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LETTER TO EDITOR
Year : 2017  |  Volume : 65  |  Issue : 1  |  Page : 208-209

Unusual presentation of an intracranial hemangiopericytoma as a cystic intraparenchymal mass lesion closely mimicking a glioma


1 Department of Neurosurgery, Beijing Tiantan Hospital, Beijing, China
2 Department of Neurosurgery, Beijing Tiantan Hospital, Beijing; Beijing Neurosurgical Institute, Capital Medical University, Beijing, China

Date of Web Publication12-Jan-2017

Correspondence Address:
Zhongli Jiang
Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, No. 6 TiantanXili, Dongcheng District, Beijing - 100 050
China
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0028-3886.198222

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How to cite this article:
Lin Z, Wang Y, Zhao M, Li Z, Chen X, Jiang Z. Unusual presentation of an intracranial hemangiopericytoma as a cystic intraparenchymal mass lesion closely mimicking a glioma. Neurol India 2017;65:208-9

How to cite this URL:
Lin Z, Wang Y, Zhao M, Li Z, Chen X, Jiang Z. Unusual presentation of an intracranial hemangiopericytoma as a cystic intraparenchymal mass lesion closely mimicking a glioma. Neurol India [serial online] 2017 [cited 2017 Mar 27];65:208-9. Available from: http://www.neurologyindia.com/text.asp?2017/65/1/208/198222


Sir,

A 23-year-old female patient was admitted to a local hospital with a 4-day history of severe headache, nausea, and vomiting. Computed tomography (CT) scan of the brain revealed a hypodense cystic mass in the left parietal-occipital lobe, with prominent perilesional brain edema and slight midline shift. Her symptoms of intracranial hypertension were relieved after dehydration therapy was instituted. She was transferred to the Beijing Tiantan hospital with a radiological diagnosis of intracranial space occupying lesion. Neurological examination revealed evident papillary edema. Magnetic resonance (MR) images of the brain revealed an intra-axial cystic lesion in the subcortical white matter of the left parieto-occipital lobes. The lesion showed hypointense T1 and hyperintense T2 signals as well as ring enhancement [Figure 1]a,[Figure 1]b,[Figure 1]c,[Figure 1]d,[Figure 1]e. Perilesional brain edema was noted. No evidence of necrosis, hemorrhage, or calcification were seen in the lesion. Thus, a provisional diagnosis of glioma was made according to the radiological characteristics of the lesion. Total removal of the tumor was performed through the left parieto-occipital craniotomy. During the operation, we found that the dura mater was normal and there was no surfacing component of the tumor. In addition, the tumor was found to be a cystic, well-demarcated mass lesion. Unexpectedly, the postoperative histopathology revealed the diagnosis of an anaplastic hemangiopericytoma (World Health Organization grade III) [Figure 1]f with positivity for vimentin, CD31, CD34, local positivity for S100, negativity for epithelial membrane antigen (EMA), and Ki-67 >10%. To rule out an extracranial hemangiopericytoma (HPC) that could have metastasized to the brain, a whole body positron emission tomography (PET)-CT was finally performed. However, no extracranial HPC was identified. The patient was discharged 1 week after the surgery without any neurological deterioration. She did not undergo additional radiotherapy. The postoperative follow-up revealed local recurrence 15 months after surgery.
Figure 1: Magnetic resonance imaging showing T1 hypointense (a) and T2 hypointense (b) signals in the subcortical white matter of the left parieto-occipital lobe with ring enhancement (c-e). Histological presentation (hematoxylin and eosin stain) of the tumor revealed the diagnosis of anaplastic hemangiopericytoma (f)

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A primary intracranial HPC is a rare and highly vascularized mesenchymal tumor with a high rate of recurrence and the propensity to metastasize to numerous extracranial locations.[1],[2] Theoretically, it can arise from pericytes anywhere in the intracranial compartment; however, the detected lesions have mostly been dural-based masses attached to the convexity, falx, tentorium, dural sinuses. and skull base.[3]

Non-dural based HPCs are exceedingly rare. [Table 1] summarizes the reported cases over the last 20 years. The location of non-dural based HPCs included the lateral ventricle, third ventricle, sellar region, pineal region, and within the brain parenchyma. Purely intraparenchymal HPC are rarer among non-dural based HPCs, and are more inclined to behave as cystic lesions, which pose a difficult diagnostic dilemma based on their radiographic appearance. Radiologically, the present cystic mass was entirely subcortical and showed hypointensity on T1-weighted images, hyperintensity on T2-weighted images, and ring enhancement. These features led us to believe that it was a glioma.
Table 1: Summary of cases of non-dural based HPC in the literature over the last 20 years

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Thus, the imaging features of the HPC in our patient closely resembled that of a glioma suggesting that this entity should be considered as a rare differential diagnosis of the latter lesion.

Financial support and sponsorship

National Natural Science Foundation of China (Grant No. 81402052); Beijing Nova Program (xx2016040).

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
Rutkowski MJ, Jian BJ, Bloch O, Chen C, Sughrue ME, Tihan T, et al. Intracranial hemangiopericytoma: Clinical experience and treatment considerations in a modern series of 40 adult patients. Cancer 2012;118:1628-36.  Back to cited text no. 1
    
2.
Louis DN, Ohgaki H, Wiestler OD, Cavenee WK, Burger PC, Jouvet A, et al. The 2007 WHO classification of tumours of the central nervous system. Acta Neuropathol 2007;114:97-109.  Back to cited text no. 2
    
3.
Guthrie BL, Ebersold MJ, Scheithauer BW, Shaw EG. Meningeal hemangiopericytoma: Histopathological features, treatment, and long-term follow-up of 44 cases. Neurosurgery 1989;25:514-22.  Back to cited text no. 3
    


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