Intracranial capillary hemangioma: case report and review of the literature

doi:10.1016/j.surneu.2004.10.025

Surgical Neurology

Volume 64, Issue 2, August 2005, Pages 154-159

https://doi.org/10.1016/j.surneu.2004.10.025 Get rights and content

Abstract

Background

Capillary hemangiomas are benign vascular lesions that commonly present at birth or in early infancy on the face, scalp, back, or chest. The authors present an exceedingly rare case of an intracranial capillary hemangioma arising in an adult. Only 4 biopsy-proven cases have been reported in the pediatric population previous to this case report.

Case Description

A 31-year-old pregnant woman presented at 38 weeks of gestation with severe headaches, nausea, and vomiting. Imaging revealed an extra-axial mass lesion arising from the tentorium with both supra- and infratentorial components. The patient underwent a resection of her tumor, which was diagnosed as a capillary hemangioma by histopathologic examination. The patient required 2 further resections after the lesion exhibited a rapid regrowth from residual tumor in the left transverse sinus. The patient has remained free of disease 41 months out from her third surgery.

Conclusions

Intracranial capillary hemangiomas are exceedingly rare entities, with a capability for rapid growth. When gross total resection cannot be achieved, these patients should be observed closely, and the use of adjuvant radiotherapy should be considered.

Introduction

Capillary hemangiomas are benign vascular neoplasms. They commonly present congenitally or in early infancy, with 10% of these tumors presenting in the first year of life [2], [20]. Typically, these lesions grow rapidly until their growth plateaus between 8 and 12 months. Often, these lesions undergo complete spontaneous regression by 5 years. When these lesions do not regress, they are usually treated surgically. When these tumors occur in adults [14], they occur more often in women, where these tumors may undergo changes in their size relative to hormonal cycles and pregnancy [6]. They are usually found on the face, scalp, back, or chest, but may appear anywhere in the body. Although capillary hemangiomas are benign tumors, they can recur after partial [25] or even complete [5] resection.

Histologically, these tumors are characterized by a low-power lobular architecture with cellular lobules separated by variable degrees of fibrosis, depending on the age of lesion and the extent of regression. Careful inspection reveals plump endothelial cells forming poorly defined capillary channels. Fibroblasts, pericytes, and mast cells are also seen in these lesions. Characteristic features of these lesions, including their vascular nature when densely cellular, may be highlighted by histochemical and immunohistochemical special stains [9].

Capillary hemangiomas involving the nervous system are extremely rare. Cases of capillary hemangiomas arising from the meninges [35], nerve roots [30], cauda equina [11], [15], [18], [28], and spinal cord [1], [23], [31] have been previously reported. Although intraorbital capillary hemangiomas are a well-described entity, there are only 4 other reports of this lesion occurring intracranially [32], [33], [34], [35]. We present a case of an adult with an extra-axial mass lesion arising from the tentorium into the infra- and supratentorial compartments. The lesion was also noted to invade the left transverse sinus. After resection, the tumor's histopathology was classic for a capillary hemangioma. The lesion rapidly reoccurred and the patient had to undergo re-resection twice. The management of this lesion and a review of the literature are discussed.

Section snippets

Case report

A 31-year-old woman presented in August of 1999 at 38 weeks of gestation with severe headaches, nausea, and vomiting. The patient had no history of preclampsia, stroke, or vascular risk factors. Her initial neurological examination revealed a right temporal field cut, but was otherwise within normal limits. A computerized topography scan was obtained, which revealed the presence of a large mass arising from the tentorium extending into the left occipital lobe and left cerebellar hemisphere.

Pathological findings

Gross examination of the original and recurrent tumors revealed a firm, pink-tan, hemorrhagic mass with dural attachments. All specimens were then fixed in 10% buffered formalin, routinely processed, and embedded in paraffin. Sections were stained with hematoxlyin and eosin. All stains were performed with appropriate controls. Microscopic examination revealed a vascular tumor comprised of nests and lobules of vascular channels lined by well-differentiated endothelial cells (Fig. 6). The tumor

Discussion

Capillary hemangiomas involving the central nervous system are extremely rare. Other tumors in the differential diagnosis include hemangioblastoma, hemangioendothelioma, and hemangiopericytoma. Both hemangioendothelioma and hemangiopericytoma are tumors with prominent vascular components and recognized potential for more aggressive biologic behavior. Distinguishing these entities from a capillary hemangioma is critical in preventing unnecessary morbidity due to inappropriate treatment,

Conclusions

Intracranial capillary hemangiomas are exceedingly rare entities, with a capability for rapid growth. When these lesions are encountered, a gross total resection is the goal, as it is with all neoplasms. When this cannot be achieved, these patients should be observed closely and the use of adjuvant radiotherapy should be considered.

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Cavernous Sinus capillary hemangioma: Case report and literature review
2023, Brain and Spine
Capillary hemangioma of the cavernous sinus is considered a benign vascular skull base tumor. In this case report, a patient with capillary hemangioma located in the cavernous sinus who was operated on with endoscopic endonasal approach is presented.
What should be considered when planning the treatment for capillary hemangiomas located in the cavernous sinus?
The treatment approaches applied in 12 patients with a diagnosis of capillary hemangioma located in the cavernous sinus, reported in the English literature, are reviewed in this article. We presented the clinical and radiological results of the treatments.
Cavernous sinus capillary hemangiomas are considered benign tumors. However, surgical treatment is preferred in the foreground because of the neurological deficits due to the compression effect caused by the mass. In the case reported by Masman et al. for the first time in the literature in 2021, they provided total excision with the endoscopic endonasal approach in the patient they first diagnosed by taking a biopsy with the endoscopic endonasal approach. In our case report, we provided total excision with endoscopic endonasal transsphenoidal approach.
Many factors should be considered when deciding on the treatment method in these patients. Although radiotherapy is quite effective in the treatment of capillary hemangioma, surgery should be preferred, especially in symptomatic patients. In patients who cannot undergo surgery, radiotherapy is very valuable, although the long-term results are not yet known.
Recurrent posterior fossa intracranial capillary hemangioma in a pregnant woman: A case report and review of literature
2022, Annals of Medicine and Surgery
Intracranial capillary hemangioma (ICH) is a rare tumor with a slightly higher incidence in women. Surgical management of ICH during pregnancy requires a joint decision, for it has been a contentious issue owing to the inadequate number of cases.
A 23-year-old female with an ICH in the posterior fossa underwent subtotal tumor resection (STR). One year later, she was referred to the neurosurgery department in the 8th week of pregnancy due to a progressive headache, vomit, and a bulging occipital mass. Subsequent to an abortion, preoperative angiography and Bleomycin injection were performed, and the tumor was totally resected thereafter. Over a one-year follow-up, her symptoms faded, and she experienced no recurrence.
ICH, a highly vascular entity, poses a substantial intraoperative bleeding risk. During the first surgery, intraoperative bleeding deterred the surgeon from a gross total resection (GTR), leading to a recurrence due to the growth of residual tissue during pregnancy. Having aborted the fetus, the patient underwent angioembolization to lessen the risk of intraoperative bleeding before reoperation, rendering it more possible for the surgeon to achieve GTR. Accordingly, quality of resection and a multidisciplinary approach is necessary to ensure optimal treatment.
There is a growing consensus that not only is STR a contributory factor in ICH recurrence, but female hormones and increased cardiac output in pregnancy might play a pivotal role in the progression of the tumor. Thus, paying further attention to pregnant or peripartum patients with suspected ICH should assume greater significance.
Intracranial Capillary Hemangiomas: A Peripartum Presentation and Review of the Literature
2021, World Neurosurgery
Intracranial capillary hemangiomas (ICHs) are rare vascular tumors composed of a bed of many narrow thin-walled vessels. Within the confines of the skull, these tumors can lead to serious neurologic deficits including cranial nerve dysfunction, mood/personality disturbances, and signs of intracranial mass effect.
We report the case of a 23-year-old, 5-week postpartum woman with a history of progressive painful ophthalmalgia of the right eye presenting with rapid onset of ptosis, diplopia, and right-sided facial pain and hypesthesia. Imaging demonstrated a small extraaxial mass within the right cavernous sinus. She underwent 2 operations via an endoscopic endonasal approach for biopsy followed by complete resection. Histology showed a highly mitotic capillary hemangioma, which was negative for both estrogen and progesterone receptors.
We review cases of ICH reported in the literature and provide an updated summary of the presentation, diagnosis, and treatment of ICH. We then present a brief analysis of the reported cases with respect to age and sex.
We conclude that, in experienced hands, the endoscopic endonasal approach can be used to access the cavernous sinus for complete resection of ICHs of the cavernous sinus. We also suggest that further attention be paid to such cases in pregnant and peripartum women as these tumors may progress more quickly in this subpopulation.
Adult Parasellar Capillary Hemangioma with Intrasellar Extension
2019, World Neurosurgery
Capillary hemangiomata are benign vascular tumors that typically occur in children. They rarely occur in the central nervous system. Intracranial capillary hemangiomata in adults are very rare entities with only 18 cases reported in the literature. We report a case of parasellar capillary hemangiomata that extended into the sella in a 64-year-old woman as well as a review of the literature in adults.
We report a 64-year-old patient who presented with a headache, left-sided paresthesia, and weakness. Initial computed tomography of her brain showed a left-sided 3 cm × 2.5 cm parasellar lesion with intrasellar extension and no mass effect. Subsequent magnetic resonance imaging (MRI) showed a lesion that was homogenously hyperintense on T2-weighted MRI and fluid-attenuated inversion recovery, isointense with adjacent brain parenchyma on T1-weighted MRI, and which demonstrated enhancement after contrast administration. The patient initially underwent an endoscopic transsphenoidal biopsy, which was inconclusive, followed by a craniotomy, biopsy, and debulking. Histologic examination showed fibrous tissue containing numerous thin-walled and irregular vascular channels of varying sizes. There was a very mild associated inflammatory infiltrate, mainly formed of small mononuclear chronic inflammatory cells and occasional histiocytes. The histologic appearances were in keeping with capillary hemangiomata.
Capillary hemangiomata related to the sella are very rare and can easily be misdiagnosed on imaging alone. The present case highlights capillary hemangiomata as an important, albeit rare, differential when considering a sellar or parasellar mass.
A unique case of benign intracranial hemangioma mimicking malignant transformation
2018, Radiology Case Reports
Citation Excerpt :
However, these different modalities are not clearly standard in the literature [12]. When gross total resection of the lesion cannot be achieved, the patient should be observed frequently, with consideration of adjuvant radiotherapy [3]. Histopathology examination is the gold standard for diagnosis.
Capillary hemangiomas are rare benign vascular lesions, commonly found on scalp, face, chest, or back of a neonate or infant. Hemangiomas of the central nervous system are very rare lesions. There are only a few cases of intracranial capillary hemangioma (ICH) arising in adults reported in the literature. We present a case of 59-year-old female with intermittent recurrent headache localized in the frontal area. Magnetic resonance imaging revealed left frontal extra-axial mass with peripheral enhancement. The patient underwent complete surgical resection of the tumor. Histopathology examination of the lesion revealed well defined vascular lesion composed of closely packed plump endothelial cells lining slit-like vascular channels containing scattered red blood cells. No evidence of infiltrative brain parenchyma was seen. Ki-67 proliferative index was low, less than 2%. The final diagnosis was confirmed to be ICH by histopathology and immunohistochemistry studies. The patient has remained healthy and free of disease 39 months since her initial surgery. ICH is a benign vascular lesion which rarely occurs in the central nervous system, particularly in the intracranial region. It can mimic malignant lesions on radiologic studies. Histopathology examination is the gold standard for diagnosis. If total resection is achieved, prognosis is generally good with no evidence of recurrence.
Intracranial hemorrhage in neonates: A review of etiologies, patterns and predicted clinical outcomes
2018, European Journal of Paediatric Neurology
Citation Excerpt :
Hence, surgical excision is reserved for large lesions or when signs of raised intracranial pressure are seen.130 Small intracranial hemangiomas on the other hand, could be followed for regression, especially if there is associated cutaneous disease,133 since it has been reported that intracranial hemangiomas may regress in a manner parallel to concurrent cutaneous disease.134 VGAM, another potential mimic of neonatal ICH, is rare, with an incidence of approximately 1 in 25,000 births.
Intracranial hemorrhage (ICH) in neonates often results in devastating neurodevelopmental outcomes as the neonatal period is a critical window for brain development. The neurodevelopmental outcomes in neonates with ICH are determined by the maturity of the brain, the location and extent of the hemorrhage, the specific underlying etiology and the presence of other concomitant disorders. Neonatal ICH may result from various inherited and acquired disorders. We classify the etiologies of neonatal ICH into eight main categories: (1) Hemorrhagic stroke including large focal hematoma, (2) Prematurity-related hemorrhage, (3) Bleeding diathesis, (4) Genetic causes, (5) Infection, (6) Trauma-related hemorrhage, (7) Tumor-related hemorrhage and (8) Vascular malformations. Illustrative cases showing various imaging patterns that can be helpful to predict clinical outcomes will be highlighted. Potential mimics of ICH in the neonatal period are also reviewed.

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NeoplasmIntracranial capillary hemangioma: case report and review of the literature

Abstract

Background

Case Description

Conclusions

Introduction

Section snippets

Case report

Pathological findings

Discussion

Conclusions

Ophthalmology

J Am Acad Dermatol

Surg Neurol

J AAPOS

Am J Ophthalmol

J Am Acad Dermatol

Lobular capillary hemangioma of the spinal cord: case report and review of the literature

J Neurooncol

The pathology of head and neck tumors: vasoformative tumors, part 9A

Head Neck Surg

Intralesional laser therapy of extensive hemangiomas in 100 consecutive pediatric patients

Ann Plast Surg

Central nervous system complications of von Hippel-Lindau disease and pregnancy; perinatal considerations: case report and literature review

J Matern-Fetal Med

Recurrent pyogenic granulomas: a form of lobular capillary hemangioma

Cutis

Cerebellar hemangioblastoma in pregnancy. A case report

J Reprod Med

Interferon-alfa treatment of facial infantile haemangiomas: with emphasis on the sight-threatening varieties. A clinical series

Acta Ophthalmol Scand

Diagnostic histopathology of tumors

An unusual compressive syndrome of the cauda equina

Mayo Clin Proc

Neoplasm
Intracranial capillary hemangioma: case report and review of the literature