Frontal scalp swelling.
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MRI of the brain demonstrates a large multilobulated extraaxial mass with direct extension through the skull and into the scalp soft tissues.
The mass is heterogeneous in signal with areas of cystic change and enhances brightly following administration of contrast. Seen centrally within it are numerous tortuous flow voids consistent with enlarged vessels.
This patient went on to have a resection which confirmed the diagnosis.
Sections show a highly cellular vascular neoplasm which appears to be adherent to dura matter. Numerous large thin-walled vascular channels are seen and there is a complex network of delicate small vascular sinusoids. In some areas, the tumor cells are separated by a collagenous stroma but in other regions they form more solid sheets.
Cellular morphology varies from one region to another. In some areas, the tumor cells have plumped oval nuclei and a relatively delicate chromatin resembling meningioma. In other regions, the nuclei are smaller, angulated and hyperchromatic and the cells have a spindle-cell morphology.
Cells with clear vacuolated cytoplasm are present and there are focal collections of multinucleate giant cells. The tumor cells have prominent nucleoli and mitotic activity is easily identified. Many areas of the tumor show abundant reticulin deposition which often forms delicate deposits outlining individual tumor cells. There is strong immunoreactivity for vimentin but no reaction for cytokeratin and EMA.
Final diagnosis: hemangiopericytoma.