Presentation
Headache.
Patient Data
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 hemangioblastoma. Pilocytic astrocytoma is unlikely with degree of adjacent edema 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 tumor cells show mildly enlarged nuclei with hyperchromasia and foamy vacuolated cytoplasm. Mitoses are inconspicuous. There is no necrosis. The features are those of hemangioblastoma. There is no evidence of malignancy.
DIAGNOSIS: Left cerebellar tumor: Hemangioblastoma (WHO Grade I).