Journal of Cranio-Maxillofacial Surgery (2006) 34, 494–501 r 2006 European Association for Cranio-Maxillofacial Surgery doi:10.1016/j.jcms.2006.07.864, available online at http://www.sciencedirect.com Solitary fibrous tumours of the infratemporal fossa. Two case reports Silvestre GALIOTO 1 , Valentino VALENTINI 2 , Flavia Maria Graziana FATONE 3 , Marco RABAGLIATI 1 , Luca AUTELITANO 4 , Giorgio IANNETTI 3 1 Department of Cranio-Maxillo-Facial Surgery (Chair: S. GALIOTO, MD, PhD), IRCCS San Matteo Hospital University of Pavia, Italy; 2 Department of Cranio-Maxillo-Facial Surgery (Chair: L.CALABRESE, MD, PhD), University of Tor Vergata, Rome, Italy; 3 Department. of Cranio-Maxillo-Facial Surgery (Chair: G. IANNETTI, MD, PhD), University La Sapienza, Rome, Italy; 4 Department of Cranio-Maxillo-Facial Surgery (Chair: R. BRUSATI, MD, PhD), San Paolo Hospital and University of Milan, Italy SUMMARY. Introduction: The solitary fibrous tumour is a rare neoplasm originally described as a pleural tumour. An increasing number of different locations are described in the literature. Among the extrapulmonary sites, head and neck can be involved and particularly the nose, the paranasal sinuses, the submandibular region, the parapharyngeal space and the infratemporal fossa. Material: Two cases, one of a young woman and another of an elderly gentleman are reported, each presenting with a solitary fibrous tumour of the infratemporal fossa. In one case an antero-lateral, transcranio-facial and in the other, a transmandibular approach (without labiotomy) were utilized. In both cases complete excision of the lesion and good cosmetic results were achieved. Results: Both patients were free from the disease for 5 postoperatively. Conclusions: To date, very few cases of solitary fibrous tumour of the craniofacial complex have been observed to enable an accurate prognosis. Thus, treatment and follow-up should be identical to fibrous tumours located in other areas. r 2006 European Association for Cranio-Maxillofacial Surgery Keywords: infratemporal fossa; head and neck neoplasms; solitary fibrous tumour INTRODUCTION Solitary fibrous tumours are relatively rare neoplasms of mesenchymal origin which, in most cases, develop in adults and are located in the lungs (Hasegawa et al., 1996; Chan, 1997). However, the recent literature includes descriptions of extra-pulmonary sites (Gangopadhyay et al., 1996; Khalifa et al., 1997), including some in the head and neck: infratemporal fossa (Rayappa et al., 1996), upper airways and nose (Witkin et al., 1991; Batsakis et al., 1993; Stringfellow et al., 1996; Fukunaga et al., 1997; Hicks and Moe, 2004), parapharyngeal space (Al-Sinawi and Johns, 1994; Gangopadhyay et al., 1996), deep tissues of the neck (Greig and Spraggs, 1998), orbit (Ramdial and Nadvi, 1996; Fukunaga et al., 1997), cheek and major salivary glands (Suster et al., 1995). The new WHO classification of fibroblastic/myofi- broblastic tumours has recognized that the large majority of lesions, formerly thought to be haemangio- pericytomata, are in fact essentially indistinguishable from solitary fibrous tumour, even if they are some- times more diffusely hypercellular (Fletcher, 2006). The histopathological characteristics of the lesion are: a clear circumscription, the presence of alternating hyper- and hypocellular areas with few mitotic figures and the presence of collagen fibres. In many cases, the microscopic appearance at low or medium power is similar to that of smooth muscle or neuronal tumours but higher magnification reveals the characteristic eosinophilic aspect of collagen. A cell surface glyco- protein (CD 34) has proved to be useful in making the diagnosis in doubtful cases of extra-pleural tumours (Goodlad and Fletcher, 1991; Suster et al., 1995). In this paper two cases of a solitary fibrous tumour of the infratemporal fossa are reported. One was a young lady with a solitary fibrous tumour of the infratemporal fossa which was removed via a transmandibular approach in the Department of Cranio-Maxillo-Facial Surgery, San Matteo Hospi- tal, Pavia. The other patient, a male presented with a solitary fibrous tumour of the right infratemporal fossa treated in the Department of Cranio-Maxillo- Facial Surgery, University of Rome La Sapienza. He underwent surgery with an antero-lateral, trans- facial, subtemporal, extradural approach. CASE 1 A 24-year-old woman presented with a hard swelling in left cheek that had appeared 5 years earlier: she described the onset as slow, progressive and painless. Magnetic resonance imaging (MRI) revealed the presence of a well circumscribed lesion in the left infratemporal fossa, with a high degree of contrast enhancement that led to the suspicion of hypervas- cularization (Fig. 1). Computed tomography (CT) did not show any infiltration of bone but confirmed ARTICLE IN PRESS 494