Meningeal hemangiopericytoma metastases

Case contributed by Dr Lukas Valkovic

Presentation

Patient with a history of meningeal haemangioperictyoma 5 years ago.

Patient Data

Age: 40
Gender: Female

Initial CT showed a bony destruction of the right temporal bone, followed by a contrast-enhanced study with a depiction of tumor expansion in the temporal region. 

MRI shows a well-circumscribed lobular vividly enhancing tumor with multiple cystic regions arising from the dural surface of the petrosal part of the temporal bone. It is growing extraaxially with mass effect on the ventricular system and other midline structures. Small perifocal edema. SWI depicts rich vascularization. 

MRI shows multiple vividly enhancing lesions in the liver, lungs, muscles of right abdominal/thoracic wall and next to the right kidney. They have a variable T1/T2 signal, but they are mostly isointense to adjacent parenchyma. Similarly, after early enhancement, they remain mainly isointense in later postcontrast phases.

FDG-PET/CT shows an additional finding - multiple enhancing lesions in breast parenchyma bilaterally. However, none of them show increased glucose metabolism.

Case Discussion

Patient with sensations in the right ear during pregnancy, which worsened after childbirth (tingling of the face). Initial CT and MRI with the finding of a large tumor in the right temporal lobe with an infiltration of petrosal part of the temporal bone. Subsequently treated with preoperative embolization then with a partial surgical resection followed by radiotherapy 5 years ago.

The recent follow-up study shows multiple lesions in both breasts, muscles of the abdominal/thoracic wall, liver, lungs and probably kidney which show similar characteristics. They are not easily recognizable in native CT/MRI and show no increase in glucose metabolism on PET. Their vivid early enhancement, distribution and patients history points to hemangiopericytoma metastases. 

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Case information

rID: 63323
Published: 2nd Oct 2018
Last edited: 6th Oct 2018
Inclusion in quiz mode: Included

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