1
|
Liu A, Bauer JS, Lin CC, Appelboom G, Zanazzi G. Dural composite hemangioendothelioma: The first intracranial case. Surg Neurol Int 2024; 15:55. [PMID: 38468685 PMCID: PMC10927221 DOI: 10.25259/sni_3_2024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2024] [Accepted: 01/18/2024] [Indexed: 03/13/2024] Open
Abstract
Background Composite hemangioendothelioma (CHE) is a rare, locally aggressive neoplasm of intermediate malignant potential. It is composed of a mixture of vascular tumors with a predilection for the dermis and subcutis of the extremities. Case Description In this report, we describe a 41-year-old man who presented with a 2-month history of headache, dizziness, and intermittent seizures. Magnetic resonance imaging showed a hemorrhagic, multilobulated, and dural-based mass with extension into the calvarium. The mass measured 10.3 × 4.8 × 4 cm along the interhemispheric fissure and encased the superior sagittal sinus. Excision was performed, and histopathologic examination revealed a heterogeneous mixture of vascular components consisting of epithelioid hemangioendothelioma, retiform hemangioendothelioma, and hemangioma. This is the first report of a primary intracranial CHE. Conclusion The spectrum of mesenchymal neoplasms within the cranium expands to encompass CHE.
Collapse
Affiliation(s)
- Alice Liu
- Geisel School of Medicine, Dartmouth-Hitchcock Medical Center, One Medical Center Drive, Lebanon, USA
| | - Joshua S. Bauer
- Department of Emergency Medicine, University of Iowa Hospitals and Clinics, Iowa City, USA
| | - Chun-Chieh Lin
- Department of Pathology and Laboratory Medicine, Dartmouth-Hitchcock Medical Center, One Medical Center Drive, Lebanon, USA
- Dartmouth Cancer Center, Dartmouth-Hitchcock Medical Center, One Medical Center Drive, Lebanon, USA
| | - Geoff Appelboom
- Department of Neurosurgery, New York University Langone Health, New York, USA
| | - George Zanazzi
- Department of Pathology and Laboratory Medicine, Dartmouth-Hitchcock Medical Center, One Medical Center Drive, Lebanon, USA
- Dartmouth Cancer Center, Dartmouth-Hitchcock Medical Center, One Medical Center Drive, Lebanon, USA
| |
Collapse
|
2
|
Jung SC, Jung TY, Lee TK, Kim YJ, Baek HJ, Kim SS. Kaposiform hemangioendothelioma of skull base with dura invasion in a pediatric patient: a case report. Childs Nerv Syst 2023; 39:3289-3294. [PMID: 37354290 DOI: 10.1007/s00381-023-06025-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Accepted: 06/10/2023] [Indexed: 06/26/2023]
Abstract
Kaposiform hemangioendothelioma is an extremely rare vascular tumor which shows aggressive local growth. We present a case of rapid growing vascular skull tumor with dura invasion in a pediatric patient with neurofibromatosis type 1. A 14-year-old male complained of headache and dizziness for 1 month after minor head trauma. Brain magnetic resonance imaging (MRI) revealed a 5-cm-sized tumor in the left frontotemporal bone with internal hemorrhage and cystic changes. The gross total resection of tumor was done. At the 7-month follow-up, brain MRI revealed a recurrent skull tumor with intracranial dura mass. He underwent second surgery, and the pathologic diagnosis was suggestive of Kaposiform hemangioendothelioma. For this vascular proliferative tumor, mTOR inhibitor was treated for 6 months, and there was the recurred nodular-enhancing mass along the sphenoid ridge. After additional 2 months of medication, the following MRI revealed a decreased nodular-enhancing mass.
Collapse
Affiliation(s)
- Seong-Chan Jung
- Department of Neurosurgery, Chonnam National University Medical School, Chonnam National University Hwasun Hospital, Hwasun, Republic of Korea
| | - Tae-Young Jung
- Department of Neurosurgery, Chonnam National University Medical School, Chonnam National University Hwasun Hospital, Hwasun, Republic of Korea.
| | - Tae-Kyu Lee
- Department of Neurosurgery, Chonnam National University Medical School, Chonnam National University Hwasun Hospital, Hwasun, Republic of Korea
| | - Yeong Jin Kim
- Department of Neurosurgery, Chonnam National University Medical School, Chonnam National University Hwasun Hospital, Hwasun, Republic of Korea
| | - Hee Jo Baek
- Department of Pediatrics, Chonnam National University Medical School, Chonnam National University Hwasun Hospital, Hwasun, Republic of Korea
| | - Sung Soon Kim
- Department of Pathology, Chonnam National University Medical School, Chonnam National University Hospital, Gwangju, Republic of Korea
| |
Collapse
|
3
|
Hu Y, Song D, Wu C, Wang L, Li J, Guo L. Clinical and imaging features of Kaposiform hemangioendothelioma in infants. Heliyon 2023; 9:e15425. [PMID: 37159688 PMCID: PMC10163614 DOI: 10.1016/j.heliyon.2023.e15425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 04/05/2023] [Accepted: 04/06/2023] [Indexed: 05/11/2023] Open
Abstract
Objective Kaposiform hemangioendothelioma (KHE) is a locally aggressive tumor of vascular origin. This study investigated the clinical and imaging features of KHE to provide a reference for its early diagnosis. Methods The clinical and imaging findings of 27 clinically confirmed KHE cases (including 21 with focal lesions and 6 with diffuse lesions) between January 2016 and December 2021 were retrospectively analyzed. Results The mean age of the 27 patients was 105 ± 80.27 days. Twenty-two (81.5%) of these patients had Kasabach-Merritt phenomenon. Most KHEs were located in the trunk and/or extremities (22/27). Ultrasonography showed heterogeneous echogenicity and/or striated hypoechoic bands with abundant or patchy blood flow within the tumor. On plain computed tomography (CT), they appeared as heterogeneous lesions isodense with the muscles, with a CT value of 29.58 ± 11.53 HU. In the arterial phase, the KHEs showed striated or lamellar heterogeneous enhancement, with a CT value of 153.91 ± 52.11 HU after enhancement. All KHEs showed uneven and high signal intensity on T2-weighted imaging, mixed high and low signal intensity on fat-saturated images, and no significant diffusion restriction on diffusion-weighted imaging. Conclusion KHEs can occur in various locations and present as highly infiltrative and heterogeneous masses that can invade the skin, adjacent muscles, and bones. A vascularized mass with purpuric skin changes, with uneven and high T2WI signal is highly suggestive of the diagnosis of KHE.
Collapse
Affiliation(s)
- Yuanjun Hu
- Department of Pediatric Surgery, Children's Hospital Affiliated to Shandong, University, Jinan, 250022, Shandong, China
- Department of Pediatric Surgery, Jinan Children's Hospital, Jinan, 250022, Shandong, China
| | - Dan Song
- Department of Vascular Anomalies and Interventional Radiology, Children's, Hospital Affiliated to Shandong University, Jinan, 250022, Shandong, China
- Department of Vascular Anomalies and Interventional Radiology, Jinan Children's, Hospital, Jinan, 250022, Shandong, China
- Department of Shandong Provincial Clinical Research Center for Children's Health and Disease, Jinan, 250022, Shandong, China
| | - Changhua Wu
- Department of Vascular Anomalies and Interventional Radiology, Children's, Hospital Affiliated to Shandong University, Jinan, 250022, Shandong, China
- Department of Vascular Anomalies and Interventional Radiology, Jinan Children's, Hospital, Jinan, 250022, Shandong, China
- Department of Shandong Provincial Clinical Research Center for Children's Health and Disease, Jinan, 250022, Shandong, China
| | - Liang Wang
- Department of Vascular Anomalies and Interventional Radiology, Children's, Hospital Affiliated to Shandong University, Jinan, 250022, Shandong, China
- Department of Vascular Anomalies and Interventional Radiology, Jinan Children's, Hospital, Jinan, 250022, Shandong, China
- Department of Shandong Provincial Clinical Research Center for Children's Health and Disease, Jinan, 250022, Shandong, China
| | - Jing Li
- Department of Vascular Anomalies and Interventional Radiology, Children's, Hospital Affiliated to Shandong University, Jinan, 250022, Shandong, China
- Department of Vascular Anomalies and Interventional Radiology, Jinan Children's, Hospital, Jinan, 250022, Shandong, China
- Department of Shandong Provincial Clinical Research Center for Children's Health and Disease, Jinan, 250022, Shandong, China
| | - Lei Guo
- Department of Vascular Anomalies and Interventional Radiology, Children's, Hospital Affiliated to Shandong University, Jinan, 250022, Shandong, China
- Department of Vascular Anomalies and Interventional Radiology, Jinan Children's, Hospital, Jinan, 250022, Shandong, China
- Department of Shandong Provincial Clinical Research Center for Children's Health and Disease, Jinan, 250022, Shandong, China
- Corresponding author. Department of Vascular Anomalies and Interventional Radiology, Children's, Hospital Affiliated to Shandong University, Jinan, 250022, Shandong, China.
| |
Collapse
|
4
|
Cai Y, Li J, Yang W, Zhang N, Sun H, Zhang W, Ge M. Case Report: Congenital Intracranial Kaposiform Hemangioendothelioma Treated With Surgical Resection. Front Surg 2022; 9:831190. [PMID: 35433800 PMCID: PMC9012330 DOI: 10.3389/fsurg.2022.831190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Accepted: 02/22/2022] [Indexed: 11/21/2022] Open
Abstract
Background Kaposiform hemangioendothelioma (KHE) is a locally aggressive but non-metastatic vascular neoplasm. Most studies have been restricted to small case series of limited generalizability. Intracranial KHE is extremely rare with only three cases reported in the literature. Here, we report a case of congenital intracranial KHE who underwent surgical resection, and no lesion recurrence was seen during the follow-up period of 13 months. Case Description A 2-month-old boy initially presented with a left temporal mass following birth. Antenatal ultrasound at 36 weeks of gestation demonstrated a hyperechoic signal present in the left frontal lobe, with clear borders and irregular morphology. There were neither cutaneous abnormalities nor other neurologic examination abnormalities. No laboratory abnormality was identified. Computed tomography (CT) scans suggested that a massive hematoma was noted under the left frontal skull plate, with a little subdural hemorrhage in the adjacent temporal area. The adjacent meninges enhanced and thickened on contrasted T1 magnetic resonance (MR). After the multidisciplinary diagnostic assessment, the surgery was performed by the left frontotemporal craniotomy approach. The operation was extremely difficult. We completely removed the tumor, and the involved dura and brain tissue were resected with the lesion in a piecemeal fashion. On postoperative-day (POD) 3 and POD 14, the head CT re-examination revealed that cerebral perfusion improved gradually. The MRI of 6- and 12-month after operation showed no local recurrence or metastasis. Conclusions Intracranial KHE is difficult to diagnose early and the prognosis has been uniformly poor. We supposed that meticulous intraoperative hemostasis is the key for a successful operation, and the radical resection of the tumor and involved structures are essential to reduce recurrence.
Collapse
Affiliation(s)
- Yingjie Cai
- National Center for Children's Health, Department of Neurosurgery, Beijing Children's Hospital, Capital Medical University, Beijing, China
| | - Jiayi Li
- Graduate School, National Center for Children's Health, Beijing Children's Hospital, Capital Medical University, Beijing, China
| | - Wei Yang
- National Center for Children's Health, Department of Neurosurgery, Beijing Children's Hospital, Capital Medical University, Beijing, China
| | - Nan Zhang
- National Center for Children's Health, Department of Pathology, Beijing Children's Hospital, Capital Medical University, Beijing, China
| | - Hailang Sun
- National Center for Children's Health, Department of Neurosurgery, Beijing Children's Hospital, Capital Medical University, Beijing, China
| | - Weiping Zhang
- Graduate School, National Center for Children's Health, Beijing Children's Hospital, Capital Medical University, Beijing, China
- *Correspondence: Weiping Zhang
| | - Ming Ge
- National Center for Children's Health, Department of Neurosurgery, Beijing Children's Hospital, Capital Medical University, Beijing, China
- Ming Ge
| |
Collapse
|