Case Of the Week (COW) 03 April 2016
RECURRENT HEMANGIOPERICYTOMA
Findings
Heterointense lesion with few flow voids and transcalvarial herniation in right parasagittal region in interhemispheric fissure,infilterating into corpus callosum& cingulate gyrus with surrrounding perilesional edema . The lesion shows diffusion restriction and areas of blooming on SWI. On ASL –significant hyperperfusion noted k/c/o hemangiopericytoma post op and post RT F/S/O RECURRENT HEMANGIOPERICYTOMA
Discussion
Haemangiopericytomas account for less than 1% of all intracranial tumours 1. They are typically encountered in younger adults (30s-40s) Clinical presentation As these tumours are typically large, usually supratentorial, presentation is due to mass effect and will vary depending on location. Headache, seizures, focal neurological dysfunction may all be presenting features They are more aggressive than meningiomas, have a higher frequency of recurrence, and are considered a grade II tumour in the WHO Classification Haemangiopericytomas are almost always solitary, usually supratentorial masses, often lobulated in contour. They are highly vascular and have a tendency to erode adjacent bone . CT -vivid enhancement -erosion of adjacent bone MRI T1: isointense to grey matter T2: isointense to grey matter multiple flow voids on MRI adjacent brain oedema frequently present T1 C+ (Gd) vivid enhancement heterogeneous DWI intermediate restricted diffusion (less than meningioma) MR spcetroscopy high myo-inositol absent alanaine peak (present in meningiomas) Treatment and prognosis Total surgical excision is recommended, with pre-operative catheter embolisation helpful in limiting blood loss .Adjuvant radiotherapy to reduce the incidence of recurrence has also been advocated .
RECURRENT HEMANGIOPERICYTOMA
Findings
Heterointense lesion with few flow voids and transcalvarial herniation in right parasagittal region in interhemispheric fissure,infilterating into corpus callosum& cingulate gyrus with surrrounding perilesional edema . The lesion shows diffusion restriction and areas of blooming on SWI. On ASL –significant hyperperfusion noted k/c/o hemangiopericytoma post op and post RT F/S/O RECURRENT HEMANGIOPERICYTOMA
Discussion
Haemangiopericytomas account for less than 1% of all intracranial tumours 1. They are typically encountered in younger adults (30s-40s) Clinical presentation As these tumours are typically large, usually supratentorial, presentation is due to mass effect and will vary depending on location. Headache, seizures, focal neurological dysfunction may all be presenting features They are more aggressive than meningiomas, have a higher frequency of recurrence, and are considered a grade II tumour in the WHO Classification Haemangiopericytomas are almost always solitary, usually supratentorial masses, often lobulated in contour. They are highly vascular and have a tendency to erode adjacent bone . CT -vivid enhancement -erosion of adjacent bone MRI T1: isointense to grey matter T2: isointense to grey matter multiple flow voids on MRI adjacent brain oedema frequently present T1 C+ (Gd) vivid enhancement heterogeneous DWI intermediate restricted diffusion (less than meningioma) MR spcetroscopy high myo-inositol absent alanaine peak (present in meningiomas) Treatment and prognosis Total surgical excision is recommended, with pre-operative catheter embolisation helpful in limiting blood loss .Adjuvant radiotherapy to reduce the incidence of recurrence has also been advocated .