CNS Masson Tumors: Frequent Association With Therapeutic Radiation

Intravascular papillary endothelial hyperplasia (masson tumor) of the right wrist: A case report and literature review

Intravascular papillary endothelial hyperplasia (IPEH), also called masson tumor which is a benign vascular tumor named after Pierre Masson, the French pathologist who originally described it in 1923, terming it "hémangioendothéliome végétant intravasculaire." It is characterized by a reactive proliferation of endothelial cells associated with thrombosis. Ultrasound and MRI are the main imaging examinations, but the diagnosis of IPEH was confirmed by biopsy pathology and immunohistochemistry. It is generally accepted that surgical excision is the first choice of treatment. In this report, we report a case of Masson tumor arising in the right wrist.

Radiation-Induced Cerebral Cavernous Malformations: A Single-Center Experience and Systematic Literature Review

OBJECTIVE

Radiation was first demonstrated to be associated with cavernomagenesis in 1992. Since then, a growing body of literature has shown the unique course and presentation of radiation-induced cavernous malformations (RICMs). This study summarizes the literature on RICMs and presents a single-center experience.

METHODS

A prospectively maintained single institution vascular malformation database was searched for all cases of intracranial cavernous malformation (January 1, 1997-December 31, 2021). For patients with a diagnosis of RICM, information on demographic characteristics, surgical treatments, radiation, and surgical outcomes was obtained and analyzed. A comprehensive literature search was conducted using PubMed, Embase, Cochrane, and Web of Science databases for all reported cases of RICM.

RESULTS

A retrospective review of 1662 patients treated at a single institution yielded 10 patients with prior radiation treatment in the neck or head region and a subsequent diagnosis of intracranial RICM. The median (interquartile range) latency between radiation and presentation was 144 (108-192) months. Nine of 10 patients underwent surgery; symptoms improved for 5 patients, worsened for 3, and were stable for 1. The systematic literature review yielded 64 publications describing 248 patients with RICMs. Of the 248 literature review cases, 71 (28.6%) involved surgical resection. Of 39 patients with reported surgical outcomes, 32 (82%) experienced improvement.

CONCLUSIONS

RICMs have a unique course and epidemiology. RICMs should be considered when patients with a history of radiation present with neurologic impairment. When RICMs are identified, symptomatic patients can be treated effectively with surgical excision and close follow-up.

Intraventricular Masson tumor: case report and systematic review of primary intracranial intravascular papillary endothelial hyperplasia

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.

Innumerable Meningiomas Arising in a Patient With Tuberous Sclerosis Complex Decades After Radiation Therapy

Meningioma is the most common radiation-induced brain neoplasm, usually occurring after a latency of 20 - 35 years, with multiplicity in 10% of cases. Radiation-induced meningiomas (RIMs) have not previously been reported in patients with tuberous sclerosis complex (TSC), unlike their well-known occurrence in other familial tumor predisposition syndrome patients. We report a TSC patient who developed numerous intracranial meningiomas twenty five year after radiation therapy for subependymal giant cell astrocytoma (SEGA). Autopsy examination showed innumerable, coalescent, benign, meningothelial meningiomas, WHO grade 1, ranging in size from 0.2 cm to 3.3 cm. Autopsy also showed small residual SEGA, radiation-induced cerebral vasculopathy, and classic TSC features including several small subependymal nodules ("candle gutterings"), white matter radial heterotopia, facial angiofibromas, dental enamel pitting, one ash leaf spot, and multiple hepatic and renal angiomyolipomas. Next-generation sequencing analysis utilizing a 500+ gene cancer panel demonstrated chromosomal loss involving the majority of chromosome 22, including the NF2 gene locus, as well as a truncating nonsense mutation in TSC1 p. R509*. While TSC patients rarely require radiation therapy, this striking case suggests that patients with TSC should be monitored closely if cranial therapeutic radiation is administered.

Intravascular Papillary Endothelial Hyperplasia Mimicking Vaginal Malignant Tumor in a Post-Radiotherapy Patient: A Case Report and Literature Review

Intravascular papillary endothelial hyperplasia (IPEH) is a rare benign lesion that occurs in the soft tissue of any site, including the central nervous system, extremities, head, and female reproductive system. But no case occurred in vagina was reported previously. Here, we report a case of vaginal IPEH in a 54-year-old woman who has a history of radical hysterectomy for endometrial cancer with postoperative radiotherapy. She was positive for high-risk human papillomavirus (HR-HPV) with cytology result as low-grade squamous intraepithelial lesion (LSIL), and pathology from colposcopy-directed biopsy (CDB) presented suspicious high-grade squamous intraepithelial lesion (HSIL). The colposcopy showed an 8mm neoplasm at the right apical angle of vagina. The diagnosis of IPEH was confirmed by biopsy pathology and immunohistochemistry. As the lesion was benign and rather small, we discharged the patient with annual follow-up. The case illuminated that attention should be paid to "HSIL" patients after radiotherapy to exclude the incidence of benign IPEH.

Intracranial Masson Lesion Following Stereotactic Radiosurgery for Treatment of Intracranial Arteriovenous Malformations

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.

Intravascular Papillary Endothelial Hyperplasia of the Pineal Region: A Case Report and Review of the Literature

BACKGROUND

Intravascular papillary endothelial hyperplasia (IPEH) is a benign vascular lesion that is uncommon in the central nervous system. To our knowledge, there has been only one previous report of occurrence in the pineal region. We present a second case and a review of the literature.

CASE DESCRIPTION

A 28-year-old woman presented with 1 month of headaches and visual auras. Brain magnetic resonance imaging scan demonstrated a 2.6- × 1.8- × 1.3-cm nonenhancing T1-hypointense, T2-/fluid-attenuated inversion recovery-hyperintense pineal region mass with cerebral aqueduct obstruction and hydrocephalus. She underwent placement of a right extraventricular drain followed by complete surgical resection. Histologic analysis was consistent with IPEH.

CONCLUSIONS

Although rare, IPEH is an entity that should be considered in the differential diagnosis for intracranial masses with radiographic features characteristic of vascular lesions. Tissue sampling is imperative for distinction from more malignant entities. Complete resection is curative and is the standard of care when feasible. Given the risk of local progression and neurologic compromise with subtotal resection of central nervous system lesions, further study regarding adjuvant treatment options is warranted.