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Hemangiopericytoma, anaplastic

CLINICAL HISTORY:
This 37-year old man notes episodic paresthesias with right arm weakness.

NEUROLOGICAL EXAMINATION is normal.

CONTRAST-ENHANCED CT (IMAGE 1) shows a homogeneously enhancing lesion in the left parietal region.

MRI:
a) TRANSAXIAL T2-WEIGHTED (2200/80/1) SPIN-ECHO SEQUENCE (IMAGE 2): A multilobulated lesion is seen (arrowheads), with rather inhomogeneous predominantly hypointense signal characteristics in the left postrolandic region. Accompanying edema is noted.

b) TRANSAXIAL T1-WEIGHTED (580/14/1) SPIN-ECHO SEQUENCE (IMAGE 3): The lesion is hypointense, comparable to grey matter.

c) TRANSAXIAL (IMAGE 4), CORONAL (IMAGE 5) AND SAGITTAL (IMAGE 6) GADOLINIUM-ENHANCED SPIN-ECHO SEQUENCES: The lesion shows intense and homogeneous contrast enhancement. Broad implantation of the tumor on the dura of the convexity is seen as a dural tail. The tumor is in contact with the superior sagittal sinus and the falx.

ANGIOGRAPHY: Selective injection of the left external carotid artery in the lateral projection: (IMAGES 7 AND 8). The lesion is supplied by the middle meningeal artery and the superficial temporal artery. Typically radially oriented blood vessels are noted in the early phase. Homogeneous tumor stain is appreciated in the late phase, with broad contact with the convexity.

RADIOLOGICAL DIAGNOSIS: is meningioma based on the extraaxial location, the broad implantation on the convexity and the intense enhancement.

SURGICAL FINDINGS: At surgery, a highly vascular, red-purple tumor was found. The tumor was broadly implanted on the dura of the convexity. It was adherent to the lateral wall of the superior sagittal sinus, but without invasion.

ANATOMOPATHOLOGY is hemangiopericytoma Grade III.

FOLLOW-UP: Four years post-op, the patient is doing well without recurrence on serial CT studies.

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Hemangiopericytoma

 

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Fig. 1

Hemangiopericytoma, anaplastic, Fig. 1
Hemangiopericytoma, anaplastic, Fig. 2
Hemangiopericytoma, anaplastic, Fig. 3
Hemangiopericytoma, anaplastic, Fig. 4
Hemangiopericytoma, anaplastic, Fig. 5
Hemangiopericytoma, anaplastic, Fig. 6
Hemangiopericytoma, anaplastic, Fig. 7
Hemangiopericytoma, anaplastic, Fig. 8