A unique case of benign intracranial hemangioma mimicking malignant transformation

Abstract

Capillary hemangiomas are rare benign vascular lesions, commonly found on scalp, face, chest, or back of a neonate or infant. Hemangiomas of the central nervous system are very rare lesions. There are only a few cases of intracranial capillary hemangioma (ICH) arising in adults reported in the literature. We present a case of 59-year-old female with intermittent recurrent headache localized in the frontal area. Magnetic resonance imaging revealed left frontal extra-axial mass with peripheral enhancement. The patient underwent complete surgical resection of the tumor. Histopathology examination of the lesion revealed well defined vascular lesion composed of closely packed plump endothelial cells lining slit-like vascular channels containing scattered red blood cells. No evidence of infiltrative brain parenchyma was seen. Ki-67 proliferative index was low, less than 2%. The final diagnosis was confirmed to be ICH by histopathology and immunohistochemistry studies. The patient has remained healthy and free of disease 39 months since her initial surgery. ICH is a benign vascular lesion which rarely occurs in the central nervous system, particularly in the intracranial region. It can mimic malignant lesions on radiologic studies. Histopathology examination is the gold standard for diagnosis. If total resection is achieved, prognosis is generally good with no evidence of recurrence.

Keywords: Brain tumor; Intracranial capillary hemangioma; Vascular lesion.

Fig. 1

Intracranial capillary hemangioma with avid peripheral enhancement. (A) Sagittal and (B) coronal magnetic resonance imaging (MRI) view showing extra-axial mass lesion in the left frontal region with strong predominant peripheral enhancement. (C) Perfusion study showed significant increased perfusion within the peripherally enhancing aspect of the tumor. (D) Postoperative examination reveals focal hematoma without definite active tumor enhancement. (E) Axial MRI scan performed on the patient ∼39 months following initial surgery, no recurrence of the tumor was detected.

Fig. 2

Intracranial capillary hemangioma. (A) Low-power examination reveals a well-demarcated lesion, partially capsulated vascular lesion (hematoxylin and eosin (H&E); 4×). (B) High-power examination shows vascular spaces lined by plumb endothelial cells containing red blood cells (H&E; 40×). (C) Immunohistochemistry stain reveals positivity for CD31 in the vascular spaces (40×). (D) Immunohistochemistry shows positivity for CD34 in the vascular spaces (40×).