Intracranial solitary fibrous tumor/hemangiopericytoma: tumor reclassification and assessment of treatment outcome via the 2016 WHO classification

PURPOSE

As per the 2016 World Health Organization (WHO) guidelines on the classification of central nervous system tumors, solitary fibrous tumors (SFTs) and hemangiopericytomas (HPCs) constitute a single disease entity, known as SFT/HPC. This study provides a clinical analysis of these tumors and describes the treatment outcomes of SFT/HPCs.

METHODS

This retrospective study included 76 patients with histopathologically proven SFT/HPC. Reclassification according to the 2016 WHO guideline was done for patients who were diagnosed with SFT or HPC based on the 2007 WHO classification. Recurrence-free survival (RFS) and overall survival (OS) were evaluated for all patients and subgroups.

RESULTS

The median follow-up period was 77.9 months. The median RFS and OS were 126.5 and 136.8 months, respectively. The 1-, 5-, 10-, and 15-year RFS rates were 93%, 72%, 40%, and 40%, respectively. The 1-, 5-, 10- and 15-year OS rates were 97%, 89%, 54%, and 35%, respectively. In multivariable analyses, stereotactic radiosurgery (SRS; p = 0.009, hazard ratio [HR] 6.986), female sex (p = 0.023, HR 1.76), and age over 45 (p = 0.037, HR 2.74) were associated with shorter RFS. Patients who underwent SRS as initial treatment had a shorter OS than that of patients who underwent primary resection (p < 0.001, HR 12.86).

CONCLUSIONS

High-grade tumors tended to have worse OS and occur extracranial metastases earlier than low-grade tumors. The median RFS was not different between grade II and III tumors. Male sex, younger age, and GTR were associated with a better RFS. A history of SRS before tumor resection was associated with a shorter RFS and OS.

Diagnosis and treatment of solitary fibrous tumor/hemangiopericytoma of central nervous system. Retrospective report of 17 patients and literature review

To investigate the diagnosis, treatment and prognosis of solitary fibrous tumor (SFT)/ hemangiopericytoma (HPC) of central nervous system (CNS), we retrospectively reviewed records of 17 patients who were treated for CNS SFT/HPC at the Department of Neurosurgery, China-Japan Union Hospital of Jilin University from December 2010 to June 2016, and reevaluated their pathological diagnoses according to the 2016 WHO classification of CNS tumors. We then analyzed their clinical symptoms, imaging characteristics, treatments and outcomes. Clinical manifestations of CNS SFT/HPC were diverse, but mainly included headache, increased intracranial pressure, seizures, and focal neurological deficits. In MRI, CNS SFT/HPC usually shows heterogeneous signals, and unusual enhancements; we saw lobulated shapes in 13 patients and necrotic or cystic changes in 12 patients. Tumors of all 17 patients were resected surgically; 9 patients also received postoperative adjuvant radiotherapy. Mean follow-up time was 21 months (range: 2-67 months). The 17 surgeries included 11 total resections, 4 subtotal resection, and 2 partial resections. We followed up 12 patients; 9 of the patients who received total resections had no disease progression; among the 6 patients who did not receive total resections, 2 died of tumor recurrence, 1 has not shown any disease progression. Thus, extent of resection has an apparently crucial influence on prognosis. Postoperative radiotherapy should be chosen carefully, based on resection extent and pathologic grade.

Recurrent Intracranial Hemangiopericytoma with Extracranial and Unusual Multiple Metastases: Case Report and Review of the Literature

Hemangiopericytoma is a rare tumor with uncommon location in the central nervous system. It has only recently been included (WHO classification 1993) in a specific group of CNS tumors and subsequently (WHO classification 1997 and 2000) as a group by itself, while before it was confused with meningeal tumors. We report on a case of a 48-year-old woman affected by this tumor. The neoplasm was located in the posterior fossa. The patient underwent primary surgery in 1990, not followed by any adjuvant therapy because of the histopathological diagnosis of meningioma. After being free from disease for eight years she developed a local recurrence in 1998. Subtotal excision of the tumor, which was finally identified as a hemangiopericytoma, was carried out, followed by adjuvant radiotherapy (64 Gy). After six months multiple metastases were found in the liver and right kidney. A radical metastasectomy was performed, followed by systemic chemotherapy. One year later (2001) the tumor recurred again intracranially and a metastases was detected in the right breast, so the patient again underwent cranial irradiation (40 Gy) and second-line chemotherapy. She died in September 2002, 12 years after the diagnosis. We may conclude that, despite the tumor's natural tendency to recur several times and the ability of intracranial hemangiopericytoma to spread outside the CNS, it is possible to ensure a long survival time.

Recent Experience in the Management of Meningeal Hemangiopericytomas

Although the histogenesis of meningeal hemangiopericytomas (HMP) remains controversial, both biological and clinical evidence seems to identify these neoplasms as a separate entity with respect to meningiomas. In order to assess the current prognosis of HMP we reviewed our personal experience limited to the last decade (1986-1995): during this period 7 patients (4M, 3F) were treated by surgery alone or surgery combined with postoperative radiotherapy. In spite of meticulous attempts at radical resection, the tumors recurred in all but two cases with a mean interval of 85 months, and a total of 18 operations were performed (2.57/patient; range 1-4). Massive intratumoral hemorrhage determined acute deterioration and required emergency surgery in two cases while in one patient diffuse visceral metastases were discovered at autopsy. Five patients are still alive at follow-up but only 2 of them are in good neurological conditions and without evidence of disease. These results are similar to those reported in other series. In view of our results we conclude that intracranial hemangiopericytomas still have a dismal prognosis. Advances in neuroimaging, neuroanesthesia, microneurosurgery and adjuvant therapy do not seem to have significantly affected the recurrence rate, quality of life and mortality.

Intraventricular Hemangiopericytoma: A Case Report and Literature Review

BACKGROUND

Hemangiopericytomas are rare intracranial neoplasms that generally occur in the fifth decade of life and are commonly dural-based, supratentorial tumors. They are classified as World Health Organization grade II or III because of their aggressive nature with high rates of local recurrence and distant metastasis. This case is of an intraventricular hemangiopericytoma in a 23-year-old man. Intraventricular locations are rare, with only 10 cases reported in the literature. Our patient is the youngest to be diagnosed with an intraventricular hemangiopericytoma outside a pediatric case discovered at autopsy.

CLINICAL PRESENTATION

A 23-year-old man with a left intraventricular hemangiopericytoma presenting with headache, word-finding difficulties, blurred vision, nausea, vomiting, photophobia, and right-sided weakness and numbness. Using a left superior parietal lobule approach, a piecemeal resection was completed, achieving radiographic gross total resection. Pathology was consistent with a hemangiopericytoma. He was treated adjunctively with 60 Gy of local radiation. At 6-month follow-up, the patient had resolution of his aphasia and improvement in his headaches, with no signs of recurrence or metastasis on imaging.

CONCLUSIONS

Standard treatment for central nervous system hemangiopericytoma includes aggressive surgical resection. The role of adjuvant radiation is less well defined but is commonly pursued postoperatively. Regardless of extent of resection or adjuvant treatment, close follow-up to evaluate for evidence of local recurrence and distant metastasis is essential.

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.

[Treatment outcome and prognosis of head and neck hemangiopericytoma]

OBJECTIVE

Aim of the study is to report the unique clinicopathologic feature, treatment outcome and prognostic factors of head and neck hemangiopericytoma (HNHPC).

METHOD

A retrospective data collection of reported HNHPC cases, in which therapy, follow-up and outcome data were available, was performed from the electronic database of PubMed, Embase, Google scholar, China National Knowledge Infrastructure, Wan Fang and Wei Pu until on December 31, 2013.

RESULT

A total of 213 HNHPC cases were identified from 122 peer-reviewed articles. The recurrence rate was 24.4% (51/209). The positive surgical margin (OR= 3. 977, P<0. 01) and poor pathologic differentiation (OR=l. 890, P<0. 01) were associated with increased local recurrence. The metastasis rate was 15.8% (22/139). The positive surgical margin (OR=13. 833, P<0. 01), poor pathologic differentiation (OR=4. 661, P<0. 01) and non-surgical treatment (OR=2. 000, P<0. 01) were associated with increased distant metastasis. The mortality rate was 15. 0% (32/213). The tumor size >5. 0 cm in diameter (OR= 2. 860, P<0. 05), positive surgical margin (OR=9. 833, P<0. 01), poor pathologic differentiation (OR=4. 061, P<0. 01) and non-surgical treatment (OR=2. 032, P<0. 01) were associated with worse mortality. The treatment included surgery alone 139 cases, multiple treatments 64 cases and non-surgical treatment 10 cases. The overall survival (OS) of the 213 cases was 85%, and the 3-year, 5-year and 10-year OS were 86%, 78% and 74%, respectively. The 3-year, 5-year and 10-year OS for surgery alone were 95%, 88% and 84%, respectively. The 3- year, 5-year and 10-year OS for surgery plus radiotherapy were 90%, 80% and 80%, respectively. The 3-year, 5- year and 10-year OS for surgery plus chemotherapy were 75%, 25% and 25%, respectively. The 3-year, 5-year and 10-year OS for surgery plus radio-chemotherapy were 67%, 58% and 46%, respectively. There were signifi- cant survival difference in recurrence-free survival (RFS), metastasis free survival (MFS) and OS depending on surgical margins (P<0. 01). RFS, MFS and OS difference were identified depending on pathologic differentiation (P<0. 01). MFS and OS differences were observed on the different treatment modality (P<0. 01). OS differences was observed on the different tumor sizes (P<0. 05). Positive surgical margins was correlated with disease recurrence (HR= 3. 680, P<0.01), while poor pathologic differentiation was correlated with metastasis and death (HR=2. 619, P<0. 05 and HR=3. 188, P<0. 05). The tumor size >5. 0 cm in diameter and non-surgical treatment was correlated with death (HR= 5. 461, P<0. 01 and HR= 8. 563, P<0. 01, respectively).

CONCLUSION

The surgical resection was the mainstream treatment and it was superior to multiple treatments. The tumor size, surgical margins, pathological differentiation and non-surgical treatment were independent prognostic factors.

[Clinical analysis of sinonasal hemangiopericytoma]

OBJECTIVE

To investigate the clinical features, therapeutic methods and therapeutic effects of sinonasal hemangiopericytoma.

METHODS

Clinical data of 6 patients with sinonasal hemangiopericytoma, diagnosed by pathology and immunohistochemistry between January 1990 and December 2012 were analyzed retrospectively. There were 4 males and 2 females, with a median age of 58 years. Clinical manifestation included epistaxis and nasal obstruction. These patients were operated on by nasal endoscopic surgery or endoscope-assisted surgery, of which 2 cases of tumor located in the nasal cavity underwent nasal endoscopic surgery and 4 cases of tumor located in the nasal cavity and sinuses underwent endoscope-assisted surgery.

RESULTS

All the patients were followed up for a period of 6 months to 7 years after operation. Two cases recurred and 4 cases didn't recurred. One case recurred 6 months after operation and underwent second operation, with no recurrence by further one year follow-up. Another case recurred 17 months after operation and underwent second operation, with recurrence by further 9 months follow-up. This patient lived with tumor over two years.

CONCLUSIONS

Hemangiopericytomas are rarely found in the sinonasal cavity. Nasal endoscopic or endoscope-assisted surgery provides satisfactory effect.

Efficacy of erlotinib in patients with relapsed gliobastoma multiforme who expressed EGFRVIII and PTEN determined by immunohistochemistry

Epidermal growth factor receptor gene (EGFR) alteration is a common feature in most of glioblastoma multiforme (GBM). Robust response of anti-EGFR treatments has been mostly associated with the EGFR deletion mutant variant III (EGFRvIII) and expression of PTEN. We have performed a prospective trial in order to confirm the efficacy of erlotinib treatment in patients with relapsed GBM who expressed EGFRvIII and PTEN. All patients included in the trial were required to be PTEN (+++), EGFR (+++) and EGFRvIII (+++) positives by immunohistochemistry. This new phase II trial enrolled 40 patients and was design to be stopped in case of fewer than two responses in the first 13 patients. Patient eligibility included histopathology criteria, radiological progression, more than 18 years old, Karnofsky performed status, KPS > 50, and adequate bone marrow and organ function. There was no limit to the number of prior treatments for relapses. No enzyme-inducing antiepileptic drugs were allowed. The primary endpoints were response and progression-free survival at 6 months (PFS6). Thirteen patients (6 men, 7 women) with recurrent GBM received erlotinib 150 mg/day. Median age was 53 years, median KPS was 80, and median prior treatments for relapses were 2. There was one partial response and three stable diseases (one at 18 months). PFS at 6 months was 20 %. Dose reduction for toxicity was not needed in any patient. Dermatitis was the main treatment-related toxicity, grade 1 in 8 patients and grade 2 in 5 patients. No grade 3 toxicity was observed. Median survival was 7 months (95 % IC 1.41–4.7). As conclusion, monotherapy with erlotinib in GBM relapses patients with high protein expression for PTEN (+++), EGFR (+++), and EGFRvlII (+++) showed low toxicity but minimal efficacy and the trial stopped.

[Diagnosis and treatment of primary mediastinal angiosarcoma]

The results of treatment of 23 patients, suffering primary angiosarcoma (AS), and 7--having mediastinal hemangiopericytoma, were analyzed. Primary mediastinal AS constitutes a quite rare tumor, for its recognition it is necessary to do differential diagnosis from tumors with possible localization in anterior mediastinum. AS differs by more aggressive course and, accordingly, by poorer results of treatment and poorer prognosis as well. Surgical treatment was conducted in 15 patients, including radical operations in 13 (in 7--for AS, in 6--hemangiopericytoma), the combined--in 4. The total survival indices during 3 - 5 yrs after radical operations for AS have had constituted, accordingly, 57.1 and 28.6%, and of recurrence-free survival--42.8 and 28.6%. Chemotherapy as a single method of treatment was conducted in 11 patients, radiation therapy--4. The total survival indices in 3 and 5 yrs follow-up have had constituted 26.6 and 7.1%. Application of taxans in the treatment of AS permits to achieve better results. Radiation therapy is applied in a chemotherapy resistant and recurrent tumors. Surgery constitutes the main method of treatment of mediastinal AS. The standard schemes of chemotherapy are lacking efficacy, the taxans are characterized by higher antitumoral activity.

Hemangiopericytoma of the adult male breast

Hemangiopericytoma (HPC) is a rare tumor originated from the vascular pericytes, and it is uncommon in the breast. Only 2 cases of HPC in the male breast have been reported in the literature. This report presents a case of a 24-year-old man with a mass in his right breast. Under local anesthesia, the tumor was excised and diagnosed as `malignant tumor of the breast, perhaps originated from the vessel tissues` based on pathological examination. Finally, a modified radical mastectomy and an axilla fossa sampling were performed, and 4 lymph nodes showed symptoms of reactive hyperplasia. We followed the patient without any treatment and no local recurrence or metastasis has been observed. We also review the literature and discuss the characteristics, immuno-phenotype, and prognosis of HPC. The accurate diagnosis of HPC depends on the appropriate histological and immunohistochemical examination.

Hemangiopericytoma of the maxilla in a pediatric patient: a case report

The hemangiopericytoma is a malignant vascular tumor arising from mesenchymal cells with pericytic differentiation. Hemangiopericytoma is most commonly seen in adults, and only 5% to 10% of cases occur in children. The tumor is extremely rare in the head and neck region (16%). Cytogenic abnormalities have been present in some hemangiopericytoma cases. Surgical resection remains the mainstay treatment. Adjuvant chemotherapy and radiotherapy is appropriate for cases of incomplete resections and life-threatening tumors particularly in children. Late relapses may occur and require long-term follow-up. A 4-year-old child patient with hemangiopericytoma of the maxilla presented with firm, recurrent, but painless jaw mass. Radiographic investigations revealed a poorly circumscribed radiolucency. The lesion biopsy showed wellcircumscribed multiple lobules of tumor mass consisting of tightly packed, spindleshaped cells. Chemotherapy and radiotherapy of the lesion was conducted. The role of the pediatric dental team is extensive in children with hemangiopericytoma, who require a regular dental review. The patient's oncologist should be immediately contacted if there is any suspicion of recurrence.

[Prenatal diagnosis of retroperitoneal neuroblastoma. Case report]

Neuroblastoma is the foremost malignant neoplasm of the fetus and neonate. It is a tumor of the sympathetic nervous system that originates from the neural crest which etiology is largely unknown. Due to its general variability in outcome, neuroblastoma has long been considered one of the most enigmatic of cancers. Although technological advances in ultrasonography have possible intrauterine detection, prenatal diagnosis is still a rare event. This kind of tumor has a high morbidity and mortality rate due to the metastatic risk. Early detection of the tumor is critical to improve outcome. We report a case of retroperitoneal neuroblastoma diagnosed at 32 week of gestation.

Suprasellar haemangiopericytoma--challenges in diagnosis and treatment

Haemangiopericytomas of central nervous system (CNS) were first defined as a separate entity in 1942. Previously they were either considered to be a histological variant of an angioblastic meningioma or a distinctive mesenchymal neoplasm. Most commonly they are located in parasagittal and falcine region. Tumours in the sellar/parasellar location are very rare and commonly escape diagnosis before operation. They are characterised by high vascularity, a high rate of local recurrence and extraneuronal metastasis. We report a 35-year-old man with a suprasellar hemangiopericytoma who presented with bilateral diminution of vision in both eyes and frontal headache. Six months after the first operation, he developed a large local recurrence. He again underwent tumour decompression followed by postoperative conformal radiotherapy and is currently asymptomatic and stable clinically and radiologically. The various differential diagnoses, the importance of a preoperative suspicion of this diagnosis and management are issues discussed in this illustrated review.

Metastatic hemangiopericytoma to the cauda equina: a case report

BACKGROUND CONTEXT

Hemangiopericytoma is an aggressive tumor associated with high recurrence and metastasis. Metastases are usually delayed, long after diagnosis of the primary lesion. Metastatic hemangiopericytoma to the spinal cord is especially rare.

PURPOSE

To report a rare clinical presentation of a metastatic intradural, intramedullary hemangiopericytoma to the cauda equina from a cerebellar hemangiopericytoma.

STUDY DESIGN

Case report with a review of the literature.

METHODS

Clinical history, physical findings, and magnetic resonance imaging studies of a patient with a metastatic intradural, intramedullary hemangiopericytoma to the cauda equina are reported.

RESULTS

A case report is presented of a female with an intradural, intramedullary lesion at the L4-S1 level, presenting initially with progressive pain and motor weakness affecting the left lower extremity. She had a history of a cerebellar hemangiopericytoma, which had been treated with total resection and radiotherapy 4 years earlier. This patient developed urinary urgency and frequency. Pathological analysis revealed a hemangiopericytoma, which had a similar character to a cerebellar lesion. After radiotherapy, the tumor was mostly diminished and her symptoms totally resolved.

CONCLUSIONS

Hemangiopericytomas have a strong tendency to both local recurrence and metastasis. Common metastatic sites are the skeletal system, lung, liver, and abdominal cavity. To the authors' knowledge, there have been no reports of spinal intradural, intramedullary metastasis of hemangiopericytoma.

Clinical and pathological characteristics of primary intraspinal hemangiopericytoma and choice of treatment

BACKGROUND

Primary intraspinal hemangiopericytoma is a rare malignant mesenchymal tumor with high rates of recurrence and metastasis. Surgery is the main therapeutic procedure for this lesion. This clinical research was undertaken to analyze the pathological characteristics, clinical course, and the choice of treatment for this lesion.

METHODS

Twenty-three patients with primary intraspinal hemangiopericytomas were treated from 1987 to 2004. The clinical and imaging features, pathological findings, therapeutic procedures, and prognosis were analyzed retrospectively.

RESULTS

Primary intraspinal hemangiopericytoma is more likely to attack middle-aged persons. The tumor mainly manifests as muscle weakness and sensor abnormalities. Microscopic examination showed slit-like vascular spaces and oral- or spindle-shaped cells with slightly acidic cytoplasm and oral nuclei. Tumors were subtotally resected in 11 patients, subtotally resected with postoperative radiotherapy in 4, totally resected in 5, and totally resected with postoperative radiotherapy in 3. Two patients were given spinal stabilization after total resection. Recurrence and metastatic rates were 50% and 0 in intradural patients. They were 73% and 27% in extradural patients, respectively.

CONCLUSIONS

The tumor should be resected en bloc with the neighboring dural mater to reduce recurrence and metastasis. Patients with subtotal resection need adjuvant radiotherapy. Patients with evident spinal involvement may benefit from spinal stabilization. The prognosis of the lesion arising from the dural mater is better.

Spinal metastasis from cranial meningeal hemangiopericytomas

Spine metastasis from cranial meningeal hemangiopericytomas are extremely rare, with five surgically verified cases. We describe a case of a 55-year-old female diagnosed with metastatic hemangiopericytoma to the cervical spine 78 months after the first operation. Because of the long latency period, aggressive spinal surveillance should be advocated along with repeated bone scintigraphy and MRI.

Hemangiopericytoma arising from the wall of the urinary bladder

Hemangiopericytoma (HPC) arising from within the urinary bladder is exceptionally rare. A 45-year-old man having the symptoms of left groin pain, vague suprapubic discomfort and frequency was admitted to our clinic. Pelvic tomography revealed a tumor in the bladder wall measuring 4 x 3 cm and was not clearly distinct from the lower abdominal wall. Partial cystectomy was performed and the histopathological examination confirmed the hemangiopericytoma. Three thousand rad exterior beam irradiation was performed after operation. Partial cystectomy and adjuvant radiotherapy may be a simple and effective alternative operation for the patient with HPC.

[Diagnostic difficulties of popliteal fossa tumors basing on material presented by the traumatic and Orthopedic Surgery unit in Dabrowa Tarnowska]

The elaboration presents cases of popliteal fossa tumors basing on the material presented by The Traumatic and Orthopedic Surgery Unit in Dabrowa Tarnowska. Special attention was given to numerous difficulties connected with the univocal diagnosis. It was based on accessible research methods and the need to extend diagnostic procedure to highly specialized procedures in justified cases.

[Diagnosis and treatment of intracranial hemangiopericytoma]

OBJECTIVE

To summarize the experience in diagnosis and treatment of intracranial hemangiopericytoma (HPC).

METHODS

The clinical data of 63 patients, 37 males and 26 females, aged 41 (14 - 77), with intracranial HPC were studied retrospectively.

RESULTS

Fifty-eight patients underwent total excision of tumor and 5 patients underwent subtotal excision. Thirty-eight patients were followed up for 3 to 84 months (on average: 25 months), of which 34 underwent conventional external beam radiotherapy as an adjuvant measure after the first operation. Six patients who had local recurrence received second operation. Two patients had metastases to the spine.

CONCLUSION

Complete excision followed with radiotherapy can delay the recurrence of HPC, a malignant tumor with rich blood supply, and improve the prognosis. Pre-operative embolization of the feeding artery may be helpful to the surgery and abundant transfusion should be ready intra-operatively.

Sinonasal hemangiopericytoma-like tumor with true pericytic myoid differentiation: a clinicopathologic and immunohistochemical study of five cases

BACKGROUND

Sinonasal hemangiopericytoma-like tumor (SHPCL) is an uncommon vascular tumor that is sometimes difficult to diagnose.

METHOD

We report five cases arising from the nasal cavity. The tumors were subdivided into two types, prototype and soft tissue type, by the difference in histologic features.

RESULTS

The prototype, made up of three tumors, is characterized by uniform, spindle-shaped myoid cells that have eosinophilic cytoplasm and uniform nuclei and lay down in an orderly fashion. The soft tissue type, made up of two tumors, is similar to the hemangiopericytoma of soft tissue. Immunohistochemically, the tumors were positive for vimentin (100%), smooth muscle actin (80%), muscle-specific actin (100%), fibroblast growth factor-2 (100%), and vascular endothelial growth factor (100%). All were negative for cytokeratin, desmin, CD34, and factor VIII-related antigen. These histopathologic features suggest myoid differentiation and angiogenic activity of the tumors. All the tumors were treated with wide surgical excision. Only one case of soft tissue-type tumor with active mitoses received additional postoperative radiotherapy. No recurrence was found during 13 to 120 months of follow-up.

CONCLUSIONS

Our data suggest that SHPCL with convincing myoid differentiation may have a more favorable clinical course than its soft tissue counterpart.

Hemangiopericytoma in an adolescent girl: a case report

Hemangiopericytoma (HPC) is a rare soft tissue tumor The few published reports account for the little information available on its clinical management. Here the authors report the successful treatment of an adolescent girl with rare HPC of the tongue. After incomplete surgical excision of the tumor she was admitted to the Hematology-Oncology Department and was treated with a 3-drug combination regimen (ifosfamide, actinomycin D, vincristine) for 8 weeks. She achieved partial remission in week 9 based on the magnetic resonance imaging (MRI)findings. Conventional radiation therapy was initiated at week 9 and continued until week 16. At week 20, according to the MRI findings, she achieved complete remission and continuation therapy was initiated. The young girl has been alive without evidence of the disease for the last 3 years of follow-up. In conclusion, the current report indicates that in cases of incomplete surgical excision of the tumor, chemotherapy and radiotherapy seem to be effective.

Characteristics and outcome of children with primary soft tissue sarcomas of extremities

OBJECTIVES

To determine the characteristics and outcome or patients with primary soft tissue sarcomas of extremities in children.

MATERIAL AND METHODS

Thirty-six patients treated for soft tissues sarcomas were enrolled into the study. Features analysed: the incidence of soft tissues sarcoma of extremities, the time from first clinical symptoms to making the diagnosis, the primary site of tumour; histopathologic type of tumour, stage of disease, methods and results of the treatment.

RESULTS

The time From first symptoms to making the diagnosis was 5.4 months (mean). The site of the tumour was the femur in 6 patients, arm in 3, knee in 1. Histopathologic types: synovial sarcoma in 4 patients, malignant haemangiopericytoma in 2, rhabdomyosarcoma in 2, sarcoma myogenes in 1, primitive neuroectodermal tumour in l. Stage of disease: III deg. -- 8 patients, IV deg. -- 2. Patients underwent treatment according to the soft tissue sarcoma protocols. Results of treatment: first complete remission was observed in 7 patients; second complete remission in 1, one patient is on postoperative treatment. One patient died.

CONCLUSIONS

1. Combined treatment achieves full remission in the majority of patients with soft tissues sarcomas localized within the limbs. 2. In patients with large tumours (>5 cm) the treatment should to be started with inductive chemotherapy, and the surgery should be postponed. 3. Early excision of the tumour should be considered in cases of small tumours (< 5 cm), when resection with wide margin of healthy tissues is possible, without deteriorating the function of the limb or cosmetic damage.

Extensive tongue hemangiopericytoma in a child: modified combined modality of treatment to preserve well functioning tongue

Hemangiopericytoma is a rare vascular tumor, usually occurring in adults. The tumor is believed to originate from pericytes, the contractile cells surrounding capillaries. It has predilection for the musculoskeletal system. Clinically, the tumor occurs at any age, with highest incidence between the third and sixth decades and without any sex predilection. Head and neck hemangiopericytoma incidence in all age groups ranges from 9.4 to 28%. In children, head and neck hemangiopericytoma is as frequent as 35%, with the highest frequency (46%) found in infants. We report a case of hemangiopericytoma of the tongue in a 6-year-old child resembling to the infantile/congenital type, which was treated by a combination of surgery, chemotherapy, and brachytherapy. This approach has resulted in a normal functioning tongue for the past 5 years.

Malignant hemangiopericytoma in the pelvic cavity successfully treated by combined-modality therapy: report of a case

A 55-year-old Japanese woman underwent extirpation of a malignant hemangiopericytoma in the pelvic cavity, followed by postoperative irradiation. An abdominal computed tomography scan 3 years later revealed a local recurrent tumor, 12 cm in diameter, in the pelvic cavity, for which transarterial embolization was done, followed by excision of the tumor employing Hartmann's procedure. Although an unresectable part of the recurrent tumor remained, postoperative irradiation reduced its size remarkably. The patient is still alive 7 years 2 months after her first operation, but with more recurrent tumors in the abdominal wall and around the bilateral iliac arteries. Because hemangiopericytoma often recurs or metastasizes after a prolonged disease-free interval, close long-term follow-up is necessary after the operation. Combined-modality therapy against the recurrent or unresectable disease may result in a good prognosis.

Hemangiopericytoma: a rare head and neck tumor

Among the rare malignant tumors of the paranasal sinuses and the middle ear, the hemangiopericytoma represents a very rare tumor entity. Reviewing four cases treated in our ENT department, we present here our experiences with this tumor. Inpatient and outpatient medical records from 1976 to 2001 were evaluated retrospectively. For the whole period we found four patients, three women and one man, who were treated with the diagnosis of hemangiopericytoma. Three tumors were localized in the paranasal sinuses (two in the maxillary sinus, one in the frontal sinus) and one in the middle ear. While the two tumors of the maxillary sinus and the tumor of the middle ear were treated only by surgery, the patient with the tumor of the frontal sinus also received postoperative irradiation because of an endocranial infiltration. This patient was the only one who developed an endocranial recurrence 14 years later on the opposite site, which again was treated with a combination of surgery and radiotherapy. The hemangiopericytoma as a very rare tumor in the paranasal sinuses and the middle ear should be treated with surgery. In our view, an adjuvant radiotherapy is indicated only in selected individual cases.

Sinonasal-type hemangiopericytoma: a clinicopathologic and immunophenotypic analysis of 104 cases showing perivascular myoid differentiation

Sinonasal-type hemangiopericytoma is an uncommon upper aerodigestive tract tumor of uncertain cellular differentiation. We report 104 cases of sinonasal-type hemangiopericytoma diagnosed between 1970 and 1995 from the files of the Armed Forces Institute of Pathology. There were 57 females and 47 males ranging in age from 5 to 86 years (mean 62.6 years). The most common clinical presentation was airway obstruction (n = 57) and/or epistaxis (n = 54), with symptoms averaging 10 months in duration. The tumors involved the nasal cavity alone (n = 47) or also a paranasal sinus (n = 26), were polypoid, and measured an average of 3.1 cm. Histologically, the tumors were submucosal and unencapsulated and showed a diffuse growth with fascicular (n = 37) to solid (n = 50) to focally whorled (n = 7) patterns. The tumor cells were uniform in appearance with minimal pleomorphism and had spindle-shaped (n = 82) to round/oval (n = 18) nuclei with vesicular to hyperchromatic chromatin and eosinophilic to amphophilic to clear-appearing cytoplasm with indistinct cell borders. Multinucleated (tumor) giant cells were identified in a minority of cases (n = 5). Mitotic figures were inconspicuous and necrosis was absent. The tumors were richly vascularized, including staghorn-appearing vessels that characteristically had prominent perivascular hyalinization (n = 92). An associated inflammatory cell infiltrate that included mast cells and eosinophils was noted in the majority of cases (n = 87). The immunohistochemical profile included reactivity with vimentin (98%), smooth muscle actin (92%), muscle specific actin (77%), factor XIIIa (78%), and laminin (52%). Surgery was the treatment of choice for all of the patients; adjunctive radiotherapy was given to four patients. Recurrences developed in 18 patients within 1-12 years from diagnosis. Ninety-seven patients were either alive (n = 51, mean 16.5 years) or dead (n = 46, mean 9.6 years) but free of disease. Four patients had disease at the last follow-up: three died with disease (mean 3.6 years) and one patient is alive with disease (28.3 years). Recurrent tumor (17.8%) can be managed by additional surgery. The majority of sinonasal-type hemangiopericytomas behave in a benign manner with excellent long-term prognosis (88% raw 5-year survival) following surgery alone. Sinonasal-type hemangiopericytomas have a characteristic light microscopic appearance with an immunophenotypic profile resembling that of glomus tumors.

Posterior cervical haemangiopericytoma with intracranial and skull base extension. Diagnostic and therapeutic challenge of a rare hypervascular neoplasm

Haemangiopericytomas are rare hypervascular tumors arising from pericytes. They may occur anywhere in the body, but posterior cervical location is rather uncommon. A case of posterior cervical haemangiopericytoma with posterior fossa and temporal bone extension is reported. Although the patient had undergone preoperative endovascular embolization and surgical resection on three separate occasions, control of the skull base extension was not successful. Following endovascular embolization combined with radiotherapy, the patient has been asymptomatic for 48 months. Angiographic features may help in differentiating haemangiopericytomas from other hypervascular lesions. Preoperative endovascular embolization is recommended due to the pronounced tendency for haemorrhage throughout biopsy and surgical procedures.

Malignant hemangiopericytoma: a clinical overview and case study

Although unusual, hemangiopericytoma (HPC) can be considered benign or malignant depending on histologic features. In some cases, malignant HPC can behave as high-grade sarcomas. When HPC is deemed malignant, radical surgical excision is the treatment of choice. Adjuvant chemotherapy and radiation therapy offer limited success in patients with this malignancy. This article details a case study of a man with metastatic malignant HPC that spanned 25 months and three major cancer centers. Throughout the case study, chemotherapy, radiation therapy, and an experimental agent were employed to attempt to achieve control of the aggressive disease. Often, patients with HPC need a multidisciplinary approach to their care that requires involvement of nutritional and social services, behavioral medicine, and home or hospice care as appropriate. A better general understanding of this disease process is needed to meet the needs of patients with malignant HPC.

Intra-extracranial hemangiopericytoma: clinical manifestations, histopathological features, diagnosis, treatment, and outcomes

BACKGROUND

Intra-extracranial hemangiopericytomas (HPCs) are rare vascular neoplasms. This paper reports the clinical manifestations, histopathological features, diagnosis, treatment, and outcomes of HPCs.

METHODS

We reviewed three patients with intracranial HPC and one patient with HPC of the scalp who were surgically treated at Taichung Veterans General Hospital between 1989 and 1999.

RESULTS

All four patients underwent surgery and postoperative radiotherapy. After surgery, three patients showed improvement compared with their preoperative neurological function. Two patients had recurrent tumors, one patient was well and free from tumor recurrence, and one patient was lost during follow-up.

CONCLUSIONS

Clinical presentation and radiographic appearance of intracranial HPC can be indistinguishable from meningioma. Intracranial HPC is an aggressive neoplasm with malignant potential. Both benign and malignant variations of HPC of the scalp exist. The principal treatment is surgical excision. Survival is influenced by more aggressive primary resection and by postoperative radiotherapy. Recurrences are common. Metastases may be multiple and can develop in many organs and systems.

Thoracic epidural hemangiopericytoma. Case report

Hemangiopericytoma is an uncommon mesenchymal neoplasm that rarely affects the spinal canal. We report a case of thoracic epidural hemangiopericytoma in a 39-year-old man with symptoms of spinal cord compression studied by myelo-computed tomography (CT) and magnetic resonance imaging (MRI). Total resection was followed by complete recovery. Postoperative radiotherapy was performed. The clinical, radiological, and histological findings of epidural spinal hemangiopericytoma are reviewed in the light of relevant literature

Recurrent congenital haemangiopericytoma in a child

A five-day-old boy was referred with a soft-tissue mass in his right upper arm. Plain radiographs and ultrasound demonstrated a lesion extending from the axilla to the elbow on the posterolateral aspect of the humerus. Open biopsy confirmed the diagnosis of congenital haemangiopericytoma. After MRI and selective angiography, excision biopsy was carried out, but no adjuvant therapy was administered. At further examination, four years and ten months later, he was noted to have three small nodules at the site of the original tumour. Excision biopsy confirmed this to be a local recurrence, although the lesion was less cellular with no appreciable mitotic activity. Congenital haemangiopericytoma is a rare cause of a soft-tissue mass in children. Most tumours are benign, and recurrence is uncommon. The treatment is controversial, but most centres recommend the use of adjuvant chemotherapy, combined with complete excision. We recommend treatment with doxorubicin. Orthopaedic surgeons should be familiar with this tumour since 30% to 50% of cases occur in the limbs.

Haemangiopericytoma of the nasal cavity

Haemangiopericytomas (HPC) are rare vascular tumours originating from a pericytes, a term coined by Zimmermann to refer to the main location of this cell line in the pericapillary connective tissue. HPC may arise in any part of the body. We report a 29-year-old man with a histologically proven nasal haemangiopericytoma-like tumour. The lesion was embolised through the ophthalmic artery before it was removed surgically. The main symptoms of nasal HPC are epistaxis and obstruction of the nose. Malignant and benign clinical courses have been described. Local recurrence and metastases may be observed years after initial diagnosis.

[Hemangiopericytoma localized in the peritoneum]

The authors present a rare case of intraperitoneal haemangiopericytoma. Diagnostic and therapeutic procedures were discussed based on current literature.

Hemangiopericytoma of the head and neck

PURPOSE

To report a series of patients with hemangiopericytoma (HP) of the head and neck, to review pathological features of these tumors, and to discuss management options.

MATERIALS AND METHODS

A retrospective review of the medical records at the University of California, Los Angeles (UCLA) Medical Center in Los Angeles, CA, was done in order to identify those patients with primary HP of the head and neck, including soft tissue and mucosal sites.

RESULTS

Ten patients with HP of the head and neck were identified. There was an equal sex distribution and an average age of 36 (range 10-65). Seven of the tumors arose from soft tissue sites in the head and neck, and the remaining 3 arose from the mucosa. All patients underwent wide excision of the primary lesion with a local recurrence rate of 40%. Thirty percent of patients developed metastatic lung disease 0 to 8 years after initial diagnosis. Each patient who developed metastatic disease had abundant mitoses on pathological review compared with rare or absent mitoses in the lesions that took a more benign course.

CONCLUSIONS

Pathological appearance of resected HP is predictive of later metastatic potential. Long-term follow-up is necessary in patients even after radical resection because recurrence or metastasis may be delayed by many years.

[Intracranial hemangiopericytoma 32 cases reports]

OBJECTIVE

To further elucidate the clinical feature, pathogenesis, treatment and prognosis of intracranial hemangiopericytomas (HPC).

METHODS

Thirty-two cases of HPC treated in our department were analyzed retropectively.

RESULTS

Grade I surgery, complet tumor removal with excision of involved dural and bone (7 cases); Grade II surgery, complet tumor removal with aggressively cauterization of dural and/or bone (13 cases); Grade III surgery, complet tumor removal but no satisfactory attempt to deal with involved dural or bone (7 cases); Grade IV surgery, tumor residual (7 cases). 13 cases were recurrent.

CONCLUSION

The prognosis of intracranial hemangiopericytomas is dismal. The recurrent rates of HPC are very high. Microneurosurgery and adjuvant radiotherapy are main treatment. It is very important that counterchecking at regular intervals.

Preoperative embolization in surgical treatment of mediastinal hemangiopericytoma

The case of a 47-year-old man with a tumor of the posterosuperior mediastinum is reported. Surgical biopsy sample revealed a hemangiopericytoma, but radical excision was impossible because of massive bleeding. Percutaneous embolization of mediastinal tumor was performed to reduce peroperative blood loss. It allowed uneventful complete removal of the lesion. We recommend preoperative embolization in cases of hypervascular mediastinal tumors.

Hemangiopericytoma in children and infants

BACKGROUND

Hemangiopericytoma (HPC) is a soft-tissue neoplasm most commonly seen in adults; only 5-10% of cases occur in children. Childhood HPC comprises two distinct clinical entities. In children older than 1 year, it behaves in a manner similar to adult HPC. Infantile HPC, however, although histologically identical to adult HPC, has a more benign clinical course. The reasons for these differences in the natural history of HPC are not well understood.

METHODS

The authors reviewed the clinicopathologic features of HPC as well as the treatment and outcomes of the 12 children (9 males and 3 females) treated for this disease at St. Jude Children's Research Hospital over a 35-year period.

RESULTS

At diagnosis, 9 patients were older than 1 year and 3 were younger than 1 year. Among the 9 older patients, tumors were most commonly found in the lower extremities (n = 5). One patient had been treated for acute lymphoblastic leukemia 15 years earlier. One patient had metastatic disease at diagnosis, and three had unresectable tumors. Two patients experienced objective responses to chemotherapy. Three patients died of disease progression. Among the three infants, two had unresectable disease at diagnosis, and both experienced excellent responses to neoadjuvant chemotherapy. In one case, the response of the tumor to chemotherapy correlated with maturation to hemangioma. All three infants are alive without evidence of disease.

CONCLUSIONS

HPC in children older than 1 year does not differ from adult HPC, and aggressive multimodality therapy is required. Infantile HPC, on the other hand, is characterized by better clinical behavior, with documented chemoresponsiveness and spontaneous regression, and requires a more conservative surgical approach. In some cases of infantile HPC, this benign behavior correlates with maturation to hemangioma.

Hemangiopericytoma of the head and neck

OBJECTIVE/HYPOTHESIS

Hemangiopericytomas are uncommon neoplasms of vascular origin that may arise in the head and neck. Their rare occurrence and variable malignant potential have limited attempts to characterize their clinical behavior. This study reviews the experience in treating hemangiopericytomas of the head and neck at a single institution.

STUDY DESIGN

Retrospective.

METHODS

The records of 12 patients with hemangiopericytomas of the head and neck presenting between 1979 and 1995 were reviewed. Site of origin included the neck (4), oral cavity (3), parotid (2), orbit (1), maxillary sinus (1) and mandible (1). Five patients had lesions characterized as high or intermediate grade histologically, and six had lesions characterized as low grade.

RESULTS

Nine patients were treated with curative intent; three presented either with pulmonary metastasis (2) or unresectable primaries (1) and were treated with radiation therapy and/or palliative Adriamycin-based chemotherapy. Patients treated with curative intent underwent a variety of surgical resections dictated by tumor location and size. Four patients received postoperative radiation therapy to a median dose of 60 Gy, for positive surgical margins (2), high-grade histology (1) or a recurrent lesion (1). Five-year overall survival in patients treated surgically was 87.5%. A single mortality occurred in a patient with a recurrent high-grade lesion who failed at local, regional, and distant sites. Median follow-up of survivors was 73 months.

CONCLUSION

The clinical behavior of hemangiopericytomas appears to be related to their histological grade. Aggressive local therapy including surgery and radiation therapy appears to be effective in providing tumor control.

[Unusual course of hemangiopericytoma]

BACKGROUND

Hemangiopericytomas, rare perivascular tumors, normally tend to be well circumscribed, however, since some have a malignant behavior they are recognized to be potentially malignant.

CASE REPORT

In the case presented here, we report the medical history of a 46-year-old man with a hemangiopericytoma of the nose. In 1983, the tumor was surgically removed, and histological examination revealed no signs of malignancy. In 1987, a local recurrence was removed followed by X-irradiation. In March 1995, the patient presented with multiple hepatic and bone metastases. Chemotherapy with ifosfamide (5 g/m2, day 1) and epirubicin (50 mg/m2, day 1) was performed. After three courses of chemotherapy a tumor stabilization was achieved. In November 1995, however, a massive progression of the hepatic lesions was found. Therefore, six courses of a second-line chemotherapy with dacarbazine (200 mg/m2, day 1 to 5) and adriamycin (60 mg/m2, day 1) were applied. A partial remission was achieved lasting until November 1996. A couple of weeks later the patient died due to hepatic failure.

CONCLUSION

Despite of unacceptably low survival rates in patients with advanced soft tissue sarcomas (especially after pretreatment with ionizing radiation) our report demonstrates that it is also possible to induce long lasting remissions without altered quality of life.

[Pelvic hemangiopericytoma in pregnancy. Report of a case]

We report a case of pelvic retroperitoneal hemangiopericytoma (HPC) discovered early during pregnancy. Preoperative diagnosis was obtained by a transvaginal biopsy. Treatment consisted of therapeutic abortion, excision surgery and radiotherapy. In the follow-up examination 32 months after operation, no evidence of tumor recurrence was found. This is the second reported case of HPC complicating pregnancy.

Metastatic meningeal hemangiopericytoma of thoracic spine

We report a case of metastatic meningeal hemangiopericytoma in thoracic spine. A 49-year-old female having a history of tentorial hemangiopericytoma first found 116 months before was admitted to our hospital with acute onset of paraplegia. Magnetic resonance image revealed a tumor invading the left lamina and pedicle of the 8th thoracic vertebra, and compressing the dural sac severely. After subtotal removal of the tumor, the patient showed rapid neurological improvement. The histological findings were characteristic of hemangiopericytoma. Because extradural metastases of meningeal hemangiopericytoma occur long after previous treatment in unexpected sites especially in skeletal system, repeated bone scintigraphy is essential.