Supratentorial meningeal hemangioblastoma mimicking angiomatous meningioma

Case contributed by Dalia Ibrahim


Headache and left lower limb weakness.

Patient Data

Age: 45 years
Gender: Male

Right high frontal extra-axial dural based space-occupying lesion. It elicits a low signal on T1 WI and a remarkable high signal on T2 WI showing prominent flow voids and vivid post-contrast enhancement. The lesion shows a slight diffusion restriction. It's surrounded by large peritumoral vasogenic edema and exerts a positive mass effect in the form of compression of the right lateral ventricle.

Based on the remarkably high T2 signal of the lesion and the vivid post-contrast enhancement; angiomatous meningioma was radiologically presumed. 

Pathology after excision: meningeal hemangioblastoma (WHO grade I)

Case Discussion

Hemangioblastomas are benign vascular tumors, commonly found in the posterior fossa or the spinal cord, whereas supratentorial hemangioblastomas with meningeal involvement are extremely rare. Hemangioblastomas are common in Von-Hipple disease.

Supratentorial hemangioblastomas are usually solid and are mostly located in the frontal lobe 1.

Characteristic imaging findings include bright signal on T2 WI, prominent flow voids, and vivid post-contrast enhancement. Also, peritumoral edema is usually observed.

Differential diagnosis includes angiomatous meningioma, hemangiopericytoma, and metastatic renal cell carcinoma.

Preoperative diagnosis can be helpful to decrease blood loss at surgery via preoperative embolization 2.

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