J Neurol Surg B 2014; 75 - A143
DOI: 10.1055/s-0034-1370549

Solitary Fibrous Tumor of the Orbit in Conjunction with Metastatic Prostate Cancer

Vernard S. Fennell 1, Robert Klein 1, Lyn Polonski 1, Michael Lemole 1
  • 1Tucson, USA

Introduction: Solitary fibrous tumors of the orbit are a very rare occurrence; those with atypical cell morphology and conjunction with metastatic disease have not been reported in the literature. Here we present a case of a solitary fibrous tumor of the anterior skull base in a 79-year-old man with metastatic prostate cancer.

Case Description: A 79-year-old man presented with progressively painful proptosis and loss of vision in the right orbit with worsening headaches. Radiographic presentation of the lesion with MRI revealed a 4.4 × 3.9 cm mass, fairly circumscribed, isointense mass on T1, and heterogeneous contrast enhancement and areas of hypointensity with an eccentric hyperintensity on STIR sequence. Radiographically, the lesion appeared to exhibit confinement within the orbital cavity, with no obvious encroachment into the optic canal, and an absence of bony erosion (Fig. 1). The patient underwent craniotomy with orbitotomy, lateral canthotomy and exenteration of the orbit and lesion. Pathologic immunohistochemical staining showed the lesion to be vimentin and CD 34 positive and negative for PSA, PSAP, S-100, HMB-45, Melan-A, MAK-6 Actin, Desmin, EMA, CD-45 and CD-31. The relatively high cellularity and lack of extensive fibrosis were deemed atypical. The patient also exhibited multiple bony metastases, with an elevated PSA (>2000) and a biopsy positive prostatic adenocarcinoma, with a Gleason score of 7.

Radiographic follow up at 8 months revealed recurrence with extension into the right temporal lobe and maxillary sinus (Fig. 2). Combined transcranial, transbuccal re-resection with postoperative radiosurgical boost is forthcoming.

Conclusion: Solitary fibrous tumors of the orbit are sparsely reported within the literature, with primarily case reports being identified. To our knowledge, there is no known report of such lesions in conjunction with metastatic prostate adenocarcinoma.

Fig. 1 Preoperative imaging shows a heterogeneously enhancing orbital mass on T1 post contrast MRI (A). Isointense on T1 without contrast (B). There is displacement of the globe inferiorly on T1 post contrast coronal view (C), also visualized on coronal CT (D), with minimal osseous erosion on axial CT (E).

Fig. 2 Immediate postoperative CT with exenterated orbit and no obvious residual tumor, (A). 8 month post operative MRI with local recurrence and extension into the temporal lobe.