Angiographic Evidence of a Purely Pial Bihemispheric Intracranial Hemangiopericytoma

Nathaniel Stetson,Jiang Y Li,Avi Setton,David J Chalif,Sudhakar Vadivelu

doi:10.1155/2016/5245078

Nathaniel Stetson, Jiang Y Li + Show 3 more

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https://doi.org/10.1155/2016/5245078

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Abstract

Background. Classification of hemangiopericytoma (HPC) has evolved to a mesenchymal, nonmeningothelial grade two or three neoplasm according to the World Health Organization; however its blood supply has always been defined by dual origin, pial and dural contribution. Case Description. We present the case of a patient with an intracranial HPC with only pial vascular supply. Angiography confirmed the lack of dural supply to this bihemispheric intracranial mass. Subsequent histologic examination confirmed the diagnosis of hemangiopericytoma. Angiographic evidence here is atypical of the natural history of hemangiopericytomas with dual vascular supply and was critical in the decision-making towards surgical resection without tumor embolization. Conclusion. Data presented suggests the lack of dural vascular supply alone does not rule out the diagnosis of hemangiopericytoma.

Highlights

In 1942, Stout and Murray [1] first termed “hemangiopericytoma” as tumors that presented with an appearance of soft tissues anywhere on the body, occurring wherever capillaries exist [2]
Intracranial hemangiopericytomas are generally considered a more aggressive phenotype in comparison to the solitary fibrous phenotype based on observations of increased cellularity and reduced collagen bands [3]
The natural history accounts for an incidence of 2-3% of all primary meningeal tumors [4], and they are believed to arise from Zimmerman pericytes, small muscular cells lining capillary and postcapillary venule walls [1]

Summary

Background

Classification of hemangiopericytoma (HPC) has evolved to a mesenchymal, nonmeningothelial grade two or three neoplasm according to the World Health Organization; its blood supply has always been defined by dual origin, pial and dural contribution. We present the case of a patient with an intracranial HPC with only pial vascular supply. Angiography confirmed the lack of dural supply to this bihemispheric intracranial mass. Subsequent histologic examination confirmed the diagnosis of hemangiopericytoma. Angiographic evidence here is atypical of the natural history of hemangiopericytomas with dual vascular supply and was critical in the decision-making towards surgical resection without tumor embolization. Data presented suggests the lack of dural vascular supply alone does not rule out the diagnosis of hemangiopericytoma

Introduction

Case Study

Discussion

Conclusion