Cerebral astrocytoma and cavernous angioma: a case report

Reviewing Schwannoma-Hemangioma Composite Tumors With Their Tumorigenetic Molecular Pathways and Associated Syndromic Manifestations

Schwannomas are common peripheral nerve sheath tumors. Cavernous hemangiomas are vascular tumors that can affect any organ system. The coexistence of cavernous hemangioma with peripheral nervous system neoplasms is a rare occurrence. So far, 37 cases have been documented, and they have been divided into two categories: conjoined association (neoplasms discovered within the tumor tissue) and discrete association (neoplasms discovered outside the tumor tissue, thus placing neoplasms and tumors in close proximity but in different locations). Schwannomas and neurofibromas are the most prevalent tumors linked to cavernous hemangiomas that have been documented. The author provides a comprehensive review of all such cases published in the past with an emphasis on the implications of their tumorigenetic molecular pathways and syndromic manifestations.

Cavernoma: New Insights From an Unusual Case

BACKGROUND

Rapid growth in cerebral cavernous malformation is rare. A review of the literature revealed 4 patients with known cerebral cavernous malformations who later developed a high-grade glioma at the same site. All 4 patients were females, ranging in age from 25 to 71 years, with imaging confirming rapid growth in the lesion.

CASE DESCRIPTION

We present the case of a 71-year-old patient with known multiple cavernomas over many years in whom one lesion showed rapid expansion in size. Histological examination revealed the coexistence of a glioblastoma within the cavernoma.

CONCLUSIONS

We conclude that, although rare, rapid expansion of an existing cavernoma should be considered suspicious for the development of other malignant tumors, and propose adding chronic inflammation in the surrounding brain caused by microbleeds and hemosiderin deposition from the cavernoma to the list of possible causes.

Glioblastoma multiforme and cerebral cavernous malformations: intersection of pathophysiologic pathways

Cerebral cavernous malformations (CCM) are known to occur in both sporadic and familial forms. To date, there has been no identified association of CCM with glioblastoma multiforme. We present a 69-year-old woman with a 14 year history of multiple CCM who developed progressive aphasia. She had no radiation exposure and had only undergone a single computed tomography scan in her entire life. MRI demonstrated irregular gadolinium enhancement in the area of a prior stable CCM, suspicious for a high grade tumor. Stereotactic biopsy revealed a glioblastoma multiforme. This is a unique case of glioblastoma multiforme arising from the "site" of a known CCM. We review the literature on the genetics of cavernous malformations and propose a mechanism for the tumorigenic potential of these vascular malformations.

Radiation-induced cavernous hemangiomas: case report and literature review

The case of a 51-year-old man diagnosed with two acquired cavernous hemangiomas 17 years after cranial irradiation for a cerebellar astrocytoma is reported. A review of 84 cases of radiation-induced cavernous hemangiomas found in the literature is presented. In this series the mean age at the time of irradiation (+/- SD) was 10.4 +/- 2.0 years (median = 8 years), while the mean time to cavernous hemangioma diagnosis (+/- SD) was 10.3 +/- 1.9 years (median = 8 years). Time to cavernous hemangioma diagnosis was found to be inversely related to radiation dose. Hemorrhage from radiation-induced cavernous hemangiomas was found in 40.0% of patients, with an incidence of 3.9% per patient year. An inverse trend was identified between radiation dose and symptomatic presentation, cavernous hemangioma hemorrhage or surgical resection. This review of radiation-induced cavernous hemangiomas confirms that both younger patients and those who received a larger dose of radiation are at increased risk of radiation-induced cavernous hemangiomas. Our results suggest that, based on an assessment of CT or MR images, there may be an increased risk of hemorrhage when comparing radiation-induced to congenital cavernous hemangiomas. Increasing radiation doses appear to stabilize these lesions, decreasing the risk of a symptomatic presentation, cavernous hemangioma hemorrhage and surgical intervention.

Cavernous malformation within a schwannoma: review of the literature and hypothesis of a common genetic etiology

The finding of cavernous malformations within tumors of the central or peripheral nervous system is a rare occurrence. We report a case of a histologically proven cavernous malformation found within an eighth cranial nerve schwannoma in a 76-year-old man. The patient presented with progressive loss of hearing on the left, facial pain and dysesthesia. Symptoms improved significantly after the tumor was subtotally resected through a left retrosigmoid craniotomy. Including the present report, 34 cases of cavernous malformations associated with tumors of nervous system origin, 24 cases (71%) involving tumors of Schwann cell origin, and 9 cases (26%) involving gliomas have been published. The cases were classified into two forms based on the type of association. Conjoined association, in which the cavernous malformation is located within the tissue of the nervous system tumor, and discrete association, in which the cavernous malformation and nervous system tumor are in separate locations. We explore the etiology of this association and hypothesize that a common genetic pathway may be involved in a majority of these cases.