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"en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Postoperative phase. Pathology study. (a) Haematoxylin-eosin stain 10×. Mesenchymal proliferation arranged in a swirling growth pattern, consisting of spindle cells and occasional interspersed thin bands of collagenous tissue. They are accompanied by frequent branching blood vessels with perivascular hyalinisation. (b) Haematoxylin-eosin stain 40×. Spindle-shaped tumour cells (predominant), ovoid and round, with elongated nuclei and few atypical nuclei. No significant mitotic activity or areas of necrosis are evident. (c) CD34 immunohistochemistry 20×. Positive diffuse cytoplasmic CD34 immunoreactivity. (d) STAT6 immunohistochemistry 20×. Highly-specific and sensitive STAT6 nuclear staining of solitary fibrous tumour.</p>"
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"textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Solitary fibrous tumour (SFT) is a rare mesenchymal tumour.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> Intracranial SFT (ISFT) develop from mesenchymal cells of the dura mater, and make up only 0.09% of all tumours of dural origin.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> ISFT have been described in various locations, including convexity, skull base and parasagittal.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> ISFT of the skull base (ISFTsb) are particularly unusual, with a limited number of cases documented to date.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> Within this subgroup, only two cases were described at the level of the olfactory groove.<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4,5</span></a> ISFT present clinically with headache and variable signs/symptoms depending on their location and the neurovascular structures involved. They cannot be easily distinguished from other more common intracranial lesions from a radiological point of view (mainly meningiomas). If the lesion is large and/or is causing clinical repercussions, surgery with total resective intent should be the first therapeutic approach to consider. The degree of surgical resection, as well as the final pathology diagnosis, will be decisive in defining the prognosis and postoperative follow-up and treatment regimens.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a></p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Case report</span><p id="par0010" class="elsevierStylePara elsevierViewall">We present the case of a 57-year-old male, with no relevant medical or surgical history, who came to our hospital's Accident and Emergency department with a six-month history of bilateral frontal headache, anosmia and behavioural alterations (disorganised behaviour, social isolation and deficiency in self-care). A non-contrast and contrast-enhanced brain computed tomography (CT) scan showed a large tumour mass measuring 8cm × 6.5cm x 6.5 cm, extra-axial in appearance and located in the anterior cranial fossa, initially consistent with a giant olfactory groove meningioma. A scheduled non-contrast and contrast-enhanced brain magnetic resonance imaging (MRI) scan was performed, the results of which did not alter the initial suspected diagnosis (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). Given the large size and clinical impact of the lesion, resective surgery was considered as the first therapeutic option. A bifrontal transbasal approach was performed incorporating the anterior wall of the frontal sinus in a single piece. Macroscopically-complete resection of the lesion was carried out using a microsurgical procedure. The patient made a good recovery postoperatively. Postoperative radiological follow-up showed no complications or apparent residual tumour (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>). The provisional pathology diagnosis was a low-grade fusocellular tumour. The final pathology diagnosis was unexpected: a solitary fibrous tumour (WHO grade 1, 2021) (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Discussion</span><p id="par0015" class="elsevierStylePara elsevierViewall">The concept of SFT as we know it today is the result of successive discoveries and modifications made throughout the 20th and 21st centuries. The first report of localised primary pleural neoplasm was made by Wagner in 1870.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> In the seminal paper published by Klemperer and Rabin in 1931, primary pleural neoplasms were classified into two groups: localised and diffuse. Within the framework of the first group and defending a submesothelial histological origin, they published the first reliable anatomical-pathological description of what years later would be known as SFT.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> In contrast, in 1942 Stout and Murray suggested a mesothelial origin for this lesion.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> This led to the widespread use of certain terminology to designate it in the literature; localised fibrous mesothelioma, benign fibrous mesothelioma and solitary fibrous mesothelioma were some of the names given at that time to what we now call SFT. In the late 1980s and 90 s, with the advent of new advances and evidence in the fields of immunohistochemistry and electron microscopy, the idea of the submesothelial origin of this neoplasm regained momentum. Its nature was unequivocally defined as eminently mesenchymal and the confusing terminology previously used was progressively replaced by the current nomenclature.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a> SFT began to be reported in multiple locations, demonstrating that the lesion was not specific to the pleura or other serous cavities. In fact, 1996 was considered by some authors as <span class="elsevierStyleItalic">the year of the SFT</span>.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> The history of SFT paralleled that of haemangiopericytoma (HPC), a lesion of uncertain histology rich in capillary structures and perivascular cells described by Stout and Murray in 1942.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a> SFT and the HPC co-existed as separate entities for years. However, due to the significant histological overlap between them and the lack of clear criteria for deciding whether a given lesion should be called one or the other, the latter term was gradually abandoned in favour of the former.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> In the 2016 WHO classification of tumours of the central nervous system, the hybrid concept SFT/HPC was used to designate the same anatomical and pathological entity with two varieties. In the 2021 classification, however, the term HPC was definitively deleted.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">SFT is an unusual tumour of mesenchymal origin.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> It can develop in any part of the body, but is typically located in the pleural area. ISFT develop from the mesenchymal cells of the intracranial dura mater. These lesions have an estimated annual incidence of 1.3%, accounting for 0.09% of all tumours of dural origin. They tend to occur most frequently in people in their thirties and forties, with no clear gender predilection.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> ISFT have been described in multiple locations, including convexity, skull base, parasagittal and interventricular.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> The main review published to date on ISFTsb collected 60 cases in total,<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> of which only two were at the level of the olfactory groove.<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4,5</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">The most frequently-described presenting symptoms in ISFTsb were visual disturbances (52%) and headache (38%).<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> The clinical onset of ISFTsb of the olfactory groove was in the form of epileptic seizures in one case and headache, ataxia, anosmia, decreased taste sensation and visual field alterations in the other.<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4,5</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">Radiologically, ISFT cannot be clearly distinguished from other lesions, particularly meningiomas. On CT they appear as isodense lesions that are intensely and diffusely contrast enhanced, show no calcifications and cause little or no bone erosion. On MRI it is usually possible to identify a heterogeneous pattern in T2-weighted sequences, with the hypodense areas in these sequences showing intense enhancement in the contrast-enhanced T1-weighted sequence.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> Identification of a <span class="elsevierStyleItalic">dural tail</span> is possible in some cases. On MR spectroscopy it is common to recognise a myo-inositol peak.<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a> Arteriogram usually identifies main arterial inflow from the internal carotid artery, an intratumoural <span class="elsevierStyleItalic">corkscrew</span> angioarchitectural pattern and absence of early draining veins. The normalised apparent diffusion coefficient and the intratumoural susceptibility signal intensity have been shown to be useful radiological markers to differentiate ISFT from meningiomas. Specifically, the combination of a normalised apparent diffusion coefficient value >1.15 and an intratumoural susceptibility signal intensity value >1.00 had a sensitivity of 81.25% and a specificity of 78.12% in distinguishing ISFT from meningiomas.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">Pathology is the diagnostic gold standard for SFT.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> Macroscopically, they usually have a multilobular appearance, a hard consistency and a greyish colour.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> Microscopically, they are characterised by the presence of mesenchymal cells of spindle-shaped morphology between which collagen fibres are interspersed, together with vascular structures of variable size that generally adopt a branching growth pattern. Immunohistochemically, positivity for nuclear STAT6 and cytoplasmic CD34 is typical. Other markers that may be positive include CD99, Bcl-2 and vimentin. The markers S-100, cytokeratin, smooth muscle actin and epithelial membrane antigen are negative.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> The 2021 WHO classification of central nervous system tumours identified three histological grades.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> Grade 1 shows a hypocellular pattern with a high content of collagen fibres. In grade 2, a hypercellular pattern with low collagen fibre content and a branching vascular pattern characteristic of <span class="elsevierStyleItalic">deer antlers</span> is identified. In grade 3, in addition, ≥5 mitoses can be identified per 10 high-resolution fields.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">The treatment of choice for ISFT should be surgical with resective intent as wide as possible (ideally total), being especially indicated in those of large size and/or causing symptoms.<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2,4,5</span></a> Gross-total resection has been shown to significantly prolong progression-free survival and overall survival and is therefore the main therapeutic weapon available for these tumours.<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a> The location of an ISFT at the skull base generally adds an additional level of technical complexity to the surgical procedure and may be associated with lower total resection rates.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> The bifrontal transbasal approach can be considered in the case of a giant ISFTsb of the olfactory groove such as the one presented here, given its versatility and ability to provide an excellent view of the anterior cranial fossa and its neurovascular structures.<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a> In the two cases of ISFTsb of the olfactory groove documented in the literature, this approach was performed. The degree of resection achieved was total in both cases. The suitability of other surgical approaches to ISFTsb of the olfactory groove has not been proven to date.<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4,5</span></a> Adjuvant radiotherapy has been shown to be useful in patients in whom macroscopic subtotal resection has been achieved, but has not been shown to be useful in cases of macroscopic complete resection.<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a> Schedules of 25–35 sessions of adjuvant radiotherapy to achieve a final dose of 46−52 Gy have been described in the literature. The response of ISFT to radiotherapy is dose-dependent, with higher rates of local control achieved at doses of 45 Gy or higher. Chemotherapy has not been proven to be useful so far.</p><p id="par0045" class="elsevierStylePara elsevierViewall">ISFT are prone to local recurrence and malignant transformation and can cause extracranial metastases at any time in their natural history (even those of low histological grade). Close cranial and extracranial radiological monitoring is therefore warranted, although standardised recommendations have yet to be established.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a></p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Conclusions</span><p id="par0050" class="elsevierStylePara elsevierViewall">Cases of ISFTsb of the olfactory groove are rare in the literature. Macroscopically and radiologically, it is highly unlikely to be distinguishable from an olfactory groove meningioma, and a definitive diagnosis can only be made by pathology examination. The tendency of these tumours to recur locally makes total surgical resection very important. We recommend the bifrontal transbasal approach as a surgical therapeutic option in a case such as the one we present here, taking into account the wide exposure and excellent view it offers of the anterior cranial fossa. Moreover, the tendency of these tumours to become malignant and cause extracranial metastases makes close outpatient follow-up (especially radiological) necessary, even if total macroscopic resection has been achieved. More studies are needed to assess the suitability of other surgical approaches and standardised follow-up plans in cases such as ours.</p></span></span>"
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0 => "Giant solitary fibrous tumor"
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1 => array:4 [
"clase" => "abr"
"titulo" => "Abbreviations"
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2 => "SFT"
3 => "ISFT"
4 => "ISFTsb"
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0 => "Tumor fibroso solitario gigante"
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"resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Solitary fibrous tumors are rare mesenchymal neoplasms that can develop in any part of the body, with those that settle intracranially being confused with meningiomas as a general rule. We present the case of a 57-year-old man referred to our hospital due to bifrontal headache, anosmia, and behavioral alterations of 6 months' duration. Radiological studies revealed the existence of a large tumor mass with an extra-axial appearance and location in the anterior cranial fossa, initially compatible with a giant meningioma of the olfactory groove. Gross total resection of the mass was carried out. The pathological diagnosis was unexpected: a solitary fibrous tumor (WHO grade 1, 2021). Given the aggressive nature of these lesions, with a tendency to recurrence, malignant transformation and even metastasis, surgery with macroscopically complete resection intention should constitute the first therapeutic option. Close clinical-radiological follow-up after the procedure is justified.</p></span>"
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"titulo" => "Resumen"
"resumen" => "<span id="abst0010" class="elsevierStyleSection elsevierViewall"><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Los tumores fibrosos solitarios son neoplasias mesenquimales infrecuentes que pueden desarrollarse en cualquier parte del organismo, siendo aquellos que se asientan intracranealmente confundidos con meningiomas por norma general. Presentamos el caso de un varón de 57 años remitido a nuestro centro presentando cuadro de cefalea bifrontal, anosmia y alteración del comportamiento de 6 meses de evolución. Los estudios radiológicos revelaron la existencia de una gran masa tumoral de apariencia extra-axial y localización en fosa craneal anterior, inicialmente compatible con un meningioma gigante del surco olfatorio. Se llevó a cabo la resección quirúrgica radical de la lesión. El diagnóstico anatomopatológico resultó inesperado: un tumor fibroso solitario (grado 1 de la OMS, 2021). Dada la naturaleza agresiva de estas lesiones, con tendencia a la recidiva, transformación maligna e incluso metastatización, la cirugía con intención resectiva macroscópicamente completa debe constituir la primera opción terapeútica. El seguimiento clínico-radiológico estrecho tras el procedimiento está justificado.</p></span>"
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"en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Preoperative phase. Radiological study. (a–c) Contrast-enhanced brain CT scan in axial, sagittal and coronal views, respectively. There is a large extra-axial tumour mass located in the anterior cranial fossa, measuring 8cm × 6.5cm × 6.5 cm, which is intensely and homogeneously enhanced with contrast. The tumour does not cause frank erosion of the floor of the anterior cranial fossa or hyperostosis. (d–f) Contrast-enhanced brain MRI in axial, sagittal and coronal views, respectively. The suspected radiological diagnosis is giant olfactory groove meningioma. Note how the tumour displaces both anterior cerebral arteries in a posterolateral direction. No <span class="elsevierStyleItalic">dural tail</span> is clearly visible. Intra-surgical phase. (g) Patient positioning. Head held with Mayfield clamp in neutral position. Biauricular incision. (h) Bone exposure. Subgaleal dissection with preservation of the periosteum. Craniotomy planning. (i) Exposure and emptying of the tumour mass. Note its greyish and multilobular appearance. (j) Identification and protection of the olfactory nerve over the anterior cranial fossa. (k) Intra-tumoural emptying is continued until blunt dissection of the tumour capsule over the anterior cranial fossa is achieved. (l) Craniotomy. Bone piece.</p>"
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"en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Postoperative phase. Radiological study. (a–c) Contrast-enhanced brain CT scan in axial, sagittal and coronal views, respectively. (d and e) Contrast-enhanced brain MRI in axial and sagittal views, respectively. No apparent contrast-enhancing residual tumour can be seen. No major complications are seen. (f) Brain CT scan in 3D reconstruction. The surgical approach used can be appreciated.</p>"
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"en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Postoperative phase. Pathology study. (a) Haematoxylin-eosin stain 10×. Mesenchymal proliferation arranged in a swirling growth pattern, consisting of spindle cells and occasional interspersed thin bands of collagenous tissue. They are accompanied by frequent branching blood vessels with perivascular hyalinisation. (b) Haematoxylin-eosin stain 40×. Spindle-shaped tumour cells (predominant), ovoid and round, with elongated nuclei and few atypical nuclei. No significant mitotic activity or areas of necrosis are evident. (c) CD34 immunohistochemistry 20×. Positive diffuse cytoplasmic CD34 immunoreactivity. (d) STAT6 immunohistochemistry 20×. Highly-specific and sensitive STAT6 nuclear staining of solitary fibrous tumour.</p>"
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