Nearly asymptomatic intracranial capillary hemangiomas: A case report and literature review

Abstract

The present study reported a nearly asymptomatic case of intracranial capillary hemangioma (ICHs), which are rare benign vascular tumors or tumor-like lesions. A 33-year-old female came to the hospital with a complaint of a slight but recurring morning headache concentrated in the left posterior occipital area. These headaches spontaneously resolved without any treatment. Computed tomography and magnetic resonance imaging revealed a mass inside the left occipital lobe. The patient refused to undergo conservative observation at home and insisted on radical therapy. Prior to surgery, an atypical meningioma or astrocytoma was suspected. A navigation-guided brain-mass resection was performed under general anesthesia and a solid mass closely associated with the tentorium cerebelli was completely resected. Histopathological analysis confirmed diagnosis of an ICH. The patient recovered well and experienced no major neurological defects, apart from an issue with the right visual field. The present study also conducted a retrospective literature review of papers published in English describing cases of intracranial capillary hemangiomas. A PubMed search identified 19 articles comprising 29 cases. The clinical symptoms of ICH are diverse and all reported cases in the literature were symptomatic. Previous studies demonstrated that diagnoses of intracranial capillary hemangioma are usually made during surgical resection by histopathological examination. Treatment for ICH remains empirical and surgery is the most common method of treatment. Patient prognosis is generally good-the majority of patients achieve long-term, event- and progression-free survival.

Keywords: asymptomatic; diagnosis; intracranial; intracranial capillary hemangioma; literature review.

Figure 1.

Computed tomography of the patient's brain prior to surgery. A high-density, round mass (indicated by the arrow was detected with a diameter of ~2.0 cm and areas of higher density inside the left occipital lobe. Edema was observed along the edges.

Figure 2.

Brain magnetic resonance imaging of the current patient prior to surgery. A mass with heterogeneous, long T1 and T2 signals located inside the left occipital lobe and was near the posterior horn of the left ventricle close to the tentorium. Marked uneven reinforcement was observed when enhanced.

Figure 3.

Cerebral vascular angiography of the current patient prior to surgery. Abnormal architecture of tumor vascularity was detected, including chaotic distribution, tumor staining and pooling of contrast material. Clear time of contrast agent at tumor area was ~5 sec later than other areas. The arrow indicates tumor location.

Figure 4.

Computed tomography of the patient 1 day after initial surgery indicating complete resection of the tumor. An infratentorial epidural hematoma was detected near the surgery area (indicated by arrow).

Figure 5.

Post-gadolinium axial T1-weighted image from the scan performed on the patient ~2 months following initial surgery. No recurrence of the tumor was detected and the surgical pathway through the cortex is clearly presented.

Figure 6.

Histopathological observations of the tumor itself. (A) The tumor was completely resected as a dark-red, firm, solid, 2.2×1.6×1.7 cm mass with a broad-based dural attachment. (B) Photomicrographs of the surgical specimen identified the area encompassed by the tumor with moderate-to-dense cellularity containing numerous vascular channels and spaces. Hematoxylin and eosin staining, magnification ×100. (C and D) Vascular structures and the endothelial cell lining of this tumor exhibited high expression of the vascular markers CD31 and CD34. CD31 and CD34 immunohistochemical staining, magnification ×100.