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Ivren M, Cherkezov A, Reuss D, Haux D, Herold-Mende C, Mohr A, Krieg SM, Unterberg A, Younsi A. Intracranial angioleiomyoma: a case series of seven patients and review of the literature. J Neurooncol 2024:10.1007/s11060-024-04734-y. [PMID: 38842695 DOI: 10.1007/s11060-024-04734-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2024] [Accepted: 06/01/2024] [Indexed: 06/07/2024]
Abstract
PURPOSE Angioleiomyoma, predominantly arising from the extremities, is a benign soft tissue tumor. Reports on its intracranial location are rare. We assessed clinical, radiological, and pathological features of intracranial angioleiomyoma (iALM) treated at our neurosurgical institution. METHODS We consecutively enrolled all patients with neuropathologically confirmed iALM treated at a single neurosurgical institution between 2013 and 2021. Clinical and imaging data were collected, and histological tissue sections were analyzed. A review of the literature on iALM was conducted. RESULTS Seven patients with iALM (four female) with a median age of 45 years (range: 32-76 years) were identified. In three cases, the lesion was found incidentally. In magnetic resonance imaging (MRI), all tumors were hypo- to isointense on T1-weighted, hyperintense on T2-weighted sequences, and gadolinium-enhancing. A strong FLAIR signal was seen in six patients. Surgery consisted of gross total resection in all cases without perioperative complications. Neuropathological staining was positive for smooth muscle actin (SMA) in all lesions. Mature smooth muscle cells arranged around blood vessels were typically observed. The Ki-67 index was ≤ 3%. The patients were discharged after a median of 6 days (range: 4-9 days). During a median follow-up time of 14 months (range: 4-41 months), no tumor recurrence occurred. In the current literature, 42 additional cases of iALM were identified. CONCLUSION Intracranial angioleiomyoma is a benign soft tissue tumor treated by gross total resection. Tumor morphology and positive staining for SMA lead to the neuropathological diagnosis.
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Affiliation(s)
- Meltem Ivren
- Department of Neurosurgery, Heidelberg University, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany.
| | - Asan Cherkezov
- Department of Neuopathology, Heidelberg University, Im Neuenheimer Feld 672, Heidelberg, Germany
| | - David Reuss
- Department of Neuopathology, Heidelberg University, Im Neuenheimer Feld 672, Heidelberg, Germany
| | - Daniel Haux
- Department of Neurosurgery, Heidelberg University, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
| | - Christel Herold-Mende
- Department of Neurosurgery, Heidelberg University, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
| | - Alexander Mohr
- Department of Neuroradiology, Heidelberg University, Im Neuenheimer Feld 400, Heidelberg, Germany
- Department of Neuroradiology, Klinikum Darmstadt, Grafenstraße 9, Darmstadt, Germany
| | - Sandro M Krieg
- Department of Neurosurgery, Heidelberg University, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
| | - Andreas Unterberg
- Department of Neurosurgery, Heidelberg University, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
| | - Alexander Younsi
- Department of Neurosurgery, Heidelberg University, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany.
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Zhang S, Wang Z, Zhang G, Ji Y, Wang Y, Xiao S. Primary angioleiomyoma of right frontal cranial base with intracranial and extracranial communication. Br J Neurosurg 2023; 37:1010-1015. [PMID: 33095082 DOI: 10.1080/02688697.2020.1837731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Accepted: 10/13/2020] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Primary intracranial angioleiomyoma (ALM) is quite rare and ALM of the adolescent is even rarer. To date, only three cases of adolescents have been reported. MATERIAL AND METHODS We carefully introduced a new location of intracranial ALM in an adolescent. The clinical, pathological and imaging features of intracranial ALM were described in detail and published literature was reviewed. RESULTS To our best knowledge, we presented the fourth primary intracranial ALM of adolescent and the first ALM of the right frontal cranial base with intracranial and extracranial communication. We not only summarize the generalities of ALM but also illustrate the difference between adult and adolescent ALM in the aspects of gender and age predominance, etiology, common location and pathologic subtype. CONCLUSIONS We reported the first ALM of the right frontal cranial base with intracranial and extracranial communication of an adolescent with a good prognosis. We also summarize the generalities of ALM and illustrate the difference between adult and adolescent ALM. Future investigation of control study with large patient cohorts is needed for both adult and adolescent ALM to compare the difference between them.
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Affiliation(s)
- Shizhen Zhang
- Department of Neurosurgery and Neurosurgical Disease Research Centre, the Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Zhaotao Wang
- Department of Neurosurgery and Neurosurgical Disease Research Centre, the Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Guilong Zhang
- Department of Neurosurgery and Neurosurgical Disease Research Centre, the Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Yunxiang Ji
- Department of Neurosurgery and Neurosurgical Disease Research Centre, the Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Yezhong Wang
- Department of Neurosurgery and Neurosurgical Disease Research Centre, the Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Shiyin Xiao
- Department of Neurosurgery and Neurosurgical Disease Research Centre, the Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
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Chen F, Pan Y, Teng Y, Pan X, Yu Y. Primary Intracranial Angioleiomyoma: A Case Report and Literature Review. World Neurosurg 2020; 138:145-152. [PMID: 32058118 DOI: 10.1016/j.wneu.2020.01.239] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Revised: 01/30/2020] [Accepted: 01/31/2020] [Indexed: 11/18/2022]
Abstract
BACKGROUND Angioleiomyoma is a benign soft tissue tumor that manifests as pain and is more common in the extremities. However, primary intracranial angioleiomyoma is an extremely rare entity that is poorly characterized clinically, radiologically, and histopathologically. We compiled and examined reported cases of intracranial angioleiomyoma to provide an up-to-date summary of the condition. A literature search was performed using PubMed with specific key terms. Selected case studies and case series were then compared, and statistical analyses were performed where appropriate. CASE DESCRIPTION A 59-year-old woman presented with epileptic seizures and a 2-month history of progressive headache. Magnetic resonance imaging of the brain revealed a right temporal pole tumor near the right cavernous sinus. Gross total resection was performed. Histopathologic and immunohistochemical examination demonstrated an angioleiomyoma. No adjuvant radiation or chemotherapy was administered. Magnetic resonance imaging of the brain performed at 6-month follow-up showed no signs of recurrence. CONCLUSIONS Primary intracranial angioleiomyoma is an exceedingly rare central nervous system tumor. The clinical and radiologic manifestations are nonspecific. The diagnosis depends on the histopathologic and immunohistochemical examination. For patients with clinical symptoms, surgical resection should be the first-choice treatment.
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Affiliation(s)
- Fan Chen
- Department of Neurosurgery, The First Hospital of Jilin University, Changchun, China
| | - Yuehai Pan
- Department of Hand and Foot Surgery, The Affiliated Hospital of QingDao University, ShangDong, China
| | - Yongliang Teng
- Department of Pathology, The First Hospital of Jilin University, Changchun, China
| | - Xingchen Pan
- Department of Molecular Biology, College of Basic Medical Science, Jilin University, Changchun, China
| | - Ying Yu
- Department of Neurosurgery, The First Hospital of Jilin University, Changchun, China.
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Ding J, Wang F, Li Y, Sun T. Rare giant primary intracranial angioleiomyoma in lateral ventricle: a case report and the literature review. Br J Neurosurg 2020; 34:710-714. [PMID: 32003238 DOI: 10.1080/02688697.2020.1719037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Background: Angioleiomyomas are benign tumors and can occur in subcutaneous tissues all over the body, and lower extremities are more common. Primary intracranial angioleiomyomas are rare. We present a case of intracranial angioleiomyoma and review the literature.Case description: A 35-year-old Chinese women presented with one-year history of the left leg claudication. MRI revealed a 6.3 × 7.4 × 5.4 cm lesion located in the lateral ventricle, which, to our knowledge is the first lateral ventricle ALM reported. The tumor was resected. The pathological results were consistent with angioleiomyoma. Hemiplegia of left limb was found during post-operative period and no recurrence was found during five month of follow-up.Conclusion: ALM is a rare intracranial tumor but can occur.
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Affiliation(s)
- Jiangwei Ding
- Ningxia Key Laboratory of Cerebrocranial Disease, Ningxia Medical University, Yinchuan, Ningxia, China.,Department of Neurosurgery, General Hospital of Ningxia Medical University, Yinchuan, Ningxia, China
| | - Feng Wang
- Ningxia Key Laboratory of Cerebrocranial Disease, Ningxia Medical University, Yinchuan, Ningxia, China.,Department of Neurosurgery, General Hospital of Ningxia Medical University, Yinchuan, Ningxia, China
| | - Yuan Li
- Department of Neurosurgery, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Tao Sun
- Ningxia Key Laboratory of Cerebrocranial Disease, Ningxia Medical University, Yinchuan, Ningxia, China.,Department of Neurosurgery, General Hospital of Ningxia Medical University, Yinchuan, Ningxia, China
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Altieri R, Morrone A, Certo F, Parisi G, Buscema G, Broggi G, Magro G, Barbagallo GM. Tentorial Angioleiomyoma: A Rare Neurosurgical Entity. Case Report and Review of the Literature. World Neurosurg 2019; 130:506-511. [PMID: 31349075 DOI: 10.1016/j.wneu.2019.07.129] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2019] [Accepted: 07/16/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND Angioleiomyoma (ALM) is a soft tissue neoplasm rarely described in the intracranial site. Because of their uncommon presentation, atypical neuroradiologic and pathologic features, ALMs are often misdiagnosed. CASE DESCRIPTION We describe the neuroradiologic, clinical, and pathologic data of a 37-year-old male patient suffering from a tentorial ALM. He was admitted at our hospital because of a posterior cranial fossa mass. Magnetic resonance imaging (MRI) showed a left tentorial tumor, hypointense on T1-weighted sequences, with heterogeneous contrast enhancement after gadolinium injection ("salt-and-pepper" fashion) and slightly hyperintense signal on T2-weighted sequence. After surgery, pathological examination showed a tumor composed of several thick-walled blood vessels mixed with a population of deeply eosinophilic spindle-shaped smooth muscle cells arranged in bundles. Necrosis was absent. Neither cellular pleomorphism nor mitoses were detected. Immuno-histochemical analysis confirmed the smooth muscle phenotype of the spindle cell component: diffuse and strong positivity for alpha-smooth muscle actin, desmin, and h-caldesmon. Based on both morphologic and immunohistochemical findings, a diagnosis of primary intracranial ALM was rendered. CONCLUSIONS We add to the literature the tenth case of this exceedingly rare tumor and submit that ALM should be suspected when a tentorial mass with a "flame-like" time-dependent pattern of contrast enhancement on MRI, a "salt-and-pepper" post-contrast appearance on MRI T1-weighted sequences, and a relation with large intracranial feeding vessels are present.
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Affiliation(s)
- Roberto Altieri
- Division of Neurosurgery, Department of Neurosciences, Policlinico "G. Rodolico", University Hospital, Catania, Italy; Neurosurgical Unit, Department of Neuroscience, University of Turin, Turin, Italy.
| | - Antonio Morrone
- Division of Neurosurgery, Department of Neurosciences, Policlinico "G. Rodolico", University Hospital, Catania, Italy
| | - Francesco Certo
- Division of Neurosurgery, Department of Neurosciences, Policlinico "G. Rodolico", University Hospital, Catania, Italy; Multidisciplinary Research Center on Brain Tumors Diagnosis and Treatment, University of Catania, Catania, Italy
| | - Giuseppe Parisi
- Division of Neurosurgery, Department of Neurosciences, Policlinico "G. Rodolico", University Hospital, Catania, Italy
| | - Giovanni Buscema
- Department of Anaesthesiology, University of Catania, Turin, Italy
| | - Giuseppe Broggi
- Department of Medical, Surgical Sciences and Advanced Technologies and Biotechnological Sciences G.F. Ingrassia, Anatomic Pathology, University of Catania, Catania, Italy
| | - Gaetano Magro
- Department of Medical, Surgical Sciences and Advanced Technologies and Biotechnological Sciences G.F. Ingrassia, Anatomic Pathology, University of Catania, Catania, Italy
| | - Giuseppe M Barbagallo
- Division of Neurosurgery, Department of Neurosciences, Policlinico "G. Rodolico", University Hospital, Catania, Italy; Multidisciplinary Research Center on Brain Tumors Diagnosis and Treatment, University of Catania, Catania, Italy
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Li CB, Xie MG, Ma JP, Wang L, Hao SY, Zhang LW, Jia W, Jia GJ, Zhang JT, Li D, Li H, Wu Z. Primary Intracranial Angioleiomyomas as Rare, Nonmalignant, and Distinct Neoplastic Entities: A Series of 8 Cases and a Literature Review. World Neurosurg 2018; 113:1-13. [DOI: 10.1016/j.wneu.2018.01.207] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2017] [Revised: 01/29/2018] [Accepted: 01/30/2018] [Indexed: 10/18/2022]
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Abstract
A 43-year-old man arrived at the emergency department following a syncopal episode. Computed tomography and magnetic resonance images demonstrated a small interhemispheric, anterior parafalcine mass that mimicked a meningioma. Surgical excision and subsequent pathologic evaluation revealed an angioleiomyoma and the patient recovered without incident. Angioleiomyomas are classified as benign smooth muscle tumors and are classically seen in adult females arising in the soft tissues of the lower extremities. Although rare, these masses have been described in various intracranial locations, usually extra-axially. A comprehensive review of the literature and discussion are provided, emphasizing histopathologic and imaging features of this uncommon intracranial neoplasm.
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Affiliation(s)
- Susana Calle
- Department of Diagnostic and Interventional Imaging, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - David Louis
- Department of Pathology, Massachusetts General Hospital, Boston, MA, USA
| | - Richard Westmark
- Department of Neurosurgery, Bay Area Regional Medical Center, Webster, TX, USA
| | - Kaye Westmark
- Department of Diagnostic and Interventional Imaging, University of Texas Health Science Center at Houston, Houston, TX, USA
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Sun L, Zhu Y, Wang H. Angioleiomyoma, a rare intracranial tumor: 3 case report and a literature review. World J Surg Oncol 2014; 12:216. [PMID: 25027207 PMCID: PMC4114082 DOI: 10.1186/1477-7819-12-216] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2013] [Accepted: 07/04/2014] [Indexed: 11/12/2022] Open
Abstract
Three cases of intracranial angioleiomyoma (ALM) in our neurosurgery center are reported in detail. ALM is a benign soft tissue tumor comprised of mature smooth muscle cells and a prominent vascular component, which is extremely rare as a primary intracranial lesion. Altogether, only 12 cases were recorded in the literature to date, to the best of our knowledge. Case 1 is the second report of intra-sella ALM, a 51-year-old woman presented with visual deterioration for 2 months. An MRI showed an intra-sella 3-cm tumor, partially flame-like, enhanced with gadolinium. Using microscopic endonasal transsphenoidal approach, the tumor was completely resected with great difficulty. At 11 days post-surgery, she died of a sudden catastrophic nasal hemorrhage. An angiography revealed a pseudo-aneurysm of ICA (internal carotid artery). Case 2 is a 49-year-old man who presented with weakness of the lower limbs for 1 year. A large subtentorial mass was found affixed to the torcular and straight sinus, which was partially flame-like, dramatically enhanced as in case 1. Case 3 is that of a 77-year-old man. An ALM mass was revealed in the diploe of left temporal bone, and had eroded the inner table. Immunohistochemical workup confirmed the diagnosis of angioleiomyoma in all 3 cases. The radiology, operation, and complication of surgery in each case were discussed. In conclusion, intracranial ALMs are extremely rare, usually located ex-neuro axis (such as in our cases), in the sella, in posterior fossa, or in the skull. Magnetic resonance imaging (MRI) revealed a special feature of flame-like partial enhancement that may be helpful to distinguish ALM from pituitary tumors or meningiomas, and should result in the consideration of this rare tumor entity early on in the diagnostic process. A definitive diagnosis depends on histological analyses. The resection of ALM in certain locations is difficult and risky because of the rich blood supply.
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Affiliation(s)
- Lijun Sun
- Department of Neurosurgery, Tianjin Cerebral Vascular and Neural Degenerative Diseases Key Laboratory, Tianjin Huanhu Hospital, 122 Qixiangtai Street, 300060 Tianjin, China.
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