Intravascular Papillary Endothelial Hyperplasia (Masson tumor) of the Skull : Case Report and Literature Review

Abstract

A 10-year-old female patient presented with a rapidly growing nodular mass lesion on her right frontal area. On skull radiography and computed tomography (CT) imaging, this mass had a well-demarcated punch-out lesion with a transdiploic, exophytic soft tissue mass nodule on the frontal scalp. Magnetic resonance (MR) imaging revealed the presence of a 1.5×1.2×1 cm sized calvarial lesion. This lesion was hypointense on T1 and heterogenous hyperintense on T2 weighted MR images, and exhibited heterogeneous enhancement of the soft tissue filling the punch-out lesion after intravenous administration of gadolinium. En block removal of the tumor with resection of the rim of the normal bone was performed. The pathological diagnosis was intravascular papillary endothelial hyperplasia (IPEH). After surgery, no recurrence was found for 8 months. IPEH is a rare and benign reactive lesion usually found in thrombosed subcutaneous blood vessels. Involvement of skull bone is rare. In this article, we present a case of IPEH involving the calvarium, in a 10-year-old woman.

Masson´s Tumor in the Maxillary Sinus

“…Similar radiological findings can also be seen in other lesions such as eosinophilic granuloma, aneurysmal bone cyst, medullary fibrosarcoma, hemangioma, and metastatic tumours from the thyroid or kidney. It is diagnosed, usually, by anatomophatological analysis after being removed surgically [9]. In the present case, the lesion was removed based on the tomography disclose, suspecting it was a fungus lesion.…”

“…Post contrast T1WI showed heterogeneous enhancement [14]. There is little differentiating IPEH from eosinophilic granuloma but Gadolinium-enhanced MRI scans are useful to demonstrate the extremely vascular and hyper dense nature of IPEH [4,9]. The histologic differential diagnosis of IPEH includes angiosarcoma, intravenous atypical vascular proliferation, spindle-cell hemangioendothelioma, malignant endovascular papillary angioendothelioma and intravenous pyogenic granuloma [14].…”

“…Histopathological analysis is mandatory to avoid misdiagnosis. IPEH is most commonly a cutaneous or subcutaneous lesion, frequent in the head and neck regions [4], but it can occur in any part of the body [7,9]. The occurrence in the paranasal sinus is extremely rare [4,6,7,10,11].…”

Surgical management of intracranial capillary hemangiomas in children: report of 2 cases

“…PEH is thought to be an exuberant form of organizing thrombus that can arise in a preexisting vascular abnormality (intravascular) or hematoma (extravascular). 12 MRI of PEH shows poor to variable enhancement, with evidence of old hemorrhage and variable amounts of mild edema. Histopathologically, numerous vascular channels surround fibrin cores.…”

Intracerebral Masson's Tumor—Slow-Filling Vascular Lesion Demonstrated by Indocyanine Green Video Angiography

“…Although relatively uncommon, it is most often seen in skin and soft tissue where it resembles a sarcoma 2 . However, it can arise from any vascular origin in the body and has been described in a variety of locations such as the oral cavity 3,4 , ulnar artery 5 , internal auditory canal 6 , bladder 7 , hand 8 and skull 9 . The central nervous system can also be affected by this lesion.…”