Difficulties in differential diagnosis of intracranial solitary fibrous tumor: a clinical case

According to the 5th edition of the World Health Organization (WHO) Classification of Tumors of the Central Nervous System (CNS), published in 2021, solitary fibrous tumor (SFT) has been established as a distinct nosological entity within the category of rare mesenchymal neoplasms, exhibiting a propensity for early recurrence and systemic dissemination.The limited prevalence of SFTs accounts for the scarcity of publications describing their specific neuroimaging patterns, while the clinicopathological features of this tumor have been well-characterized. The lack of robust diagnostic criteria poses significant challenges in differentiating SFTs from other intracranial neoplasms, which require fundamentally distinct therapeutic approaches. This report describes the clinical case of a 40-year-old male patient presenting with headache, systemic dizziness, recurrent syncopal episodes, and generalized tonic-clonic seizures over a two-month period. Brain MRI revealed an extra-axial mass in the left parasellar region, attached with its base to the dura mater, accompanied by perifocal edema, mass effect of the left temporal lobe, prominent vascularity, intense homogeneous contrast enhancement, and elevated perfusion values. The preoperative differential diagnosis included meningioma, schwannoma, dural metastatic lesion, chondrosarcoma, and MALT lymphoma. The «YinYang» sign emerged as the most significant diagnostic criterion, characterized by heterogeneous tumor signal intensity on T2- and T2-FLAIR sequences. The patient underwent microsurgical resection of the tumor. Histopathological examination confirmed the diagnosis of SFT. Thus, the use of a comprehensive multiparametric MRI protocol enables a high-probability preoperative suspicion of SFT, which is critical for surgical planning.