Papillary endothelial hyperplasia presenting as recurrent malignant glioma

Abstract

The initial management of patients with malignant gliomas depends on accurate histologic diagnosis which, in turn, directs appropriate treatment planning. However, the diagnosis of recurrent disease is often based solely on radiological data which can occasionally be misinterpreted as showing recurrent tumor. Lack of awareness of conditions that mimic recurrent tumor and potentially confound radiological diagnosis can lead to inappropriate therapeutic decisions. We report the case of a patient whose imaging studies suggested recurrence of malignant glioma; however, surgical resection of the lesion guided by MRI scans resulted in the correct diagnosis of papillary endothelial hyperplasia and led to appropriate management of this condition that mimicked tumor recurrence. In this report, we provide a comprehensive review of this rare entity and emphasize the importance of adequately pursuing appropriate diagnostic considerations prior to making definitive treatment decisions.

Intravascular papillary endothelial hyperplasia (Masson′s tumor) of the scalp with intracranial extension

“…Treatment of IPEH is complete surgical excision. [ 3 4 ] In our case, since the tumor was easily accessible, complete resection was possible, and there was no recurrence on follow-up MRI after 1 year. However, with subtotal resection in case of intracranial tumors where complete removal is not possible, recurrence or progression may be seen.…”

“…[ 1 2 9 ] IPEH presenting as an intracranial lesion is very rare, with only 32 cases reported in the literature. [ 3 ] Only two cases of IPEH presenting as scalp swelling have been reported in the literature. One of these cases presented with a right frontal palpable mass with skull involvement.…”

“…Gadolinium-enhanced scans show enhancement thus demonstrating the extremely vascular nature of IPEH. [ 3 10 ] There are no specific radiological features that characterize IPEH, and the final diagnosis requires careful histological examination.…”

“…[ 1 2 ] Tumors with intracranial location or extension are extremely rare with only 32 cases been reported in the literature. [ 3 ] Only two cases of IPEH presenting as scalp swelling have been reported in the literature. [ 4 5 ] It needs to be differentiated from the malignant angiosarcoma because complete excision can lead to cure and prevent the patient from undergoing unnecessary adjuvant therapy.…”

Masson’s tumor of the pineal region: case report

“…22 Due to the high risk for recurrence in cases of partial resection, most authors have recommended aggressive adjuvant therapy, such as radiotherapy, Gamma Knife radiosurgery, and chemotherapy. 3,7,13,[16][17][18]20,22 Gamma Knife and stereotactic radiotherapy have been successful in terms of lesion stabilization and regression after incomplete resection or recurrence. 7,15 While stereotactic and Gamma Knife radiosurgery have been the preferred methods, the outcomes of chemotherapy are less clear.…”