Masson Tumor of the Central Nervous System: A Case Report and Review of Literature

Abstract

BACKGROUND Masson's tumor, also known as intravascular papillary endothelial hyperplasia (IPEH), is an unusual endothelial proliferation that leads to improper thrombus development due to faulty endothelial structure. Although IPEH is rare in the central nervous system, it can arise at any location in the brain. Headaches, seizures, and focal neurological symptoms ae the most common presenting symptoms. It is more common in females and it can occur at any age. CASE REPORT Herein, we present a 65-year-old female patient with a progressively enlarging right temporal lobe mass that was initially considered metastatic ovarian carcinoma. She underwent a right temporal craniotomy and the lesion was totally resected. Contrary to expectations, the pathology report was an IPEH. CONCLUSIONS In this paper, we conducted a literature review of previously reported cerebral IPEH cases, with a focus on their clinical and radiological presentations, management, and especially their association with previous radiotherapy. The important point is that one-third of the cases had a history of radiation therapy to the head, and most of them had stereotactic radiosurgery (SRS) on the location of the brain from which IPEH subsequently developed. The major question for which we are looking for an answer is its relationship with previous radiotherapies. We wanted to know how many of these cases were associated with radiotherapy in the same area, the time interval from radiotherapy to the onset of IPEH or symptoms, the dose of the previous radiotherapy, and, overall, if there is any cause-effect relationship between IPEH and radiotherapy.

Figure 1.

(A) Preoperative brain MRI, T2, showing mixed hyper- and hypointense mass (blue arrow) and surrounding brain edema. (B) Preoperative brain MRI, T1 without contrast, showing the hypointense mass (blue arrow). (C) Preoperative brain MRI, T1 after contrast injection, showing the heterogeneously enhancing mass (blue arrow). (D) Follow-up postoperative brain MRI 12 months after surgery, T2, showing the empty space of resected lesion (double blue arrow). (E) Follow-up postoperative brain MRI, 12 months after surgery, T1 after contrast injection, showing no residual mass. (F) Macroscopic photo of the lesion after gross total resection.

Figure 2.

(A) Routine hematoxylin and eosin stain showed mainly hemorrhage and reactive glial tissue. (B) Elastic histochemical stain. Elastic stain highlighted network of vascular channels. (C) CD34 immunohistochemical stain (endothelial marker). CD34 showed thin vascular channels lined by endothelium.

Figure 3.

(A) 40-power magnification and (B) 20-power magnification of H&E staining of our case.