A Large Solitary Hemangioblastoma of the Lateral Ventricles: A Case Report and Literature Review

Abstract

Hemangioblastoma (HB) in the supratentorial region of the brain is rare and only a few cases are reported on intraventricular HB. HB of the lateral ventricles is even rarer. We present a case of a 30-year-old man with generalized tonic clonic seizures. The brain computed tomography showed a 5.5 cm heterogeneous mass extending into both lateral ventricles with partial enhancement. Based on the size and imaging features, we present the fourth documented case of a large solitary intraventricular HB. Our approach to this unique case and some treatment complexities are also described. Considering the rarity of the case and the patient's imaging features, the present study provides a better understanding of HB and recommends HB to be considered in the differential diagnosis of masses in the lateral ventricles. In addition, some preventable pitfalls in the treatment of such complex cases are described.

Keywords: Hemangioblastoma; Hydrocephalus; Lateral ventricle; Magnetic resonance imaging; Seizure; Solitary.

Figure1

Preoperative and postoperative images of a 30-year-old man with intraventricular hemangioblastoma. A 5.5 cm heterogeneous mass located in midline position extending into both lateral ventricles (a). An irregular enhancement, greater in the central portion of the mass, on axial without (b) and axial with gadolinium injection (c) views. The postoperative brain computed tomography scan revealed a small remnant of the tumor in the left lateral ventricle (d). The right-sided fronto-parietal chronic epidural hematoma on the last magnetic resonance imaging (axial view) was drained via one burr hole (e).

Figure2

H&E ×200). Immunohistochemistry study of samples revealed positive reactivity for neuron-specific enolase (c). CD34 highlighted vascular channels (d). Ki67 was positive in 2-3% of tumoral cells (e). Histopathologic appearances and the results of immunohistochemical staining matched with HB diagnosis.