Sclerosing epithelioid fibrosarcomas involving the neuraxis: Report of three cases

OBJECTIVE AND IMPORTANCE: Sclerosing epithelioid fibrosarcoma (SEF) is a ra re mesenchymal neoplasm composed of rounded, vimentin-immunoreactive tumor cells disposed in nests and cords within a hyalinized collagenous matrix. M ost examples arise in the deep skeletal muscles of adults. The cases record ed to date have been characterized by protracted clinical evolutions with a tendency for stubborn local recurrence, followed by late metastasis. Accor dingly, SEF has been regarded as a low-grade sarcoma. A single instance of brain and vertebral metastasis has been described. We report three examples of SEF distinguished by primary involvement of the neuraxis at initial pre sentation. CLINICAL PRESENTATION: Two tumors had intracranial, calvarial and extracalv arial, soft-tissue components, whereas the third tumor manifested as a para spinal mass with extension into the T12-L1 neural foramen and invasion of t he T12 nerve root. INTERVENTION: All three affected patients experienced local recurrence and distant metastasis after resection of the primary site. These complications appeared early in the disease course in two cases. In no case was there a response to adjuvant chemotherapy or radiotherapy. CONCLUSION: Our experience indicates that SEFs arising along the neuraxis m ay demonstrate unexpectedly aggressive clinical behavior, compared with tho se arising in the more typical location of deep skeletal muscles.