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Hemangiopericytoma

CLINICAL HISTORY:
This 80-year old woman underwent resection of a right parietal hemangiopericytoma 9 years ago. For the past year, she complained of paresthesias on the left side. Recently, she notes increasing headaches, disequilibrium, disorientation and weakness in the left arm.

NEUROLOGICAL EXAMINATION is difficult since the patient is wheel-chair bound. A paresis of the left arm is obvious.

CONTRAST-ENHANCED CT (IMAGE 1): An intensely enhancing mass is seen abutting the falx in the parietal area. Some edema is seen. Post-surgical changes are noted.

MRI:
a) TRANSAXIAL T2-WEIGHTED (5000/128/1) SPIN-ECHO SEQUENCE (IMAGE 2): The mass (arrowheads) is inhomogeneous, but with overall isointensity to grey matter. Accompanying edema and substantial midline shift is identified, with compression of the right lateral ventricle.

b) TRANSAXIAL T1-WEIGHTED (560/15/1) SPIN-ECHO SEQUENCE (IMAGE 3): The lesion (arrowheads) is slightly hyperintense to grey matter.

c) TRANSAXIAL (IMAGE 4), CORONAL (IMAGE 5) AND SAGITTAL (IMAGE 6) GADOLINIUM-ENHANCED SPIN-ECHO SEQUENCES: Moderate to intense enhancement is seen with slight inhomogeneity. The mss appears somewhat multilobulated. Predominant insertion is noted at the level of the falx (arrowheads).

RADIOLOGICAL DIAGNOSIS: Meningioma of the falx based on the extraaxial location, the broad implantation on the dura of the falx and the convexity and the intense enhancement. The multilobulated appearance might suggest hemangioblastoma.

SURGICAL FINDINGS: The tumor tightly adhered to and grew into the parasagittal dura of the superior sagittal sinus and was highly vascular. Resection was hampered by scar tissue. Total excision was however possible.

ANATOMOPATHOLOGY (IMAGE 7) shows hemangiopericytoma.

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Hemangiopericytoma

 

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Fig. 1

Hemangiopericytoma, Fig. 1
Hemangiopericytoma, Fig. 2
Hemangiopericytoma, Fig. 3
Hemangiopericytoma, Fig. 4
Hemangiopericytoma, Fig. 5
Hemangiopericytoma, Fig. 6
Hemangiopericytoma, Fig. 7