Solitary fibrous tumor of temporal and infratemporal region: A case report and review of rare entity

Solitary fibrous tumor (SFT) is a rare, benign spindle-cell neoplasm initially thought to be of mesothelial origin but later recognized as mesenchymal. While uncommon in the head and neck region, SFTs typically present in the oral cavity, orbit, and paranasal sinuses. The tumor's imaging characteristics, such as those seen in ultrasound and MRI, can often mimic vascular lesions, leading to diagnostic challenges. This report presents a case of a 36-year-old female with a painless, gradually enlarging mass in the left temporal region. Imaging suggested a fusiform hypoechoic lesion in the infratemporal region, likely involving the temporal bone and masticator space. Surgical excision was performed using the Alkayat-Bramley approach with zygomatic arch osteotomy for better access. Histopathology revealed spindle cells in a collagenous stroma with vascular spaces, multinucleated giant cells, and hemorrhagic areas, confirmed as SFT by positive immunohistochemical markers (Vimentin, S100, CD34, BCL2, and STAT6). Postoperative recovery was uneventful, and there was no recurrence at follow-up.

SFTs in the head and neck often present with nonspecific symptoms due to their slow growth and lack of compression of vital structures. Imaging features may suggest a vascular lesion, but definitive diagnosis requires histopathological and immunohistochemical confirmation. Surgical excision remains the treatment of choice, with radiotherapy reserved for challenging cases. While chemotherapy has limited efficacy, complete resection with long-term follow-up is crucial due to the potential for recurrence, especially in malignant forms. This case highlights the importance of including SFT in the differential diagnosis for head and neck lesions and underscores the role of histological analysis in achieving an accurate diagnosis.