High-grade thoracic intradural extramedullary solitary fibrous tumor: A case report and literature review

Background: Solitary fibrous tumor (SFT) is an uncommon mesenchymal neoplasm of the central nervous system. Spinal intradural extramedullary SFT is particularly rare and can resemble more common lesions, including meningioma and schwannoma, on preoperative imaging. Case Description: A 57-year-old female presented with a 5-month history of progressive motor and sensory thoracic paraparesis. Magnetic resonance imaging demonstrated a 34 × 15 × 10 mm intradural extramedullary mass extending from T3 to T5 with marked spinal cord compression. Surgery included T3–T4 laminectomy, durotomy, microsurgical tumor resection, and T2–T5 posterior instrumented fusion. Subtotal resection was performed because of nerve-root infiltration. Histopathology demonstrated a grade 3 SFT with focal necrosis, up to 6 mitoses per 10 high-power fields, a Ki-67 index of approximately 20%, and diffuse signal transducer and activator of transcription 6 positivity. Two months postoperatively, the patient ambulated independently with 5/5 motor function, residual L5-distribution dysesthesia, and preserved continence. Conclusion: High-grade spinal intradural extramedullary SFT is rare; histopathological and immunohistochemical confirmation is essential, and high-grade histology with subtotal resection warrants prolonged surveillance and multidisciplinary evaluation of adjuvant therapy.