Spinal solitary fibrous tumor metastatic to the fourth ventricle: illustrative case.

Authors

Ryan Wang, Shervin Pejhan, Claire I Coire, Lee Cyn Ang, Joseph F Megyesi

Published in

Journal of neurosurgery. Case lessons. Volume 11. Issue 26. Jun 29, 2026. Epub Jun 29, 2026.

Abstract

CNS solitary fibrous tumors (SFTs) are rare mesenchymal neoplasms that arise from the meninges and are characterized by a NAB2-STAT6 gene fusion and abundant STAT6 nuclear expression on immunohistochemistry. On imaging, SFTs can mimic meningiomas, but they differ in their clinical behavior. CNS SFTs have a propensity to recur locally and metastases, although rare, have been described.
The authors report the case of a 76-year-old male with a history of a lower cervical spine SFT treated with surgery and radiation therapy. He presented with progressively worsening gait and balance, and headaches. Imaging showed a fourth ventricular mass that was resected via a midline suboccipital craniectomy. Pathological analysis showed a WHO grade 2 epithelioid SFT, confirmed by STAT6 expression and a rare NAB2ex5-STAT6ex17 fusion variant. The histology slides from 22 years prior were compared and found to be similar, suggesting metastasis of the original tumor.
To the authors' knowledge, this is the first reported case of a spinal SFT with metastasis to the fourth ventricle and the first epithelioid SFT presenting within the fourth ventricle. Long-term follow-up is recommended due to the risk of local recurrence and metastases. https://thejns.org/doi/10.3171/CASE25414.

PMID:
42372303
Bibliographic data and abstract were imported from PubMed on 30 Jun 2026.

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