Primary hemangiopericytoma in the axis bone: case report and review of literature

SPINE METASTASIS OF INTRACRANIAL HEMANGIOPERICYTOMA: CASE REPORT OF TWO TREATMENTS

Objective:

To report the use of two techniques (radiosurgery and en bloc vertebrectomy) on the same patient for the treatment of two metastases in different sites of the spine arising from intracranial hemangiopericytoma. Intracranial hemangiopericytomas are rare, comprising approximately 2.4% of meningeal tumors and <1% of all tumors of the central nervous system. Metastases to the spine are even rarer: The largest case series reported in the literature has 5 and 7 cases.

Methods:

A 37-year-old man diagnosed with intracranial hemangiopericytoma was referred for a metastatic lesion in T12 and underwent en bloc resection using the Tomita technique.

Results:

The disease evolved with a metastasis to T2 treated by radiosurgery with 1600 cGy. The patient died 1,706 days after the en bloc resection of T12 and 1324 days after the radiosurgery of T2, and no recurrence occurred in these locations due to progression of the systemic diseases (liver and central nervous system).

Conclusion:

This is the first case reported in the literature in which two different techniques were used to treat metastatic lesions in the spine from an intracranial hemangiopericytoma and is unique for its use of two treatments in the same patient. Level of evidence: V, case report

Solitary Fibrous Tumour of the Clavicle: A Rare Case Report

A Solitary Fibrous Tumour (SFT) is the preferred term by most of the pathologists than "haemangiopericytoma". SFT is a heterogeneous group of benign and malignant neoplasms along a morphologic continuum. Here we report a case of SFT of the clavicle in a 26-year-old male patient, who presented to us with complaints of pain and swelling over the dominant shoulder. No signs of metastasis were noted clinically and radiologically. He underwent surgical resection of swelling. At 6 months after resection and after 22 cycles of radiotherapy, he was noted to have excellent prognosis with satisfactory shoulder function.

Metastatic Hemangiopericytoma Presenting as an Epidural Spinal Cord Lesion

Objective:

Hemangiopericytoma is an aggressive vascular tumour that rarely affects the central nervous system and is even more rarely spinal in presentation. The clinical features of a patient with a recurrent extraspinal hemangiopericytoma presenting with an epidural spinal cord compression by local invasion are described, including a review of the literature on metastatic hemangiopericytoma to the spine.

Methods:

A case of a 53-year-old male, with a recurrent extraspinal hemangiopericytoma which metastasized to the thoracic spine five years after detection of the primary tumour is presented. A chart review was conducted where all pertinent history, physical, laboratory, and radiological data were collected. A Pub-Med search using the keyword “hemangiopericytoma” identified all reported cases documenting clinical features, treatment, recurrence and outcome with respect to metastatic hemangiopericytoma to the spine.

Results:

Nine patients have been reported to have metastatic hemangiopericytoma to the spine. The median patient age was 47 years and there was a slight male preference. An unusual feature of the hemangiopericytoma is the prolonged period, up to 16 years, between the diagnosis of the primary hemangiopericytoma and the metastases to the spine. All patients were treated with a combination of radiation and surgery.

Conclusion:

Hemangiopericytomas show a slow clinical evolution with a strong propensity to relapse long after previous treatment and thus, once identified, prolonged follow-up for recurrence is indicated. A close follow-up of these patients is required because of frequent recurrences and delayed metastases even if the primary lesion was well-controlled. Although overall uncommon, hemangiopericytoma should be kept in mind in the differential diagnosis of vascular epidural spinal cord tumours.

Myopericytoma of the thoracic spine: a case report and review of literature

BACKGROUND CONTEXT

Myopericytoma is a recently proposed term to describe a group of tumors originating from perivascular myoid cells. The tumor is most commonly located in the subcutaneous tissues and dermis of the extremities. Myopericytoma involving the skeletal system is a very rare entity, with only two such cases previously reported in literature.

PURPOSE

To present only the third reported case of myopericytoma of the spine along with a review of literature.

STUDY DESIGN

Case report with and review of literature.

METHODS

We report the case of a 50-year-old woman who presented with pain in the back with gradual onset of paraparesis. Magnetic resonance imaging showed ill-defined signal changes in the body and posterior elements of the vertebrae with epidural soft tissue mass encasing the spinal cord.

RESULTS

The patient underwent excision of the lesion with spinal fusion followed by a short course of radiotherapy. The patient recovered functional power after surgery, and at 32-month follow-up, there is no radiological evidence of recurrence of the lesion.

CONCLUSIONS

Myopericytoma should be considered in the differential diagnosis of lytic lesions of the spine. Surgery is curative; however, a short course of chemotherapy or radiotherapy may be required to prevent recurrent disease in case of incomplete tumor excision.

Fat-forming solitary fibrous tumour (lipomatous haemangiopericytoma) of the spine: case report and literature review

Solitary fibrous tumour (SFT) is a rare soft tissue tumour of uncertain histogenesis and unpredictable biological behaviour, which was first described in the pleura and subsequently in many extra-pleural locations. Fat-forming SFT is a sub-type of SFT and only a handful of cases have been reported in the literature. We present the clinical, radiological and histological features of a case of intraspinal fat-forming SFT, along with a literature review. This is the first known report of a fat-forming SFT in the spine.

Hemangiopericytomas of the spine: case report and review of the literature

We describe a rare case of a primary intracranial meningeal hemangiopericytoma (HPC) with late metastasis to the cervical spine. A 36-year-old woman had a left occipital lesion that was histopathologically identified as HPC. Fourteen years after resection, the tumor recurred and was treated with radiotherapy. Three years later, CT imaging showed a large mass in the liver consistent with metastatic HPC, and MRI of the cervical spine showed an extensive lesion of the C3 vertebral body. The patient underwent C3 corpectomy with en-bloc tumor removal and follow-up radiation with no local recurrence or other spinal metastasis for the following 4 years. Regardless of the subtype of spinal HPC, complete surgical removal and radiotherapy appear to be treatment of choice.

Oncogenous osteomalacia and myopericytoma of the thoracic spine: a case report

STUDY DESIGN

A case report.

OBJECTIVE

To illustrate a rare case of oncogenous osteomalacia caused by a spinal thoracic myopericytoma.

SUMMARY OF BACKGROUND DATA

Osteomalacia related to a tumor is well known. The cause of the disorder is usually a highly vascularized, benign tumor of mesenchymal origin. Location of the tumor in the spine is very rare. Removal of the tumor is followed by resolution of osteomalacia.

METHODS

Diagnosis of oseomalacia was established on the presence of cardinal clinical, biologic, and radiologic features of osteomalacia. Localization of the tumor at T5 and T6 levels was obtained by magnetic resonance imaging. Surgical treatment consisted in a circumferential correction-fusion with hemivertebrectomy of T5 and T6 and tumor removal.

RESULTS

Tumor removal was rapidly followed by disappearance of the clinical symptoms of osteomalacia, and by correction of hypophosphatemia. At 2-years follow-up, no recurrence of the tumor was detectable on imaging studies-the correction fusion remained stable. Histologically, the tumor was classified as a myopericytoma. There was no relapse of the clinical features of osteomalacia. However, secondary recurrence of the biologic markers due to an incomplete tumor removal was disclosed.

CONCLUSION

Removal of the tumor was followed by healing of the clinical features of osteomalacia, demonstrating the causal connection between the myopericytoma and the osteopathy.

Intermittent atlantoaxial subluxation caused by a prolapsing neurofibroma. Case report

In this report, the authors describe a unique case of intermittent high cervical cord compression caused by a prolapsing neurofibroma at the C1-2 level. This 21-year-old man with known neurofibromatosis Type 1 presented with a mass between the anterior arch of the atlas and the odontoid peg, causing atlantoaxial dissociation and cord compression. The cervicomedullary compression appeared to be caused in part by the neurofibroma but also by the abnormal alignment and thickening of the ligaments between the clivus and C-2. Preoperative imaging repeated on the morning of surgery revealed that the atlantoaxial dissociation had reduced with relief of cord compression and the lesion prolapsed inferiorly. The authors discuss this unusual lesion and describe the associated operative findings and surgical management.

Pediatric extradural spinal tumors

We have reviewed 16 children with extradural spinal tumors, both benign and malignant, treated from 1998 to 2006 in Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India. The duration of symptomatology, clinical signs, radiological investigations, surgical approach, outcome and histopathological variation from the Western world was noted and evaluated. The age of these children ranged from 3 to 20 years. There were 11 boys and 5 girls. The duration of symptoms was 2-18 months, relatively longer in benign (mean 9.5 months) than malignant (mean 4.2 months) tumors. The follow-up ranged from 3 to 72 months and patients were graded preoperatively and postoperatively with the McCormick Functional Grading System. There was significant improvement in grade III-V patients, i.e. 74% of patients were grade III-IV at presentation, and only 35% at the last follow-up. There was deterioration from grade III to grade IV in 2 patients (PNET + metastatic adenocarcinoma) and 2 patients (neuroblastoma + Ewing's sarcoma) maintained their grades of IV and V, respectively. There was a wide range of histological variants seen in our series and the patients were treated primarily with a suitable surgical approach and adjuvant chemoradiotherapy, wherever indicated.

Subpial hemangiopericytoma with marked extramedullary growth: case report

OBJECTIVE

Hemangiopericytomas, vascular tumors arising in soft tissue, are relatively rare in the central nervous system; they comprise less than 1% of all hemangiopericytomas. Central nervous system hemangiopericytomas occur primarily in the epidural space of the brain and spinal cord. There are no previous reports of subpial, extramedullary growing central nervous system hemangiopericytomas.

CLINICAL PRESENTATION

We document the first case of a subpial hemangiopericytoma with extramedullary growth in the thoracic spine. The patient was a 31-year-old man who developed progressively worsening left lower limb numbness that was followed by gait disturbance over the course of 4 months.

INTERVENTION

Magnetic resonance imaging revealed an intradural tumor at the T4-T6 level of the thoracic spine. Because the patient's symptoms progressed, he underwent resection of the tumor, which had arisen in the spinal cord subpially without attachment to the dura mater.

CONCLUSION

The pathological diagnosis was hemangiopericytoma. Differential diagnoses include hemangioblastoma, meningioma, schwannoma, and solitary fibrous tumor, the clinical course and prognosis of which are different from hemangiopericytoma. Our experience indicates that hemangiopericytomas can occur as intradural tumors arising from the subpial portion.

Hemangiopericytoma of thoracic spine: a rare bony tumor

CASE REPORT

We report the case of a 16-year-old girl who developed hemangiopericytoma of the thoracic spine; the main clinical symptoms were of spastic paraparesis with sensory involvement and uro-fecal incontinence. She was initially put on antitubercular treatment keeping in mind the endemicity of tuberculosis in the region. When she deteriorated on conservative management, she was operated upon, and the histopathological report was suggestive of hemangiopericytoma.

MATERIALS AND METHODS

Additional immunocytochemistry was performed in the paraffin-embedded tumor sections.

CONCLUSIONS

An extremely rare case of primary epidural malignant hemangiopericytoma of the thoracic spinal column is described. It is a rare tumor, which is locally aggressive, and a potentially malignant tumor. The tumor is more commonly found in the cranium, and spinal involvement is rare, and only few case reports could be retrieved from the literature. We discuss the clinical profile, management, and outcome of spinal hemangiopericytomas along with pertinent review of the literature.

Delayed manifestation of spinal metastasis: a special feature of hemangiopericytoma

Metastatic hemangiopericytoma to the spine is rare, and operative management of these highly vascularized tumors is challenging. Review of the literature identified only seven previously reported cases. Metastases of hemangiopericytomas to the spine are diagnosed often only after a long delay following resection of the primary tumors. To emphasize the clinical and histopathological features of metastatic hemangiopericytoma to the spine and to review treatment options, a case of a delayed metastatic hemangiopericytoma to the cervicothoracic spine is reported: a 48-year-old woman presented with a large metastatic hemangiopericytoma to the cervicothoracic spine causing left-sided cervicobrachialgias and gait disturbance. Magnetic resonance imaging studies revealed a large left-sided dumbbell-shaped intraspinal and extraspinal tumor from C6 to T2. The patient underwent two-staged total removal of the cervicothoracic mass with posterior stabilization and subsequent radiotherapy. Histopathological findings revealed a malignant hemangiopericytoma which had identical features to the primary cranial meningeal tumor removed 8 years earlier. The radicular symptoms and the gait ataxia disappeared, postoperatively. One year later, however, new metastases were present. Patients with hemangiopericytoma should be controlled regularly for local recurrence and systemic tumor spread. The best available treatment for delayed metastasis to the spinal column is complete tumor removal followed by postoperative radiotherapy.

Myopericytoma of the thoracic spine: a case report

STUDY DESIGN

A case of myopericytoma of the thoracic spine is reported.

OBJECTIVE

To report a recently described and extremely rare soft tissue neoplasm in the previously unreported location of the thoracic spine.

SUMMARY OF BACKGROUND DATA

Myopericytoma is a recently described soft tissue neoplasm with perivascular myoid differentiation. All cases have been reported in the subcutaneous and superficial soft tissues of the extremities. This represents the first reported case of this unusual lesion in the spine.

METHODS

A patient with a 3-month history of progressive weakness of the arms and legs was found to have a lytic lesion of T3. The lesion was surgically treated by curettage followed by a course of radiation. Presenting symptoms, imaging studies, histologic findings, and related literature are reviewed in this study.

RESULTS

Histologic evaluation of sections of the surgically removed lesion revealed a concentric, periluminal proliferation of cells with prominent positive smooth muscle actin immunoreactivity. These findings are consistent with the diagnosis of a myopericytoma, a lesion not previously reported in the spine.

CONCLUSIONS

This study shows the presence of a lesion in the thoracic spine only previously described in the soft tissue of the extremities. The diagnosis of myopericytoma should be included, along with hemangiopericytoma, in the differential diagnosis of lytic lesions of the spine.

Primary epidural hemangiopericytoma in the lumbar spine: a case report

STUDY DESIGN

A case report of primary epidural hemangiopericytoma in the lumbar spine and a review of the literature are presented.

OBJECTIVE

To present the result of pathologic diagnosis using immunohistochemical staining and the treatment of spinal hemangiopericytoma.

SUMMARY OF BACKGROUND DATA

Spinal hemangiopericytoma is a very rare soft tissue tumor with specific pathologic features and a clinical course featuring high rates of recurrence and metastasis.

METHODS

A 39-year-old woman reported numbness in both legs. Neither sensory abnormalities nor muscle weakness was present in her lower extremities. Magnetic resonance imaging showed a tumor dorsal to the thecal sac at L1-L2. After L1 and L2 laminectomy, the tumor with its dural base was resected en bloc.

RESULTS

The patient's clinical and neurologic symptoms disappeared after surgery. Microscopic examination showed oval- or spindle-shaped cells with slightly acidic cytoplasm and oval nuclei. Silver staining emphasized fibers around tumor cells. The test results for the tumor cells were positive for vimentin staining, but negative for alpha-TM staining using thrombomodulin, a marker for endothelial cells. On the basis of these pathologic findings, the tumor was diagnosed as a hemangiopericytoma, a type of tumor composed of mesenchymal hemangiopericytes. Neither recurrence nor metastasis of the tumor was found during the 2-year follow-up period after surgery.

CONCLUSIONS

Soft tissue hemangiopericytoma is a well-recognized entity considered to be an aggressive neoplasm with a high rate of recurrence and a propensity to metastasize. Immunohistochemical investigation was essential for the diagnosis of this tumor. Although hemangiopericytoma very rarely occurs in the spine, surgeons treating patients with this tumor should be aware of its metastatic potential.