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Hemangioblastoma, case 1 Hemangioblastoma, case 2 Hemangioblastoma, case 3 Hemangioblastoma, intraventricular Hemangiopericytoma Hemangiopericytoma, anaplastic Hemangiopericytoma, evolution Meningioma, atypical: case 1 Meningioma, atypical: case 2 Meningioma, convexity, T2 hyperintense Meningioma, cystic Meningioma en plaque Meningioma, intraventricular, possibly anaplastic Meningioma, lipoblastic Meningioma, multiple Meningioma of the cavernous sinus Meningioma of the cavernous sinus, totally calcified Meningioma of the cerebellopontine angle Meningioma of the falx cerebri, case 1 Meningioma of the falx cerebri, case 2 Meningioma of the falx cerebri, case 3 Meningioma of the falx cerebri with invasion of the superior sagittal sinus Meningioma of the foramen magnum Meningioma of the olfactory groove, case 1 Meningioma of the olfactory groove, case 2 Meningioma of the posterior fossa with intracanalicular enhancement Meningioma of the sellar diaphragm Meningioma of the sphenoid Meningioma of the tentorium, case 1 Meningioma of the tentorium, case 2 Meningioma of the tentorium with extension through the incisura tentorii Meningioma of the tentorium with supra- and infratentorial extension Meningioma of the tuberculum sellae Meningioma, pseudocystic Meningioma, totally calcified Meningioma wiht bone invasion Meningioma with hyperostosis of the bone Pseudomeningioma, metastasis Solitary fibrous tumor, case 1 Solitary fibrous tumor, case 2 Typical meningioma, convexity

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Hemangiopericytoma, evolution

CLINICAL HISTORY:
This 57-year old woman was operated upon 6 years ago for a sphenoid meningioma, discovered during workup for partial complex seizure, with speech disturbances as the main clinical manifestation. Anatomopathology pointed to a mixed endotheliomatous and fibromatous meningioma. Since then she has been receiving anti-epileptic medication. Now she complains of increasing headache.

NEUROLOGICAL EXAMINATION is normal.

MRI:
a) TRANSAXIAL T2-WEIGHTED (2500/90/1) SPIN-ECHO SEQUENCE (IMAGE 1): A rounded hyperintense mass is seen (arrowheads) at the left frontal convexity. Two similar lesions were present in the neighborhood of the lesion, centered on the convexity (not illustrated).

b) TRANSAXIAL T1-WEIGHTED (600/15/1) SPIN-ECHO SEQUENCE (IMAGE 2): The mass (arrowheads) is slightly hypointense.

c) TRANSAXIAL (IMAGE 3), CORONAL (IMAGE 4) AND SAGITTAL (IMAGE 5) GADOLINIUM-ENHANCED SPIN-ECHO SEQUENCES: There is intense and homogeneous enhancement of the lesion. Note the presence of two similar lesions in the vicinity of the first one (arrows). All lesions have broad implantation on the dura of the convexity and of the anterior cranial fossa.

ANGIOGRAPHY: lateral projection of the selective left internal maxillary artery injection (IMAGE 6): All lesions are hypervascular (arrowheads) and supplied by meningeal arteries.

RADIOLOGICAL DIAGNOSIS is multiple meningioma based on the extraaxial location, the broad implantation on the dura and the homogeneous and intense enhancement.

SURGICAL FINDINGS: At surgery, the three meningiomas and a fourth one, not illustrated, were removed. In the vicinity about 5 micro-tumors, measuring less than 1 mm in diameter, were found and resected, together with the dura.

ANATOMOPATHOLOGY shows hemangiopericytoma.

COMMENT: Two years later the patient complains again of headache, difficulties with concentration, memory and speech disturbances. Neurological examination reveals mild right hemiparesis and motor dysphasia.

CT:
a) NON-CONTRAST SCAN (IMAGE 7): A new spontaneously hyperdense lesion is seen at the left frontotemporal convexity. The overlying bone is thickened.

b) CONTRAST-ENHANCED SCAN (IMAGE 8): Intense and homogeneous enhancement of the tumor is noted.

MRI:
a) TRANSAXIAL T2-WEIGHTED (2500/90/1) SPIN-ECHO SEQUENCE (IMAGE 9): A huge mass, with broad implantation on the convexity is seen, in the left frontotemporal region. The mass is homogeneous and isointense to grey matter. There is evidence of edema.

b) TRANSAXIAL T1-WEIGHTED (680/20/1) SPIN-ECHO SEQUENCE (IMAGE 10): The mass is spontaneously somewhat hyperintense.

c) TRANSAXIAL (IMAGE 11), CORONAL (IMAGE 12) AND SAGITTAL (IMAGE 13) GADOLINIUM-ENHANCED SPIN-ECHO SEQUENCES: There is intense and homogeneous enhancement of the tumor.

RADIOLOGICAL DIAGNOSIS is meningioma.

SURGICAL FINDINGS: A mass with broad implantation on the dura, measuring 7 cm in diameter was removed.

ANATOMOPATHOLOGY was consistent with hemangiopericytoma.

NOTE: Clinically the patient is doing well since then, with a follow-up of two years. A recent CT showed a new tumor in the left parietal convexity.

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Hemangiopericytoma, evolution, Fig. 1	Hemangiopericytoma, evolution, Fig. 2	Hemangiopericytoma, evolution, Fig. 3

Hemangiopericytoma, evolution, Fig. 4	Hemangiopericytoma, evolution, Fig. 5	Hemangiopericytoma, evolution, Fig. 6

Hemangiopericytoma, evolution, Fig. 7	Hemangiopericytoma, evolution, Fig. 8	Hemangiopericytoma, evolution, Fig. 9

Hemangiopericytoma, evolution, Fig. 10	Hemangiopericytoma, evolution, Fig. 11	Hemangiopericytoma, evolution, Fig. 12

Hemangiopericytoma, evolution, Fig. 13