells with INI-1 retention, KI67 was increased. SMA, DESMIN, EMA, SOX 10, or TLE-1 were not reactive.