Cerebellar haemangioblastoma

Case contributed by A.Prof Frank Gaillard

Presentation

Headache.

Patient Data

Age: 25
Gender: Male
Modality: MRI

Cystic left cerebellar hemisphere mass measuring 2.9 x 3.0 x 2.1 cm (AP x ML x SI) demonstrates an internal left lateral vividly enhancing mural nodule, abutting the pial surface and measuring 12 x 11 x 16 mm. This nodule contains a small branching nonenhancing component which is likely due to flow void within a vascular pedicle. A few adjacent enhancing vessels and flow voids are noted, however these are not prominent compared to the contralateral side. The adjacent sigmoid sinus is unremarkable. Moderate surrounding T2 hyperintensity within left cerebellar white matter.

Moderate mass effect with lateral distortion of the fourth ventricle. The ventricle is not entirely effaced.Minimal prominence of the temporal horns for age may reflect early hydrocephalus. No other intra or extra axial lesion and no other areas of abnormal enhancement.

Conclusion:

Features are most consistent with a left cerebellar haemangioblastoma. Pilocytic astrocytoma is unlikely with degree of adjacent oedema and at this age. Cystic metastasis would also be most unlikely. No evidence of further lesions to suggest VHL.

Case Discussion

The patient went on to have a craniotomy. 

Histology

MICROSCOPIC DESCRIPTION: Sections of the cerebellum show scattered stromal cells in a background of many congested capillary-sized blood vessels. The tumour cells show mildly enlarged nuclei with hyperchromasia and foamy vacuolated cytoplasm. Mitoses are inconspicuous. There is no necrosis. The features are those of haemangioblastoma. There is no evidence of malignancy.

DIAGNOSIS: Left cerebellar tumour: Haemangioblastoma (WHO Grade I).

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Case Information

rID: 29570
Case created: 5th Jun 2014
Last edited: 28th Oct 2015
Inclusion in quiz mode: Included

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