Cerebellar Hemangioblastoma Mimicking Arteriovenous Malformation: A Case Report

Abstract

Hemangioblastoma (HBM) is a tumor distinguished by the presence of stromal cells and small vessels. These stromal cells represent stem cells, which, due to the influence of the neoplasm, proliferate and differentiate into "vasoformative elements" that create new blood vessels. Hemangioblastomas resemble arteriovenous malformation (AVM) in imaging features, characterized by an apparent vascular blush, the presence of multiple feeding vessels, and evident draining veins observed on digital subtraction angiography (DSA). Our study presents a case of HBM in the right cerebellar hemisphere mimicking AVM. The patient had been diagnosed with AVM in the same location two years ago and managed with endovascular embolization. One month prior, the patient experienced severe headaches, imbalance, nausea, left ear fullness, blurry vision, and high blood pressure. The imaging feature suggests HBM rather than AVM. The patient next underwent sub-occipital craniotomy and tumor resection with external ventricular drainage (EVD) insertion. The histopathological report of the excised mass confirmed HBM. In conclusion, AVM and HBM rarely occur together. Recent research indicates that HBM and AVM have exact embryologic origins and need later genetic alterations to develop into symptomatic lesions. Further research is required to clarify the uncommon combination of these lesions.

Keywords: avm; case report; hemangioblastoma; imaging; neuroradiology.

Figure 1. Post-embolization CT brain without contrast

Figure 2. (A) CT brain without contrast. (B) T2-weighted image. (C) FLAIR. (D) Diffusion-weighted image. (E) Axial T1 post-contrast. (F) Coronal T1 post-contrast.

FLAIR: Fluid-attenuated inversion recovery.

Figure 3. (A) T2-weighted image. (B) FLAIR. (C) Diffusion-weighted image. (D) Axial T1 post-contrast.

FLAIR: Fluid-attenuated inversion recovery.