Atypical meningioma simulating a hemangiopericytoma: case presentation and literature review
DOI:
https://doi.org/10.59156/z3a6h009Keywords:
Solitary fibrous tumor (SFT)Abstract
Background: angiomatous meningiomas (AMs) are a rare variant of WHO grade I meningiomas, representing approximately 2.1% of all meningiomas. While their prominent vascularity is a distinguishing characteristic that helps differentiate them from other tumors, solitary fibrous tumors (SFTs) are also highly vascularized and constitute less than 1% of all intracranial neoplasms, making their accurate diagnostic differentiation essential.
Objectives: to report the unusual case of an AM mimicking an SFT and literature review.
Case description: a 61-year-old male patient, with a history of hospitalization for headache and dizziness treated with steroids, presented to the emergency department due to worsening symptoms. Magnetic resonance imaging revealed a large contrast-enhancing mass in the left frontal lobe, extending across the midline into the contralateral hemisphere, with a dural tail sign.
Surgery: digital subtraction angiography (DSA) and subsequent embolization were performed, which identified a vascular supply from branches of the anterior cerebral artery and lateral contributions from the left middle meningeal artery. No substantial decrease in tumor size was observed. An anterior interhemispheric approach was used for tumoral resection. Histology showed heterogeneous hypercellularity and superficial invasion of the brain parenchyma. EMA and progesterone receptor (PR) positivity were observed. Ki-67 was 5-7%. The lesion was consistent with an atypical meningioma (WHO Grade II).
Conclusion: the vascular prominence of meningiomas presents challenges in preoperative diagnosis due to their significant similarities to sarcomas, making it important to consider them in the differential diagnosis.
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References
1. Zhang AS, Ostrom QT, Kruchko C, Rogers L, Peereboom DM, Barnholtz-Sloan JS. Complete prevalence of malignant primary brain tumors registry data in the United States compared with other common cancers 2010. Neuro Oncol. 2017;19(5):726-35. DOI: https://doi.org/10.1093/neuonc/now252
2. Louis DN, Ohgaki H, Wiestler OD, Cavenee WK. WHO Classification of Tumours of the Central Nervous System. 4.ta ed. Lyon: World Health Organization; 2016.
3. Coppola F, Campbell JI, Herrero JM, Volpe E, Cersósimo T. Análisis comparativo de meningiomas cerebrales Grado I vs Grado II en una serie retrospectiva de 63 pacientes operados. Rev Argent Neurol. 2017;31(2):90-6.
4. Liu Z, Wang C, Wang H, Wang Y, Li JY, Liu Y. Clinical characteristics and treatment of angiomatous meningiomas: a report of 27 cases. Int J Clin Exp Pathol. 2013;6(4):695-702.
5. Louis DN, Perry A, Reifenberger G, von Deimling A, Figarella-Branger D, Cavenee WK, y col. The 2016 World Health Organization classification of tumors of the central nervous system: a summary. Acta Neuropathol. 2016;131(6):803-20. DOI: https://doi.org/10.1007/s00401-016-1545-1
6. Ratneswaren T, Hogg FRA, Gallagher MJ, Ashkan K. Surveillance for metastatic hemangiopericytoma-solitary fibrous tumors-systematic literature review on incidence, predictors and diagnosis of extra-cranial disease. J Neurooncol. 2018;138(3):447-67. DOI: https://doi.org/10.1007/s11060-018-2836-2
7. Díaz Escareño JM, Vergara Pajares CE, Gutiérrez CSL, Ramírez JAC, Ramírez JMO. Hemangiopericitoma maligno: reporte de un caso y revisión de la literatura. Rev Mex Neurocienc. 2021;22(4):159-71.
8. Wilson TA, Huang L, Ramanathan D, Lopez-Gonzalez M, Pillai P, De Los Reyes K, Kumal M, Boling W. Review of Atypical and Anaplastic Meningiomas: Classification, Molecular Biology, and Management. Front Oncol. 2020 Nov 20;10:565582. doi: 10.3389/fonc.2020.565582. PMID: 33330036; PMCID: PMC7714950. DOI: https://doi.org/10.3389/fonc.2020.565582
9. Friedmann DR, Grobelny B, Golfinos JG, Roland JT Jr. Nonschwannoma tumors of the cerebellopontine angle. Otolaryngol Clin North Am. 2015;48(3):461-75. DOI: https://doi.org/10.1016/j.otc.2015.02.006
10. Soon WC, Fountain DM, Koczyk K, y col. Correlation of volumetric growth and histological grade in 50 meningiomas. Acta Neurochir (Wien). 2017;159(11):2169-77. DOI: https://doi.org/10.1007/s00701-017-3277-y
11. Ansari SF, Shah KJ, Hassaneen W, Cohen-Gadol AA. Vascularity of meningiomas. Handb Clin Neurol. 2020;169:153-65. DOI: https://doi.org/10.1016/B978-0-12-804280-9.00010-X
12. Barba I, Moreno A, Martinez-Pérez I, y col. Magnetic resonance spectroscopy of brain hemangiopericytomas: high myoinositol concentrations and discrimination from meningiomas. J Neurosurg. 2001;94(1):55-60. DOI: https://doi.org/10.3171/jns.2001.94.1.0055
13. Shah A, Choudhri O, Jung H, Li G. Preoperative endovascular embolization of meningiomas: update on therapeutic options. Neurosurg Focus. 2015;38(3):E7. DOI: https://doi.org/10.3171/2014.12.FOCUS14728
14. Kim YJ, Park JH, Kim YI, Jeun SS. Treatment strategy of intracranial hemangiopericytoma. Brain Tumor Res Treat. 2015;3(2):68-74. DOI: https://doi.org/10.14791/btrt.2015.3.2.68
15. Hua L, Luan S, Li H, Zhu H, Tang H, Liu H, et al. Angiomatous meningiomas have a very benign outcome despite frequent peritumoral edema at onset. World Neurosurgery. 2017;108:465-73. DOI: https://doi.org/10.1016/j.wneu.2017.08.096
