Intraosseous Hemangioma of the Skull with Dural Tail Sign: Radiologic Features with Pathologic Correlation
Maria Politia,
Bernd F.M. Romeikeb,
Panagiotis Papanagiotoua,
Abdullah Nabhanc,
Tobias Strufferta,
Wolfgang Feidenb and
Wolfgang Reitha
a From the Department of Diagnostic and Interventional Neuroradiology, University of Saarland, Homburg, Saarland, Germany
b the Institute for Neuropathology, University of Saarland, Homburg, Saarland, Germany
c the Department of Neurosurgery, University of Saarland, Homburg, Saarland, Germany
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FIG 1. 46-year-old woman with a gradually enlarging mass on her forehead. Noncontrast axial T1-weighted MR image (A) reveals a well-circumscribed mass, measuring 3 x 4 x 6 cm in the right frontal bone with intra- and extracranial extension. The lesion is well defined, and the signal intensity is of mixed intensity with some central hyperintensity and bone destruction. T2-weighted image (B) shows a lesion of high signal intensity with central areas of hypointensity. The lesion is well demarcated from the galea extracranially (outer uniform dark line) and the underlying dura intracranially (inner dark line). There is no surrounding edema. After gadopentetate dimeglumine administration (C), strong and homogeneous enhancement of the mass, relative enhancement of the bone marrow, and a dural tail sign are observed. The lesion extends intracranially and appears to compress the underlying brain, but without intraparenchymal extension. On the inner table in the parietal area, the small enhancing nodule corresponds to a vessel.
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FIG 2. External carotid angiogram, lateral view, with midarterial (A) and capillary (B) phase, shows the rich vascularity of the tumor. The tumor shadow is fed by the right middle meningeal artery (black arrow) and by branches of the superficial temporal artery (white arrow).
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FIG 3. Intraoperatively, the rich vascular network of the tumor is seen.
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FIG 4. Correlation of T1-weighted contrast-enhanced MR image (A) with gross formalin-fixed specimen. Gross examination after formalin fixation shows a brown–red mass in the diploe, with radiated spicules and disruption of the outer and inner table (B); the bulk of the intra- and extracranial mass is missing as a result of the surgical excision technique. In the histomorphological representative section of the extraosseous fraction of the lesion (C), the fat cells (*) are seen as clear spaces without rimming; the vessels ( ) are irregularly shaped dilated spaces lined by a single layer of inconspicuous endothelial cells (arrow) and often filled with erythrocytes (#) (hematoxylin and eosin, original magnification x40). The vessels are arranged in a diffuse haphazard pattern. No signs of thrombosis or bleeding are seen. Intraosseous fraction (D) shows the hemangioma lying between plump bony trabeculae (double arrows) in irregularly shaped marrow spaces (hematoxylin and eosin, original magnification x20). Immunohistochemically, the antibodies were directed against vimentin, which labels all mesenchymal cells (ie, all vessel walls and fat cells) (E), and CD34 (F), which labels endothelial cells (immunoperoxidase/diaminobenzidine method, original magnification x100). In the correlation of the T1-weighted contrast-enhanced MR image with the histologic specimen at the site of dural tail sign (G), the dura is not invaded by the lesion; instead, the lesion grew along the inner surface of the skull. The van Gieson stain labels the cavernous hemangioma yellow–brown (mesenchymal component [µ]) and the collagenous fibers red (dura matter [$]). The arrow indicates the sharp delineation of the hemangioma (original magnification, x20).
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