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.