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Anghileri E, Pollo B, Ferroli P, Aquino D, Demichelis G, Schiariti M, Ferrau F, Chiapparini L, Cuccarini V. Case report: Multiple brain intravascular papillary endothelial hyperplasia: incidence, diagnostic challenges, and management approach. Front Neurol 2023; 14:1115325. [PMID: 37153668 PMCID: PMC10157200 DOI: 10.3389/fneur.2023.1115325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Accepted: 03/17/2023] [Indexed: 05/10/2023] Open
Abstract
Multiple hemorrhagic brain lesions are mainly diagnosed based on clinico-radiological features integrated with histological data. Intravascular papillary endothelial hyperplasia (IPEH), or Masson's tumor, is a very rare entity, particularly when localized in the brain. In this study, we describe a case of multiple recurrent brain IPEHs and provide details on the diagnostic phase, therapeutic approaches, and related challenges. A 55-year-old woman presented with a relapsing neurological deficit. Brain magnetic resonance imaging (MRI) revealed a hemorrhagic right frontal-parietal lesion. When new neurological symptoms occurred, subsequent MRI scans detected more bleeding cerebral lesions. She underwent a series of single hemorrhagic lesion debulking. For any samples that underwent histopathological examination, the first results were not informative; the second and the third results revealed hemangioendothelioma (HE); and the fourth results led to the IPEH diagnosis. Interferon alpha (IFN-α) and subsequently sirolimus were prescribed. Both were well tolerated. Clinical and radiological features remained stable 43 months after starting sirolimus therapy and 132 months after the first diagnosis. To date, 45 cases of intracranial IPEH have been reported, mostly as single lesions without parenchymal location. They are usually treated by surgery and sometimes by radiotherapy upon recurrence. Our case is notable for two main reasons: because of the consecutive recurrent multifocal exclusively cerebral lesions and the therapeutic approach we used. Based on multifocal brain recurrence and good performance, we propose pharmacological therapy, including IFN-α and sirolimus, to stabilize IPEH.
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Affiliation(s)
- Elena Anghileri
- Neuroncology Unit, Fondazione Irccs Istituto Neurologico Carlo Besta, Milan, Italy
- *Correspondence: Elena Anghileri
| | - Bianca Pollo
- Neuropathological Unit, Fondazione Irccs Istituto Neurologico Carlo Besta, Milan, Italy
| | - Paolo Ferroli
- Neurosurgical Department, Fondazione Irccs Istituto Neurologico Carlo Besta, Milan, Italy
| | - Domenico Aquino
- Neuroradiological Unit, Fondazione Irccs Istituto Neurologico Carlo Besta, Milan, Italy
| | - Greta Demichelis
- Neuroradiological Unit, Fondazione Irccs Istituto Neurologico Carlo Besta, Milan, Italy
| | - Marco Schiariti
- Neurosurgical Department, Fondazione Irccs Istituto Neurologico Carlo Besta, Milan, Italy
| | | | - Luisa Chiapparini
- Radiodiagnostic Department, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Valeria Cuccarini
- Neuroradiological Unit, Fondazione Irccs Istituto Neurologico Carlo Besta, Milan, Italy
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Shen L, Wei Y, Ji Q, Zhu Q. Intravascular papillary endothelial hyperplasia of the adrenal gland: A rare tumor in a rare location. Asian J Surg 2022; 45:2790-2791. [PMID: 35840525 DOI: 10.1016/j.asjsur.2022.06.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Accepted: 06/01/2022] [Indexed: 12/15/2022] Open
Affiliation(s)
- Luming Shen
- Department of Urology, The Second Affiliated Hospital of Nanjing Medical University, 121 Jiangjia Yuan, Nanjing, Jiangsu, 210003, China
| | - Yong Wei
- Department of Urology, The Second Affiliated Hospital of Nanjing Medical University, 121 Jiangjia Yuan, Nanjing, Jiangsu, 210003, China; Department of Urology, Affiliated Hospital of Nanjing University of Chinese Medicine, 155 Hanzhong Road, Nanjing, Jiangsu, 210006, China
| | - Qianying Ji
- Department of Urology, The Second Affiliated Hospital of Nanjing Medical University, 121 Jiangjia Yuan, Nanjing, Jiangsu, 210003, China; Department of Urology, Affiliated Hospital of Nanjing University of Chinese Medicine, 155 Hanzhong Road, Nanjing, Jiangsu, 210006, China
| | - Qingyi Zhu
- Department of Urology, The Second Affiliated Hospital of Nanjing Medical University, 121 Jiangjia Yuan, Nanjing, Jiangsu, 210003, China.
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Huang WP, Li LM, Zhu LN, Gao JB. Intravascular papillary endothelial hyperplasia of the spleen in a child: a case report. BMC Med Imaging 2022; 22:207. [PMID: 36434525 PMCID: PMC9701009 DOI: 10.1186/s12880-022-00936-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Accepted: 11/11/2022] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Intravascular papillary endothelial hyperplasia (IPEH) is a vascular tumor characterized by the proliferation of endothelial cells with papillary formation. It is a rare benign condition affecting the head and neck. Currently, no cases of IPEH of the spleen have been reported. Here, we report a case of IPEH of the spleen in a child and discuss its clinical manifestations, imaging features, and surgical treatment. CASE PRESENTATION A 5-year-old female presented with a 4-month-old tumor in the left upper abdomen, abdominal pain, and constipation. She underwent radiography, barium enema, US, and MRI. A solid space-occupying mass was found in the left abdominal cavity on preoperative imaging, and it was diagnosed as angiosarcoma. The lesion was surgically resected. Histopathological analysis was consistent with IPEH. CONCLUSION Clinicians should consider the possibility of IPEH in patients presenting with tumors in the spleen, which is curable by surgical resection. Malignant vascular tumors must be excluded in the differential diagnosis of IPEH to prevent misdiagnosis and inappropriate overtreatment.
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Affiliation(s)
- Wen-peng Huang
- grid.412633.10000 0004 1799 0733Department of Radiology, The First Affiliated Hospital of Zhengzhou University, No.1, East Jianshe Road, Zhengzhou, 450052 Henan Province China
| | - Li-ming Li
- grid.412633.10000 0004 1799 0733Department of Radiology, The First Affiliated Hospital of Zhengzhou University, No.1, East Jianshe Road, Zhengzhou, 450052 Henan Province China
| | - Li-na Zhu
- grid.412633.10000 0004 1799 0733Department of Radiology, The First Affiliated Hospital of Zhengzhou University, No.1, East Jianshe Road, Zhengzhou, 450052 Henan Province China
| | - Jian-bo Gao
- grid.412633.10000 0004 1799 0733Department of Radiology, The First Affiliated Hospital of Zhengzhou University, No.1, East Jianshe Road, Zhengzhou, 450052 Henan Province China
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Manoranjan B, Mann JA, Joseph JT, Kelly JJ. Intraventricular Masson tumor: case report and systematic review of primary intracranial intravascular papillary endothelial hyperplasia. J Neurosurg Sci 2022; 66:420-424. [PMID: 34342194 DOI: 10.23736/s0390-5616.21.05372-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Intracranial Masson tumor (intravascular papillary endothelial hyperplasia, IPEH) is a benign lesion that is thought to originate from a reactionary process in response to compromised blood flow. IPEH may be classified into one of three subtypes based on etiology as it may result from the excessive proliferation of endothelial cells within a normal vessel (primary), vascular malformation (type II), or organized hematoma (type III). We report the case of a 79-year-old woman who presented with confusion, gait instability, and urinary incontinence. Neuroimaging revealed a hemorrhagic lesion within the right lateral ventricle, which was successfully resected. To our knowledge, this is the first reported case of an intraventricular IPEH and 33rd case of primary intracranial IPEH. We further performed a systematic review of the literature on all prior type I intracranial IPEH cases and discuss the importance of long-term follow-up in intracranial IPEH.
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Affiliation(s)
- Branavan Manoranjan
- Section of Neurosurgery, Department of Clinical Neurosciences, Foothills Medical Centre, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada -
| | - Jennifer A Mann
- Section of Neurosurgery, Department of Clinical Neurosciences, Foothills Medical Centre, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Jeffrey T Joseph
- Department of Pathology & Laboratory Medicine, Foothills Medical Centre, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - John J Kelly
- Section of Neurosurgery, Department of Clinical Neurosciences, Foothills Medical Centre, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
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Gajaria PK, Shenoy AS, Baste BD, Goel NA. Intravascular papillary endothelial hyperplasia of the cavernous sinus-A rare occurrence. INDIAN J PATHOL MICR 2021; 64:541-544. [PMID: 34341268 DOI: 10.4103/ijpm.ijpm_499_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Intravascular papillary endothelial hyperplasia (IPEH) is a benign, reactive proliferation of endothelial cells within areas of thrombus. It most commonly occurs in the skin and subcutaneous tissue, with less than 40 cases reported in intracranial location. Ours is the first case report from India of IPEH in the cavernous sinus. A 45-year-old male presented with headache and decreased visual acuity. Magnetic resonance imaging (MRI) revealed a well-defined, homogeneously contrast-enhancing mass in the cavernous sinus. Postoperatively, examination of tissue showed organizing thrombus within the vessel wall along with delicate, acellular, pseudopapillary cores. The fibrin-rich connective tissue of these showed blue staining with Masson's trichrome stain. These were lined by a single layer of endothelial cells without evidence of atypia; no nuclear pleomorphism, hyperchromasia, atypical mitosis, or areas of necrosis were seen. Hence, it was diagnosed to be IPEH. Follow-up MRI revealed no residual disease and the patient is disease-free at 8 months. Recognition of this entity by pathologic examination is important to rule out angiosarcoma. Gross total resection is curative. Residual lesions have the potential for recurrence, requiring adjuvant therapy.
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Affiliation(s)
- Pooja K Gajaria
- Department of Pathology, Seth G S Medical College and K E M Hospital, Mumbai, Maharashtra, India
| | - Asha S Shenoy
- Department of Pathology, Seth G S Medical College and K E M Hospital, Mumbai, Maharashtra, India
| | - Balaji D Baste
- Department of Pathology, Seth G S Medical College and K E M Hospital, Mumbai, Maharashtra, India
| | - Naina A Goel
- Department of Pathology, Seth G S Medical College and K E M Hospital, Mumbai, Maharashtra, India
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Intracranial Masson Lesion Following Stereotactic Radiosurgery for Treatment of Intracranial Arteriovenous Malformations. World Neurosurg 2020; 141:406-412. [PMID: 32389876 DOI: 10.1016/j.wneu.2020.04.224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2020] [Revised: 04/28/2020] [Accepted: 04/29/2020] [Indexed: 11/20/2022]
Abstract
OBJECTIVES Masson tumor or intravascular papillary endothelial cell proliferation was first described in 1923. Only a few cases of intracranial Masson tumor have been reported following stereotactic radiosurgery (SRS). We report a series of 6 cases, age range 28-56 years, with intracranial Masson tumor following SRS for treatment of an intracranial arteriovenous malformation (AVM). METHODS We performed a retrospective case note review, reviewed the imaging, SRS records, and neuropathology specimens following surgical excision. RESULTS In our series all patients received Leksell SRS with the periphery of the AVM receiving doses ranging from 22-25 Gy. The time lapse from SRS to a clear enhancing mass appearing on imaging ranged from 5-10 years. Four patients underwent craniotomy and excision of the enhancing lesion for persistent edema and an enlarging cyst resulting in a resolution of symptoms. CONCLUSIONS SRS is an effective treatment for obliteration of intracranial AVMs.
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