Hemangiopericytoma: a 20-year single-institution experience

BACKGROUND

Hemangiopericytoma is an uncommon soft tissue sarcoma. We sought to evaluate the long-term outcome of a consecutively treated patient cohort with hemangiopericytoma.

METHODS

The study involved 36 adult patients (older than 16 years) with hemangiopericytoma treated at The University of Texas M. D. Anderson Cancer Center between July 1975 and July 1995. Data on clinicopathologic parameters, surgical treatment, adjuvant therapy, disease recurrence, and survival were obtained from a review of medical records.

RESULTS

The median follow-up was 57 months. Twenty-eight patients (78%) underwent complete and potentially curative resection of their primary disease. Of the nine patients (32%) who had local recurrences, four (57%) had epidural tumors and three (43%) had retroperitoneal tumors, but none had extremity tumors. Extremity tumors were associated with a significantly prolonged local recurrence-free survival compared to tumors at nonextremity anatomic sites (P <.05). Ten patients had recurrences at distant sites. Of the 13 patients who experienced any form of disease recurrence, four had recurrences after a disease-free interval of more than 5 years. The 5-year actuarial survival rate for the entire group of 36 patients was 71%. Noncurative surgical treatment (P=.007) and development of distant metastatic disease (P=.013) were associated with shortened survival.

CONCLUSION

Extended survival is common in hemangiopericytoma patients treated with curative intent. However, local and distant recurrences may occur after a prolonged disease-free interval, emphasizing the need for long-term follow-up. Retroperitoneal and meningeal tumors were associated with higher local recurrence rates; therefore, adjuvant therapies should be considered and evaluated for tumors at these sites.

Primary malignant pulmonary hemangiopericytoma

A primary malignant pulmonary hemangiopericytoma was diagnosed in a 45-year-old woman who complained of 10 months of cough and exertional dyspnea. One year after resection of the mass, a metastatic lesion was removed from the contralateral lung. The literature on this unusual pulmonary lesion is reviewed.

[Experiences with hemangiopericytoma in cranial base surgery]

BACKGROUND

Haemangiopericytomas are rare vascular neoplasms which show either slow local tumour growth or aggressive progression in size with a high tendency of recurrence and metastasis. Manifestations of haemangiopericytomas in the area of the nose and sinuses are supposed to have a relatively benign course. To date clinical and histological parameters for prognosis are uncertain. Therefore in a quite large number of cases only the clinical course allows to evaluate the dignity of a haemangiopericytoma.

PATIENTS AND RESULTS

We present our experience with five haemanglopericytomas in contact with the skull base out of a total number of 457 skull base tumours. The site of origin of these five haemangiopericytomas were: nasal septum, pterygopalatine fossa, oronasopharynx, temporal bone, and parotid gland. All neoplasms showed primary or recurrent tumor in contact with the skull base and an intracranial extension was observed twice. One patient died postoperatively of a cerebral infarction. Three patients showed one or more recurrences which were treated surgically. In one case 5 recurrences occurred. Despite of 4 surgical procedures within a period of 15 months, the tumour could be controlled only for a short period of time, and the patient died 16 months after the first operation.

CONCLUSION

One has to consider that haemangiopericytomas of the head and neck show a potential malignant course. The vascular tumor may recur decades later. Adequate therapy and life-long follow-up are therefore mandatory in haemangiopericytomas. Complete surgical resection of the tumour is usually the treatment of choice, in spite of the high degree of surgical skill required, especially in advanced tumour and in case of recurrence.

[Unusual coincidence of partially active endocrine tumors]

We report on a female patient who developed five different tumors between the age of 53 and 62 years. The following tumors were diagnosed, three of which showed endocrine activity: uterine myoma; hemangiopericytoma of the meninges; pleural mesothelioma; preperitoneal leiomyoma; medullary carcinoma of the thyroid (sporadic form) in a hyperthyroid goiter. Coexistence of hyperthyroidism and medullary carcinoma of the thyroid is rare. Paraneoplastically induced hypoglycemia--in this patient induced by the pleural mesothelioma and less by the preperitoneal leiomyoma--is of similarly infrequent occurrence. Tumors of epithelial or mesenchymal origin may cause hypoglycemia as a result of peptide secretion, exerting an insulin-like effect. The detection of IGF-I and IGF-II in the serum confirms the diagnosis. Insulinoma can be differentiated by the absence of hyperinsulinemia.

Radiotherapy of bone metastases of a spinal meningeal hemangiopericytoma

Hemangiopericytoma is a rare tumor arising from pericapillary cells or pericytes of Zimmerman, and can occur anywhere capillaries are found. We describe a patient with a meningeal hemangiopericytoma who was treated with primary surgical resection and experienced multiple bone metastases 20 years after the first treatment. This patient with multiple bone metastases was treated with multiple courses of irradiation and good palliation was achieved.

Malignant meningioma: an indication for initial aggressive surgery and adjuvant radiotherapy

Malignant meningiomas constitute a rare subset of meningiomas and display a marked propensity for postsurgical recurrence. This retrospective study evaluates the various parameters which alter the recurrence rate. The records of all malignant meningioma patients treated from 1984 through 1992 were reviewed, and the time to recurrence or current patient status was determined, and the influence of various patient and disease parameters were analyzed. Thirty-eight patients were treated with 48 malignant meningioma resections performed (28 total and 20 subtotal), 25 at initial presentation and 23 for recurrent disease; 19 patients received postoperative radiotherapy. Subtypes included 32 anaplastic meningioma, 11 hemangiopericytoma, 2 meningiosarcoma, and 3 papillary meningioma. Followup ranged from 3 to 144 months, with five patients excluded from analysis. Actuarial disease free/progression free survival (DFS) at 5 years was 39% following total resection versus 0% after subtotal resection (p=0.001). For all totally excised lesions, the 5-yr DFS was improved from 28% for surgery alone to 57% with adjuvant radiotherapy (p=NS). Adjuvant irradiation following initial resection increased the 5-yr DFS rates from 15% to 80% (p=0.002). When administered for recurrent lesions, adjuvant radiotherapy improved the 2-yr DFS from 50% to 89% (p=0.015), but had no impact on 5-yr DFS. Multivariate analysis indicates extent of resection, adjuvant radiotherapy, and recurrence status are independent prognostic factors. Malignant meningiomas display a tendency for post surgical recurrence, with recurrence significantly increased for multicentric and recurrent disease. Complete surgical resection and the administration of adjuvant irradiation following initial resection are crucial to long-term control.

[Meningeal hemangiopericytomas. A retrospective reciew of 20 cases]

BACKGROUND AND PURPOSE

Meningeal hemangiopericytomas (MHP) account for 2% of meningeal tumours. Clinical features, radiology findings, therapy and outcome of 20 MHP operated in our department from 1965 through 1995 were analyzed to determine presurgical features for diagnosis, histologic diagnostic criteria and the role of adjuvant post-operative radiotherapy.

METHODS

In conformity with the new WHO classification which differentiates MHP from meningiomas, 20 patients with tumors compatible with this definition were reviewed.

RESULTS

The clinical features differed slightly from meningiomas. Only epidemiologic data were different. The CT and MRI scanning gave no preoperative distinction between MHP and meningiomas. Angiography played a predominant role in this distinction. The 20 patients were operated. Twelve received post-operative radiotherapy. The rate of local recurrency was 45%. Of these, 88% did not receive radiotherapy post-operatively. Two patients (10%) presented late recurrence and three patients (15%) one or more extra-neural metastases. Two patients received radiosurgical treatment. In one case with disseminated metastasis, chemotherapy was used without success. Three patients died during the follow up.

CONCLUSION

Considering our review and the current literature, it seems that complete excision followed by adjuvant radiotherapy of more than 50 Gy significatively reduces the risk of recurrence (p < 0.0001). Radiosurgery is indicated for recurrent tumors measuring less than 30 mm in their greatest diameter.

Vulvar hemangiopericytoma. Case report

A rare case of a hemangiopericytoma of the vulva, observed in a 55-year old woman, is presented. So far, only six cases of this uncommon disease--which continues to be a source of uncertainty from both a prognostic and therapeutic point of view--have been reported. The case is described along with a review of international literature.

[Hemangiopericytoma: diagnostic-therapeutic considerations]

The Authors report a clinical case of hemangiopericytoma recently observed. The biological behaviour of this tumour presents a character of unforeseeableness and, in every chance, needs a long period of follow-up. Based on literature data, the Authors report some diagnostic-therapeutic precise information and underline the scanty reliability of the prognostic factors.

Hemangiopericytoma presenting as a congenital midline nasal mass

Hemangiopericytoma is a rare tumor that is thought to originate from the vascular pericytes of Zimmerman. Although they represent less than 1% of all vascular neoplasms, 15% to 30% of these tumors are found in the head and neck. The benign or malignant nature of a hemangiopericytoma is determined clinically, not histologically, indicating the need for close and careful follow-up. We describe a congenital midline nasal mass in a 2-year-old boy that proved to be a hemangiopericytoma. Clinical photographs, a magnetic resonance imaging scan, and histologic photographs depict the findings. The evaluation and differential diagnosis of midline nasal masses are discussed.

Orbital hemangiopericytoma: case report of a long-term recurrency

Among tumors concerning the orbit, hemangiopericytoma is one of the most unusual forms. This tumor has a vascular origin and usually appears as a fleshy, well-circumscribed mass, characterized by slow growth and lack of soreness. Its biological traits include a mostly benign nature, a potential malignancy, and, most of all, a highly frequent recidivation. This study of double recidivation shows this can occur even after a long lapse of time and the new tissue can acquire malignant traits. Finally, we describe the modes of the surgical approach, which aims at intervening the most radical cases to reduce recidivation to a minimum.

Resection surgery in the treatment of vertebral tumors

With the purpose of clarifying the limits of resection surgery (en bloc excision) for the treatment of bone tumors of the spine, the authors report the indications and results of 43 operations. This series was homogeneous in terms of oncological and surgical staging, as well as with regard to surgical method used and anaesthesiology. Three different types of surgery were performed: en bloc resection of tumors of the body (sectors 5-9 or 4-8 depending on the WBB staging system), of the posterior arch (sectors 10-3) or characterized by eccentric growth (sectors 2-5 or 8-11). The surgical margins were histologically studied in all of the cases: based on the evaluation and on histological diagnosis further chemo- and/or radiation therapy were decided on. Long-term follow-up was obtained for all of the cases (from 6 to 153 months, mean 30 months; 26 cases followed for more than 24 months). Six of the patients died as a result of the disease from 10 to 28 months after resection. There were 4 local recurrences, 4 pulmonary metastases, and 5 metastatic disseminations to the skeleton and to other tissues observed in 11 patients. At final follow-up 33 patients (77%) were thus disease-free (32 continually), in excellent condition, and capable of living a normal life. Complications and treatment are also reported. A careful study of the neoplasm, an appropriate selection of the patients based on diagnosis and histological staging, a knowledge of the natural progression of bone neoplasms and of the surgical anatomy of the vertebral column, the application of suitable measures of anaesthesiological control, allow for a correct cost/benefit evaluation of this type of surgery as compared to oncological methods that are less effective but more diffused. On the basis of these considerations indications for en bloc resection in tumors of the spine are defined.

Computerized optimization of multiple isocentres in stereotactic convergent beam irradiation

A method for the fully computerized determination and optimization of positions of target points and collimator sizes in convergent beam irradiation is presented. In conventional interactive trial and error methods, which are very time consuming, the treatment parameters are chosen according to the operator's experience and improved successively. This time is reduced significantly by the use of a computerized procedure. After the definition of target volume and organs at risk in the CT or MR scans, an initial configuration is created automatically. In the next step the target point positions and collimator diameters are optimized by the program. The aim of the optimization is to find a configuration for which a prescribed dose at the target surface is approximated as close as possible. At the same time dose peaks inside the target volume are minimized and organs at risk and tissue surrounding the target are spared. To enhance the speed of the optimization a fast method for approximate dose calculation in convergent beam irradiation is used. A possible application of the method for calculating the leaf positions when irradiating with a micromultileaf collimator is briefly discussed. The success of the procedure has been demonstrated for several clinical cases with up to six target points.

Long-term survival after repetitive surgery for malignant hemangiopericytoma of the lung with subsequent systemic metastases: case report and review of the literature

Malignant hemangiopericytoma represent less than 1% of all vascular and about 5% of all sarcomatous tumors. We are reporting the uncommon clinical case of primary pulmonary localization, of which approximately 100 cases have been published in the literature. A 54-year-old male underwent left upper lobectomy seven years ago for a tumor which proved to be a malignant hemangiopericytoma. Six months later a metastasis in the abdominal wall in the epigastrium appeared and was completely excised without further treatment. During a follow-up of 16 months another metastasis developed in the mesenterium causing ileus and leading to laparotomy with resection of 120 cm small bowel. After this procedure followed by two cycles of chemotherapy the patient remained free of disease. Details of the clinical course and a review of the literature are presented.

A case of hemangiopericytoma of the buccal mucosa

We report a 46-year-old woman who presented with a hemangiopericytoma in the buccal mucosa. At the 2-year postoperative examination, there was no evidence of recurrence or metastasis. The findings in the present case are compared with previous reports in the Japanese literature, with regard to patient age and sex, and lesion size, location, malignancy, local recurrence and metastasis.

Epibulbar hemangiopericytoma

PURPOSE

To report a case of an epibulbar hemangiopericytoma that appeared clinically as a firm nodule.

METHODS

We examined a 28-year-old man with a 5-year history of a gradually enlarging red, firm epibulbar nodule. Excisional biopsy was performed.

RESULTS

Histopathology identified an encapsulated hemangiopericytoma. Eight-year follow-up showed no recurrence postresection.

CONCLUSIONS

Epibulbar hemangiopericytoma is rare and has a good prognosis after resection. The smaller size and more conspicuous location of epibulbar hemangiopericytomas may lead to relatively early treatment and account for a more favorable prognosis.

Orbital hemangiopericytoma--case report

A 43-year-old male presented with swelling involving the right eye. T1-weighted magnetic resonance imaging demonstrated a round tumor in the lateral region of the right orbit, which was isointense relative to the cerebral gray matter and homogeneously enhanced by gadolinium-diethylenetriaminepenta-acetic acid with a flow-void signal area in the mass. The tumor was totally resected through the transcranial and fronto-orbitotemporal approach after embolization of feeding arteries arising from the external carotid artery. The histological findings were characteristic of hemangiopericytoma. No radiation therapy was administered. The transcranial and fronto-orbitotemporal approach provides a wide operative field with excellent exposure of the highly vascular orbital tumor.

Primary pulmonary malignant hemangiopericytoma associated with coagulopathy

A 34-year-old woman with a massive pulmonary malignant hemangiopericytoma and coagulopathy as a paraneoplastic syndrome is reported. Although coagulopathy may appear as a paraneoplastic syndrome and cause treatment to be more complicated and difficult, it can also be a useful marker to monitor the results of operation and tumor recurrence. This unusual case shows that primary pulmonary malignant hemangiopericytoma deserves aggressive surgical intervention with complete resection even under the circumstances of coagulation abnormality.

Hemangiopericytoma of the liver: immunohistochemical observations, expression of angiogenic factors, and review of the literature

PURPOSE

We describe an unusual case of a hemangiopericytoma in the liver of a child, review the literature, and characterize the tumor by immunohistochemistry and electron microscopy. We study the expression of basic fibroblast growth factor (bFGF) and of vascular endothelial growth factor (VEGF) in the tumor.

MATERIALS AND METHODS

Clinical history and pathology were reviewed; sections of the tumor were studied by histology, electron microscopy, and immunohistochemistry using antibodies directed towards factor-XIIIa, HAM-56, bFGF and VEGF, among others.

RESULTS

The expression of VEGF resembled that of "proliferating" hemangiomas; however, despite being markedly elevated in the urine, bFGF could not be unequivocally detected in the tumor. A subpopulation of factor XIIIa positive cells was identified, similar to the "interstitial" cells of the cellular hemangiomas of infancy. The nature and function of these cells remains speculative.

CONCLUSIONS

Hemangiopericytomas are rare in the liver. When arising in this location in a child, they may clinically resemble a hemangioma, may express angiogenic factors in a similar fashion, and should be considered in the differential diagnosis.

Congenital hemangiopericytoma: two cases of familiar presentation

We report two cases of congenital hemangiopericytoma localized in the abdominal wall in the first patient and scalp in the second. The treatment of both cases consisted in the complete resection of the tumor mass. Four and two years later the patients remain asymptomatic. The special interest in this case report lies in the extremely low incidence of congenital hemangiopericytoma and that this is the first reference to affected siblings.