Massive Solitary Fibrous Tumor (SFT) of the Infratemporal and Pterygomaxillary Fossa Treated by Combined Endoscopic Approach

Solitary fibrous tumors (SFTs) were first described as spindle-cell tumors originating from the pleura. Until recently, there was some debate with regards to the name and origin of these tumors and their distinction from hemangiopericytomas (HPCs), a rare type of vascular tumor.

Morphologic, immunohistochemical, and clinical features of HPCs were not specific for one entity. Except for myopericytoma, infantile myofibromatosis and HPC-like lesions of the sinonasal tract show myoid differentiation; all other HPC-like lesions are best considered as subtypes of SFT. Due to their mesenchymal origin, we are now aware that SFTs may involve several extrapleural sites including soft tissues or meninges. When SFTs involve the skull base and express malignant histologic characteristics, it can be an important challenge for the surgical team.

We report a case of a 54-year-old man complaining of poor vision and facial pain worsening since last year. Computed tomography and magnetic resonance imaging indicated a massive mass involving the right infratemporal and pterygomaxillary fossa. A biopsy proved positive for an SFT with malignant features. Surgery was performed using a combined approach of frontotemporal craniotomy and nasal endoscopy. The subtotal resection, because of nodularity on the dura mater, was a success and was completed by postoperative radiation therapy. Follow-up MRIs showed no recurrence of the tumor.

This is the first case reported of a massive SFT involving this region, treated with minimal invasive surgery without any facial osteotomies.