Meningeal Hemangiopericytoma Manifesting as Massive Intracranial Hemorrhage-Two Case Reports-

Maruya, Jun; Seki, Yasuhiro; Morita, Kenichi; Nishimaki, Keiichi; Mitsui, Takashi

doi:10.2176/nmc.46.92

Cited by 12 publications

(8 citation statements)

References 22 publications

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“…It accounts for only 1% of all primary CNS tumors (5). Intracranial HPC was previously believed to originate from the meninges; thus, it was considered a subtype of meningioma.…”

Section: Discussionmentioning

confidence: 99%

MRI features of intracranial anaplastic hemangiopericytoma

et al. 2017

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Abstract. Magnetic resonance imaging (MRI) features of intracranial anaplastic hemangiopericytoma (AHPC) were analyzed. The pathological examination showed that there was a great number of irregularly arranged tumor cells with nuclear atypia, and mitotic properties were commonly seen providing support for clinical staging, therapy and prognosis judgment. Eighteen cases of intracranial AHPC proved by operation and pathology were analyzed retrospectively. Both plain and enhanced MR scans were performed and the results were compared with pathology in all cases. In all 18 cases, the tumor was positioned in the cortex; in 12 cases, it was located in the frontal falx and in 3 cases, it was located in the parietal falx. In 2 cases, the tumor was located in the middle cranial fossa, and in 1 case, it was located in the cerebellar hemispheres. Thirteen of the 18 cases showed mixed hyper-iso signal intensity with cortical grey matter, and the other 5 cases were isointense in the cortical grey matter on T1-weighted images. Fifteen of the 18 cases showed heterogeneous hyper-iso signal intensity, and the other 3 cases were isointense on T2-weighted images. Fifteen of the 18 cases showed heterogeneous enhancement in contrast-enhanced T1-weighted images. Our data show that, because intracranial AHPC has specific features on MRI, it could be very useful for its clinical diagnosis.

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“…It accounts for only 1% of all primary CNS tumors (5). Intracranial HPC was previously believed to originate from the meninges; thus, it was considered a subtype of meningioma.…”

Section: Discussionmentioning

confidence: 99%

MRI features of intracranial anaplastic hemangiopericytoma

et al. 2017

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“…According to the literature, among cases of sudden unexpected death arising from primary brain tumor, colloid cysts of the third ventricle are the most frequent, followed by gliomas, ependymomas, and meningiomas [ 6 – 10 ]. However, only three cases of sudden unexpected death arising from intracranial hemangiopericytoma have been reported, including the present case ( Table 1 ) [ 4 , 6 , 11 ].…”

Section: Discussionmentioning

confidence: 98%

“…Mena et al reported that 22 of 94 intracranial hemangiopericytoma cases (23.4%) exhibited intratumoral hemorrhage [ 13 ]. Cervoni et al summarized and reviewed nine cases of meningeal hemangiopericytoma associated with subarachnoid [ 5 ], subdural [ 3 , 14 ], intratumoral [ 12 ], and intracerebral hemorrhage [ 11 , 15 , 16 ]. All cases involved supratentorial lesions.…”

Section: Discussionmentioning

confidence: 99%

Unpredicted Sudden Death due to Recurrent Infratentorial Hemangiopericytoma Presenting as Massive Intratumoral Hemorrhage: A Case Report and Review of the Literature

Tanaka

Kato

Hasegawa

et al. 2014

Case Reports in Neurological Medicine

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Unpredicted sudden death arising from hemangiopericytoma with massive intracranial hemorrhage is quite rare. We encountered a patient with recurrent infratentorial hemangiopericytoma presenting as life-threatening massive intracerebral hemorrhage. A 43-year-old man who had undergone craniotomy for total resection of an infratentorial hemangiopericytoma 17 months earlier presented with morning headache and generalized convulsions. Computed tomography revealed a massive hematoma in the right infratentorial region causing tonsillar herniation and emergency surgery was performed to evacuate the hematoma. Histological findings revealed hemangiopericytoma with hemorrhage. Neurological status remained unimproved and brain death was confirmed postoperatively. Hemangiopericytoma presenting as massive hemorrhage is quite rare. Since the risk of life-threatening massive hemorrhage should be considered, careful postoperative long-term follow-up is very important to identify tumor recurrences, particularly in the posterior cranial fossa, even if the tumor is completely removed.

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“…Bleed in tumor is very rare. Till date, only 8 cases of hemangiopericytoma have been reported that presented with intracranial bleed . These have presented in different forms as intraparenchymal, subdural or subarachnoid hemorrhage and a combination of these .…”

Section: Discussionmentioning

confidence: 99%

“…Though pre‐operative embolization has been recommended for these vascular tumors, it is not possible in an emergency setting due to raised intracranial pressure. A staged approach can also be performed wherein evacuation of hematoma is done in first setting and tumor excised later after the patient's neurological condition improves .…”

Section: Discussionmentioning

confidence: 99%

A 40‐Year‐Old Woman With Intracranial Bleed and Osteomalacia

Gulwani

Garg

2014

Brain Pathology

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A 40-year-old woman presented with sudden onset of headache and altered sensorium for 2 days. In the emergency department, she was drowsy, disoriented with a Glasgow coma scale of 13/15 and right hemiparesis grade 3/5, with no cranial nerve deficits. She was on treatment for diffuse osteomalacia diagnosed three years ago. Her serum phosphate levels (1.5 mg/dl) were low, calcium levels (9.2 mg/dl) were normal and vitamin D levels (40 nmol/l) were reduced. NEURORADIOLOGYAn urgent CT scan revealed blood in the left medial temporal region that was seen extending to the suprasellar cistern. It was associated with diffuse subarachnoid hemorrhage with intraventricular extension ( Figure 1a). CT angiography was negative for an intracranial aneurysm. The posterior communicating artery and apex of basilar artery were, however, displaced and shifted to the right. An MRI of the brain showed an extra-axial mass in proximity to the dorsum sella causing distortion of the midbrain (Figure 1b T1) with heterogeneous contrast enhancement along with intraparenchymal bleed (Figures 1c, 1d and 1e, T1 with contrast). A skull based meningioma was considered. OPERATIVE FINDINGSAs patient had significant mass effect due to hematoma with features of raised intracranial pressure, she underwent an emergency left temporal craniotomy (navigation guided) with transcortical approach (through middle temporal gyrus) and evacuation of the hematoma. After evacuating the hematoma, tumor was encountered. Tumor was firm in consistency and moderately vascular. It was gradually mobilized after the internal decompression. The posterior portion indenting the brain stem could be mobilized with intact arachnoid between the tumor and brainstem. The medial part of tentorium was visualized and was free from the tumor. Third nerve was noted on the undersurface of tentorium, which was free from the tumor and was preserved. Last portion of the tumor appeared to be adherent to the posterior clinoid and posterior communicating artery. This couldn't be mobilized and was left behind. Postoperatively, patient recovered well. She was alert and conscious with no motor nerve deficits. However, she had third nerve palsy. Postoperative CT scan showed a small hematoma in tumor bed. MICROSCOPIC PATHOLOGYHistologic findings showed a moderately cellular neoplasm composed of round to oval spindle cells that were arranged in sheets. Several variable sized and staghorn vascular channels were scattered throughout the tumor (Figure 1f and 1g). Small amount of normal brain tissue was also included. The individual tumor cells exhibited moderate amount of eosinophilic cytoplasm with indistinct cell borders. Nuclei were hyperchromatic with mild to moderate anisokaryosis (Figure 1h). Additionally, several small to large clusters of mature adipocytes were noted throughout the tumor (Figure 1i). Areas of hemorrhage, focal necrosis and thrombosed blood vessel were also present. There was no significant increase in mitotic activity (Ki-67 labelling index-less than 1%). Immunohistochemical st...

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Meningeal Hemangiopericytoma Manifesting as Massive Intracranial Hemorrhage-Two Case Reports-

Cited by 12 publications

References 22 publications

MRI features of intracranial anaplastic hemangiopericytoma

MRI features of intracranial anaplastic hemangiopericytoma

Unpredicted Sudden Death due to Recurrent Infratentorial Hemangiopericytoma Presenting as Massive Intratumoral Hemorrhage: A Case Report and Review of the Literature

A 40‐Year‐Old Woman With Intracranial Bleed and Osteomalacia

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