Intracranial Angiomatoid Fibrous Histiocytoma: a Case report and literature review

• Published in: World neurosurgery 2016-12, Vol.96, p.403-409
• Main Authors: Alshareef, Mohammed A., MD, Almadidy, Zayed, BS, Baker, Tiffany, MD, PhD, Perry, Arie, MD, Welsh, Cynthia T., MD, Vandergrift, William A., MD
• Format: Article
• Language: English
• Subjects: Adult; Angiomatoid fibrous histiocytoma; Antigens, CD - metabolism; Antigens, Differentiation, Myelomonocytic - metabolism; Brain tumor; Cranial Fossa, Middle - diagnostic imaging; Craniotomy - methods; Female; Histiocytoma, Malignant Fibrous - diagnostic imaging; Histiocytoma, Malignant Fibrous - surgery; Humans; Intracranial tumor; Magnetic Resonance Imaging; Neurosurgery; Petrous apex tumor; Receptors, Cell Surface - metabolism; Schwannoma; Syndecan-1 - metabolism; Temporal Lobe - diagnostic imaging
• ISSN: 1878-8750; 1878-8769
• DOI: 10.1016/j.wneu.2016.09.059

Abstract Background Angiomatoid fibrous histiocytoma (AFH) is a rare and low-grade soft tissue lesion that typically arises from subcutaneous and deep dermal tissue of extremities. The first case was reported in 1979 by Enzinger, and since has become known as a distinct entity. AFH has been increasingly reported in different organ systems, with rare reports of primary intracranial AFH. To date there have been 3 reports of intracranial AFH and one report of metastasis to the brain, most of which were in young adults. Case Description In this paper, we present a case of an older patient with a large, petrous apex AFH that was clinically mistaken for a trigeminal nerve schwannoma. We discuss radiographic and histologic features initially found and the findings that ultimately led to the diagnosis of AFH. We also discuss the findings noted in all other reports of intracranial AFH. Conclusion We present a rare case of intracranial AFH in a patient relatively old for onset of diagnosis. To date, only 3 prior cases of AFH have been reported. The radiographic findings were nonspecific and initially pointed toward a diagnosis of schwannoma; whereas histopathology seemed to initially suggest meningioma. Further pathological consultation finally confirmed AFH as the diagnosis. We suspect there are more cases of intracranial AFH that are misdiagnosed due to variability of findings on pathology. The behavior of this tumor remains in question as one of the 3 reported cases demonstrated significant recurrence. As such, a gross-total resection of this lesion is preferable.