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M. Abdo E, Farouk N, E. Elshinawy W, Mohamed Ahmed E, A. Raafat M, Husien Abdo W, A. Abdel Wahab M, E. Elimam S, Alsagheer Alhewy M. Masson's Tumor as an Uncommon Cause of Neck Mass: A Case Presentation. Vasc Endovascular Surg 2024; 58:405-409. [PMID: 37962479 PMCID: PMC10996301 DOI: 10.1177/15385744231215102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2023]
Abstract
BACKGROUND Masson's tumor, commonly referred to as intravascular papillary endothelial hyperplasia (IPEH), is an uncommon growth of endothelial cells within a vessel wall that is frequently assumed to indicate an abnormal resolution of thrombosis. IPEH is most typically found in the extremities however it is rare for IPEH to appear as a neck tumor. The issue with IPEH is that it could clinically, radiologically, and pathologically imitate some malignant neoplasms such as angiosarcomas creating a diagnostic challenge. CASE REPORT We describe a 21-year-old male patient who presented with right anterolateral neck swelling for 12 months. Ultrasound revealed a 9.0 × 8.0 cm well-defined echogenic hyper-vascular lesion. The contrast computed tomography (CT) scan of the neck revealed an oval, well-defined subcutaneous mass, measuring 9 × 4.5 cm, situated over and separable from the right sternocleidomastoid muscle with no significant enhancement in the post-contract study. T1-weighted and T2-weighted MRI revealed a 10 × 9 × 7 cm well-defined subcutaneous lobulated lesion superficial to the sternocleidomastoid expanding upward to the Rt. side of the cheek and below to the suprasternal region, eliciting an intermediate signal in T1 and a heterogenous bright signal (mostly fluid) in T2 with low signal foci within the mass. The decision had been reached to entirely excise the lesion surgically with safety margins for histological evaluation. Histological examination indicated thrombosed variable-sized ectatic vascular spaces with papillary formations related to the thrombus, covered with a single layer of flat endothelium, and no features suggestive of malignancy. There was no recurrence at 18 months follow-up post-surgery. CONCLUSION Masson's tumor is a benign intravascular disease with an unclear origin and no confirmed inheritance pattern. Presentation of Masson's tumor as a neck mass is incredibly uncommon. Masson's tumor lacks a distinct or distinguishing clinical and radiological appearance. Histopathologic examination is the sole definitive way for diagnosing the disease and the only tool for distinguishing it from angiosarcoma. Surgical excision is the best treatment for IPEH. Recurrence is extremely rare.
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Affiliation(s)
- Ehab M. Abdo
- Department of Vascular Surgery, Faculty of Medicine (for Girls), Al-Azhar University, Cairo, Egypt
| | - Nehal Farouk
- Department of Vascular Surgery, Faculty of Medicine (for Girls), Al-Azhar University, Cairo, Egypt
| | - Waleed E. Elshinawy
- Department of Vascular Surgery, Faculty of Medicine (for Girls), Al-Azhar University, Cairo, Egypt
| | - Eman Mohamed Ahmed
- Pathology Department, Faculty of Medicine (for Girls), Al-Azhar University, Cairo, Egypt
| | - Mona A. Raafat
- Department of Radiodiagnosis, Faculty of Medicine (for girls), Al-Azhar University, Cairo, Egypt
| | - Walaa Husien Abdo
- Department of Radiodiagnosis, Faculty of Medicine (for girls), Al-Azhar University, Cairo, Egypt
| | - Maisa A. Abdel Wahab
- Department of Vascular Surgery, Faculty of Medicine (for Girls), Al-Azhar University, Cairo, Egypt
| | - Sameh E. Elimam
- Department of Vascular Surgery, Faculty of Medicine (for Girls), Al-Azhar University, Cairo, Egypt
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Othman F, Anantha S, Ward GH, Paulus E, Romaguera R. A Rare Instance of Chronic Masson's Tumor Presenting in the External Auditory Meatus and Surgical Plan: A Case Report. Cureus 2023; 15:e50314. [PMID: 38205451 PMCID: PMC10777616 DOI: 10.7759/cureus.50314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/10/2023] [Indexed: 01/12/2024] Open
Abstract
Intravascular papillary endothelial hyperplasia (IPEH), or Masson's tumor, is a rare and benign proliferation of endothelial cells typically of vascular origin. Common locations of Masson's tumor include the head, neck, orbit, lip, pharynx, and mandible. It is typically seen in middle-aged adult life and females. Possible differential diagnoses include hemangioma, benign vascular formation, angiosarcoma, and neurofibromatosis. The exact pathophysiology of Masson's tumor is currently unknown. We present the case of a middle-aged 47-year-old male with a pure type of Masson's tumor presenting with pedunculated, malleable lesions across the posterior scalp and circumferential neck, on the pinna of the right ear, and within the right external auditory meatus. The lesions within the right external auditory meatus caused conductive hearing loss. The plan is a complete surgical excision without wide margins. The patient was referred to an ear, nose, and throat (ENT) surgeon due to the complicated location of the lesion within the external auditory meatus. This case serves as a differential diagnosis of conductive hearing loss complicated by Masson's tumor.
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Affiliation(s)
- Feras Othman
- General Surgery, University of Miami, Miami, USA
| | | | - Gavin H Ward
- School of Medicine, St. George's University School of Medicine, True Blue, GRD
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Anghileri E, Pollo B, Ferroli P, Aquino D, Demichelis G, Schiariti M, Ferrau F, Chiapparini L, Cuccarini V. Case report: Multiple brain intravascular papillary endothelial hyperplasia: incidence, diagnostic challenges, and management approach. Front Neurol 2023; 14:1115325. [PMID: 37153668 PMCID: PMC10157200 DOI: 10.3389/fneur.2023.1115325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Accepted: 03/17/2023] [Indexed: 05/10/2023] Open
Abstract
Multiple hemorrhagic brain lesions are mainly diagnosed based on clinico-radiological features integrated with histological data. Intravascular papillary endothelial hyperplasia (IPEH), or Masson's tumor, is a very rare entity, particularly when localized in the brain. In this study, we describe a case of multiple recurrent brain IPEHs and provide details on the diagnostic phase, therapeutic approaches, and related challenges. A 55-year-old woman presented with a relapsing neurological deficit. Brain magnetic resonance imaging (MRI) revealed a hemorrhagic right frontal-parietal lesion. When new neurological symptoms occurred, subsequent MRI scans detected more bleeding cerebral lesions. She underwent a series of single hemorrhagic lesion debulking. For any samples that underwent histopathological examination, the first results were not informative; the second and the third results revealed hemangioendothelioma (HE); and the fourth results led to the IPEH diagnosis. Interferon alpha (IFN-α) and subsequently sirolimus were prescribed. Both were well tolerated. Clinical and radiological features remained stable 43 months after starting sirolimus therapy and 132 months after the first diagnosis. To date, 45 cases of intracranial IPEH have been reported, mostly as single lesions without parenchymal location. They are usually treated by surgery and sometimes by radiotherapy upon recurrence. Our case is notable for two main reasons: because of the consecutive recurrent multifocal exclusively cerebral lesions and the therapeutic approach we used. Based on multifocal brain recurrence and good performance, we propose pharmacological therapy, including IFN-α and sirolimus, to stabilize IPEH.
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Affiliation(s)
- Elena Anghileri
- Neuroncology Unit, Fondazione Irccs Istituto Neurologico Carlo Besta, Milan, Italy
- *Correspondence: Elena Anghileri
| | - Bianca Pollo
- Neuropathological Unit, Fondazione Irccs Istituto Neurologico Carlo Besta, Milan, Italy
| | - Paolo Ferroli
- Neurosurgical Department, Fondazione Irccs Istituto Neurologico Carlo Besta, Milan, Italy
| | - Domenico Aquino
- Neuroradiological Unit, Fondazione Irccs Istituto Neurologico Carlo Besta, Milan, Italy
| | - Greta Demichelis
- Neuroradiological Unit, Fondazione Irccs Istituto Neurologico Carlo Besta, Milan, Italy
| | - Marco Schiariti
- Neurosurgical Department, Fondazione Irccs Istituto Neurologico Carlo Besta, Milan, Italy
| | | | - Luisa Chiapparini
- Radiodiagnostic Department, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Valeria Cuccarini
- Neuroradiological Unit, Fondazione Irccs Istituto Neurologico Carlo Besta, Milan, Italy
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Shah VJ, Sung K, Goodwill V, Huang BK, Abrams R. Intravascular papillary hemangioendothelioma disguised as a peripheral sheath tumor of median nerve at the wrist: a case report and literature review. Skeletal Radiol 2022. [PMID: 36513787 DOI: 10.1007/s00256-022-04250-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2022] [Revised: 11/23/2022] [Accepted: 12/02/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND Intravascular papillary hemangioendothelioma (IVPH) is a benign lesion previously reported in the nasal cavity, neck, upper extremities, and breast. Diagnosis with cross-sectional imaging can prove difficult, with histopathological examination necessary for diagnosis. IVPH resulting in carpal tunnel symptoms is quite rare. CASE PRESENTATION We report the case of a 37-year-old woman who presented with a radial, volar right wrist mass enlarging over the span of 5 years. She noted numbness and tingling in her wrist and thumb, exacerbated by minor accidental collisions and wrist hyperextension. There was no antecedent trauma. On examination, a mildly tender, mobile mass was evident at the volar aspect of the right wrist. Magnetic resonance imaging (MRI) with contrast demonstrated a lobulated, predominantly T2 hyperintense, heterogeneously enhancing mass thought to be a peripheral nerve sheath tumor. The patient elected for surgical excision of the mass, and the histopathological examination showed organizing thrombi with prominent papillary endothelial hyperplasia. At the 2-month follow-up, the patient had full range of motion of her fingers and wrist, with subjectively normal sensation in the distribution of the median nerve. CONCLUSION Carpal tunnel syndrome, in exceedingly rare occasions, can result from an IVPH. MRI findings may be confused with more common entities. Histopathological confirmation remains necessary for conclusive diagnosis.
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Manoranjan B, Mann JA, Joseph JT, Kelly JJ. Intraventricular Masson tumor: case report and systematic review of primary intracranial intravascular papillary endothelial hyperplasia. J Neurosurg Sci 2022; 66:420-424. [PMID: 34342194 DOI: 10.23736/s0390-5616.21.05372-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Intracranial Masson tumor (intravascular papillary endothelial hyperplasia, IPEH) is a benign lesion that is thought to originate from a reactionary process in response to compromised blood flow. IPEH may be classified into one of three subtypes based on etiology as it may result from the excessive proliferation of endothelial cells within a normal vessel (primary), vascular malformation (type II), or organized hematoma (type III). We report the case of a 79-year-old woman who presented with confusion, gait instability, and urinary incontinence. Neuroimaging revealed a hemorrhagic lesion within the right lateral ventricle, which was successfully resected. To our knowledge, this is the first reported case of an intraventricular IPEH and 33rd case of primary intracranial IPEH. We further performed a systematic review of the literature on all prior type I intracranial IPEH cases and discuss the importance of long-term follow-up in intracranial IPEH.
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Affiliation(s)
- Branavan Manoranjan
- Section of Neurosurgery, Department of Clinical Neurosciences, Foothills Medical Centre, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada -
| | - Jennifer A Mann
- Section of Neurosurgery, Department of Clinical Neurosciences, Foothills Medical Centre, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Jeffrey T Joseph
- Department of Pathology & Laboratory Medicine, Foothills Medical Centre, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - John J Kelly
- Section of Neurosurgery, Department of Clinical Neurosciences, Foothills Medical Centre, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
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Endo T, Katsuno H, Kikuchi K, Ochi T, Matsuo K, Suzuki K, Yasuoka H, Nakano Y, Nakagawa M, Kuroda M, Morise Z. Intravascular papillary endothelial hyperplasia in the cecum: a case report. Surg Case Rep 2022; 8:179. [PMID: 36155876 PMCID: PMC9510079 DOI: 10.1186/s40792-022-01512-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Accepted: 07/29/2022] [Indexed: 11/23/2022] Open
Abstract
Background Intravascular papillary endothelial hyperplasia (IPEH), also known as Masson's tumor, is a benign, non-neoplastic vascular lesion that is characterized by reactive proliferation of papillary endothelial cells associated with a thrombus. These lesions typically develop in the vascular regions of the head and neck, oral cavity, or extremities; however, other organ systems have been affected. IPEH in the gastrointestinal tract is rare, with only a few cases reported to date. Thus, the pathogenesis and clinical features of IPEH in the gastrointestinal tract are not entirely understood. Moreover, the local excision of certain subtypes of IPEH can be curative; this makes timely diagnosis essential. We present the case of a patient with IPEH in the cecum that was discovered while investigating the cause of severe anemia. Case presentation A 29-year-old woman visited a general practitioner (GP) with the complaint of abdominal pain. She was diagnosed with acute appendicitis and was prescribed antibiotics. After treatment, her abdominal pain disappeared. However, she was found to be severely anemic (hemoglobin level, 6.5 g/dl). To determine the cause of her anemia, the GP referred her to our hospital for further examination and treatment. Computed tomography scan revealed cecal wall thickening. Further, a lower gastrointestinal endoscopy revealed a 2-cm raised mass-like lesion in the cecum. This lesion was pathologically identified as an inflammatory granuloma. The cause of her anemia was determined to be bleeding from the lesion in the cecum. She underwent laparoscopic ileocecal resection. Histopathological examination of the surgical specimen revealed a spongy structure comprising many small papillary fibrous tissues lined by a typical monolayer endothelium. Further, immunohistochemical analysis showed that the cells of the endothelium monolayer expressed CD31, CD34. The Ki-67 labeling index was < 1%. Based on these findings, the lesion was identified as an IPEH in the cecum. The patient’s postoperative course was uneventful, and there was no evidence of recurrence during the 1.3 years of follow-up. Conclusions IPEH rarely arises within the abdominal cavity. Surgery remains the only treatment for IPEH and is associated with an excellent prognosis and a low recurrence rate. More aggressive lesions such as angiosarcoma should be excluded when considering the histologic diagnoses of IPEH, and expert pathologic review is vital. This is the first report of IPEH occurring in the cecum and represents a novel cause of gastrointestinal bleeding which the clinician should consider when evaluating a patient with atypical or difficult gastrointestinal bleeding sources.
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Ng HJH, Sio BR, Desai V, Chew KM, Rajaratnam V. Intravascular Papillary Endothelial Hyperplasia: Case Report of a Recurrent Masson's Tumor of the Finger and Review of Literature. J Hand Microsurg 2021; 13:164-168. [PMID: 34602798 DOI: 10.1055/s-0039-3401381] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
Intravascular papillary endothelial hyperplasia (IPEH), often referred to as Masson's Tumor, is an uncommon yet benign vascular disease of the skin and subcutaneous tissues. It usually arises within a blood vessel, but is considered to be a non-neoplastic reactive endothelial proliferation commonly associated with vascular injury. Although it is rare, knowledge of this disease is important as it may mimic other benign and malignant tumors, especially angiosarcoma, which may lead to unnecessary aggressive management. Typically, IPEHs are asymptomatic and are slow growing soft-tissue masses with extremely low-recurrence rates. In this article, we describe a 19-year-old male with a recurrence of Masson's Tumor over the right little finger within 2 months of a routine excision of the lesion. We also present accompanying multimodality clinical, radiological, and pathological imaging. This case illustrates the innocuous nature of the initial lesion easily mistaken for a hemangioma. Awareness of the possibility of a recurrence of a Masson's Tumor is important for clinicians to rule out the presence of malignant vascular lesions.
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Affiliation(s)
- Hannah Jia Hui Ng
- Department of Orthopaedic Surgery, Khoo Teck Puat Hospital, Singapore, Singapore
| | - Brenton Ruiqin Sio
- Department of Orthopaedic Surgery, Khoo Teck Puat Hospital, Singapore, Singapore
| | - Vijayadwaja Desai
- Department of Laboratory Medicine, Khoo Teck Puat Hospital, Singapore, Singapore
| | - Kian Ming Chew
- Department of Diagnostic Radiology, Khoo Teck Puat Hospital, Singapore, Singapore
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Rajagopal S. Intravascular papillary endothelial hyperplasia (Masson’s tumour) of the lower eyelid—a rare tumour of the orbital region. Eur J Plast Surg 2020; 43:843-846. [DOI: 10.1007/s00238-020-01634-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Nwokolo V, Veeramachaneni R, Rivas SD. Vulvar intravascular papillary endothelial hyperplasia or Masson's tumor: A case report. Case Rep Womens Health 2020; 28:e00250. [PMID: 32874931 PMCID: PMC7451632 DOI: 10.1016/j.crwh.2020.e00250] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Accepted: 08/12/2020] [Indexed: 11/04/2022] Open
Abstract
Masson's tumor, also known as intravascular papillary endothelial hyperplasia (IPEH), is a rare and benign vascular disease in which there is a reactive hyperplasia of intravascular endothelial cells. This tumor is most commonly found in soft tissues in the head, neck and upper extremities. We report a rare case of IPEH on the vulva. A Hispanic woman in her mid-thirties presented with a painful and pruritic left vulvar mass. On physical examination, a pedunculated mass was visualized on the left labia majora. Under pathologic examination, it was concluded the lesion was IPEH and it was surgically excised. This is a rare case of IPEH located on the vulva. However, despite this rarity, a simple local excision could be used to manage IPEH. Masson's tumor, also known as intravascular papillary endothelial hyperplasia (IPEH), is a rare and benign vascular disease. IPEH is most commonly found in soft tissues in the head, neck and upper extremities. The tumor is best treated with complete surgical resection.
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Affiliation(s)
- Vania Nwokolo
- University of Texas Rio Grande Valley School of Medicine, Edinburg, TX, United States of America
| | | | - Saul D Rivas
- University of Texas Rio Grande Valley School of Medicine, Edinburg, TX, United States of America.,Doctor's Hospital at Renaissance, Edinburg, TX, United States of America
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Huffman CA, Timoney PJ. Masquerading dacryocystitis. Oxf Med Case Reports 2020; 2019:504-506. [PMID: 31908822 PMCID: PMC6937449 DOI: 10.1093/omcr/omz120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Revised: 03/30/2019] [Accepted: 10/22/2019] [Indexed: 11/17/2022] Open
Abstract
Intravascular papillary endothelial hyperplasia (IPEH), otherwise known as Masson’s tumor, is a benign lesion of the skin with no known malignant transformations reported. It is considered a non-neoplastic lesion, as it is reactive to some vascular insult, usually a thrombus in a vein leading to vascular endothelial cell proliferation. Masson’s tumor typically presents as a slow-growing, indolent lesion commonly affecting the head, neck and arms with a female predominance. It comprises ~2% of all malignant and non-malignant vascular tumors of the skin and subcutaneous tissue. We are presenting the first case of Masson’s tumor of the right medial canthal subcutaneous tissue, masquerading as dacryocystitis.
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Affiliation(s)
- Clayton A Huffman
- University of Kentucky College of Medicine, Lexington, KY 40506, USA
| | - Peter J Timoney
- Director of Oculofacial Plastic and Orbital Surgery, University of Kentucky, Lexington, KY 40506, USA
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Sankey EW, Hynes JS, Komisarow JM, Maule J, Griffin AS, Dotters-Katz SK, Mitchell CJ, Friedman AH. Masson's tumor presenting as a left frontal intraparenchymal hemorrhage resulting in severe expressive aphasia during pregnancy: case report. J Neurosurg 2019:1-8. [PMID: 31675720 DOI: 10.3171/2019.8.jns191767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Accepted: 08/16/2019] [Indexed: 11/06/2022]
Abstract
Intravascular papillary endothelial hyperplasia (IPEH), commonly known as Masson's tumor, is a benign lesion that manifests as an excessive proliferation of endothelial cells within a vessel wall. IPEH is extremely rare in the brain, with only 36 intracranial cases previously described in the literature. It is commonly mistaken for more malignant pathologies, such as angiosarcoma. Careful histopathological examination is required for diagnosis, as no clinical or radiographic features are characteristic of this lesion. In this first published case of intracranial IPEH presenting during pregnancy, the authors describe a 32-year-old female with a left frontal intraparenchymal hemorrhage resulting in complete expressive aphasia at 28 weeks 6 days' gestation. An MRI scan obtained at a local hospital demonstrated an area of enhancement within the hemorrhage. The patient underwent a left frontoparietal craniotomy for hematoma evacuation and gross-total resection (GTR) of an underlying hemorrhagic mass at 29 weeks' gestation. This case illustrates the importance of multidisciplinary patient care and the feasibility of intervention in the early third trimester with subsequent term delivery. While GTR of IPEH is typically curative, the decision to proceed with surgical treatment of any intracranial lesion in pregnancy must balance maternal stability, gestational age, and suspected pathology.
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Affiliation(s)
| | | | | | | | - Andrew S Griffin
- 4Radiology, Duke University Medical Center, Durham, North Carolina
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Cooke P, Goldrich D, Iloreta AM, Salama A, Shrivastava R. Intravascular Papillary Endothelial Hyperplasia of the Maxillary Sinus in Patient with Tricuspid Atresia. Head Neck Pathol 2019; 14:803-807. [PMID: 31473939 PMCID: PMC7413958 DOI: 10.1007/s12105-019-01070-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Accepted: 08/20/2019] [Indexed: 11/25/2022]
Abstract
Intravascular papillary endothelial hyperplasia (IPEH) is a benign, highly vascularized, endothelial growth that can be mischaracterized as a malignancy. While hundreds of IPEH cases are reported, only four occurred in the maxillary sinus. We present the case of a 28-year-old male who underwent surgical resection of IPEH of the right maxillary sinus. An additional consideration was the patient's condition of univentricular tricuspid atresia which contributed to chronic hypoxemia and polycythemia. After complete resection from the maxillary sinus, post-operational workup determined the lesion to be IPEH. Given the potential for misdiagnosis of IPEH, careful histopathologic evaluation is required in order to avoid improper treatment.
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Affiliation(s)
- Peter Cooke
- Department of Otolaryngology- Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, NY USA
| | - David Goldrich
- Department of Otolaryngology- Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, NY USA
| | - Alfred Marc Iloreta
- Department of Otolaryngology- Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, NY USA
| | - Abeer Salama
- Department of Pathology, Icahn School of Medicine at Mount Sinai, New York, NY USA
| | - Raj Shrivastava
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY USA
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Tanaka M, Hiyama A, Sakai D, Katoh H, Sato M, Watanabe M. Intravascular Papillary Endothelial Hyperplasia (Masson's Tumor) Within Cauda Equina. J Am Acad Orthop Surg Glob Res Rev 2018; 2:e087. [PMID: 30656267 DOI: 10.5435/JAAOSGlobal-D-17-00087] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Objective: To describe a rare case of intravascular papillary endothelial hyperplasia (IPEH), also called as Masson's tumor, in a patient with the cauda equina syndrome presenting with low back pain and leg pain. Summary of Background Data: There are no studies that have reported a case of IPEH within the cauda equina. Methods: A 40-year-old man with no prior medical history presented with low back pain and leg pain beginning approximately 5 years ago and a month ago, respectively. MRI revealed a mass at the L2-L3 level that was isointense on T1-weighted images and hypointense with partial areas of high signal intensity on T2-weighted images. A myelogram demonstrated an intradural lesion without any respiratory fluctuation of tumor position, thereby suggesting a metastatic lesion; however, no abnormalities were found on a full-body CT scan or serum investigations for tumor markers. Therefore, surgery was performed on the lesion, within the cauda equina, for diagnosis as well as treatment. Results: Histopathological examination of the excised tumor indicated IPEH. The symptoms and quality of life improved postoperatively; there was no recurrence of the lesion. Conclusion: This is the first report of an IPEH intradural lesion within the cauda equina. Study Design: Case report
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Shrestha KK, Jha AK, Joshi RR, Rijal AS, Dhungana A, Maharjan S. Masson's Hemangioma of the Cheek: A Case Report. Indian J Otolaryngol Head Neck Surg 2018; 70:321-324. [PMID: 29977863 DOI: 10.1007/s12070-015-0886-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2015] [Accepted: 07/29/2015] [Indexed: 10/23/2022] Open
Abstract
We report a rare case of intravascular papillary endothelial hyperplasia (IPEH) of the cheek. This neoplasm, known as Masson's tumor, is an unusual vascular lesion of proliferating endothelial cells. It is usually confined to the lumen of preexisting vessels or vascular malformations. The principal significance of IPEH is its resemblance to a variety of benign and malignant diseases and possible misdiagnosis as such. Achieving a correct diagnosis is essential to avoid subjecting a patient to either unnecessarily aggressive or inadequate therapy. For this reason, awareness of this lesion is very important.
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Affiliation(s)
- K K Shrestha
- Department of Otolaryngology & Head and Neck Surgery, Nepal Medical College Teaching Hospital, P O Box 13344, Attarkhel, Jorpati, Kathmandu Nepal
| | - A K Jha
- Department of Otolaryngology & Head and Neck Surgery, Nepal Medical College Teaching Hospital, P O Box 13344, Attarkhel, Jorpati, Kathmandu Nepal
| | - R R Joshi
- Department of Otolaryngology & Head and Neck Surgery, Nepal Medical College Teaching Hospital, P O Box 13344, Attarkhel, Jorpati, Kathmandu Nepal
| | - A S Rijal
- Department of Otolaryngology & Head and Neck Surgery, Nepal Medical College Teaching Hospital, P O Box 13344, Attarkhel, Jorpati, Kathmandu Nepal
| | - A Dhungana
- Department of Otolaryngology & Head and Neck Surgery, Nepal Medical College Teaching Hospital, P O Box 13344, Attarkhel, Jorpati, Kathmandu Nepal
| | - S Maharjan
- Department of Otolaryngology & Head and Neck Surgery, Nepal Medical College Teaching Hospital, P O Box 13344, Attarkhel, Jorpati, Kathmandu Nepal
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Perez Prat G, Serrano Jimenez M, Cancela Caro P, Cardenas Ruiz-Valdepeñas E, Rivero Garvia M, Marquez Rivas FJ. Staged Management of Intracranial Masson Tumor: An Unexpected Gauntlet: Case Report and Review of the Literature. World Neurosurg 2018; 114:194-203. [PMID: 29550594 DOI: 10.1016/j.wneu.2018.03.054] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Revised: 03/04/2018] [Accepted: 03/06/2018] [Indexed: 12/11/2022]
Abstract
BACKGROUND Intravascular papillary endothelial hyperplasia (IPEH), also known as Masson tumor, is a benign lesion consisting of a reactive proliferation of endothelial cells with papillary formations related to thrombi. It has been reported in many different anatomic areas. Gross total resection is the elected treatment. Intracranial IPEH is rare, and only a few cases have been reported. This article reports a complicated case of cavernous sinus Masson tumor. CASE DESCRIPTION A 51-year-old woman presented because of hemicraneal headache, left facial paresthesia, and diplopia (due to a slight left ocular external rectum muscle paresis) that she had experienced the previous 60 days. She had previously received a diagnosis of neurofibromatosis type I. Contrast-enhanced magnetic resonance imaging showed a 3.5-cm contrast-enhanced tumor adjacent to the left cavernous sinus involving the Meckel cave that extended around the distal petrous portion of the left internal carotid artery. Two possibilities as a differential diagnosis were suggested: meningioma or neurogenic tumor. After a staged surgical procedure, the histopathologic findings were unexpected and showed IPEH (Masson tumor) as the cause of the mass. Despite having benign features, the IPEH showed recurrences over time, so adjuvant 3-dimensional conformal radiation therapy was initiated. CONCLUSIONS IPEH is prone to recurrences after subtotal resection. In the present case, successful surgical treatment and adjuvant radiotherapy showed an excellent outcome. To date, no adjuvant therapy has been established as a go-to option.
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Affiliation(s)
- Gustau Perez Prat
- Department of Neurosurgery, Hospital Universitari Vall d'Hebrón, Barcelona, Spain.
| | | | | | | | - Monica Rivero Garvia
- Department of Neurosurgery, Hospital Universitario Virgen del Rocío, Seville, Spain
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16
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Abstract
INTRODUCTION Intravascular papillary endothelial hyperplasia or Masson's tumor is a rare benign lesion of vascular origin characterized by abnormal proliferation of endothelial cells. CASE REPORT We present a case of this lesion involving the knee joint of a Caucasian woman who was referred to our institution for the evaluation of recurrent right knee pain. Her symptoms have started insidiously 5 years earlier following minor trauma. Recurrent symptomatic knee effusion was the cardinal symptom. Following the surgical excision of the lesion, recurrence occurred 2 years later. The tumor was successfully treated with embolization of its vascular supply. CONCLUSION Masson's tumor involving the synovium is an uncommon condition. The intermittent symptomatology and normal appearance of biopsies taken arthroscopically during asymptomatic periods can make the diagnosis challenging. Although resection is proposed to prevent recurrence, embolization of the vascular supply of the tumor can be a viable alternative.
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Affiliation(s)
| | - Asim Siddiqui
- Department of Trauma and Orthopaedic, Calderdale and Huddersfield NHS Trust, UK
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Salaud C, Loussouarn D, Buffenoir K, Riem T. Masson's tumor revealed by an intracerebral hematoma. Case report and a review of the literature. Neurochirurgie 2017; 63:327-9. [DOI: 10.1016/j.neuchi.2016.10.015] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2016] [Revised: 09/14/2016] [Accepted: 10/23/2016] [Indexed: 12/16/2022]
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Charalambous LT, Penumaka A, Komisarow JM, Hemmerich AC, Cummings TJ, Codd PJ, Friedman AH. Masson's tumor of the pineal region: case report. J Neurosurg 2017; 128:1725-1730. [PMID: 28777021 DOI: 10.3171/2017.2.jns162350] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Intracranial intravascular papillary endothelial hyperplasia (IPEH), also referred to as Masson's tumor, is a condition that rarely occurs in the nervous system. IPEH most frequently occurs extracranially in the skin of the face, skull, neck, and trunk and can easily be mistaken clinically, radiologically, and histologically for angiosarcoma, organizing hematoma, or other vascular malformations. IPEH accounts for roughly 2% of all vascular tumors and is extremely rare intracranially, with only 23 reported cases compared with more than 300 cases of IPEH occurring in the skin and subcutaneous tissue. To date, it has never been reported to occur in the pineal region. The authors report the case of a patient with an IPEH in the pineal region who underwent complex resection and experienced reversal of neurological symptoms.
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Bagga V, Kailaya-Vasan A, Wharton SB, Patel U. Intracerebral Masson's Tumor-Slow-Filling Vascular Lesion Demonstrated by Indocyanine Green Video Angiography. World Neurosurg 2017; 101:812.e15-812.e19. [PMID: 28347891 DOI: 10.1016/j.wneu.2017.03.075] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2017] [Accepted: 03/16/2017] [Indexed: 11/13/2022]
Abstract
BACKGROUND Intravascular papillary endothelial hyperplasia, or Masson's tumors, are benign vascular lesions that are rarely seen intracranially. The vascular characteristics of these lesions are also unknown. CASE DESCRIPTION We report the case of a 24-year-old male patient with a 3-year history of headache and dizziness. Neuroradiologic imaging showed a slow-growing lesion consistent with a low-grade glioma. Intraoperative appearance was of a vascular lesion that was slow filling as demonstrated with indocyanine green video angiography. Histologic analysis following resection revealed intravascular papillary endothelial hyperplasia (Masson's tumor). CONCLUSION Masson's tumors are slow-filling vascular lesions. The preoperative diagnosis of this lesion is difficult as it can mimic a neoplastic lesion. Conservative and surgical treatment options should therefore be carefully considered. Patients with subtotal resection must undergo long-term follow-up surveillance imaging as recurrence is a possibility.
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Affiliation(s)
- Veejay Bagga
- Department of Neurosurgery, Royal Hallamshire Hospital, Sheffield, United Kingdom.
| | - Ahilan Kailaya-Vasan
- Department of Neurosurgery, Royal Hallamshire Hospital, Sheffield, United Kingdom
| | - Stephen B Wharton
- Department of Histopathology, Royal Hallamshire Hospital, Sheffield, United Kingdom
| | - Umang Patel
- Department of Neurosurgery, Royal Hallamshire Hospital, Sheffield, United Kingdom
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Boukovalas S, Dillard R, Qiu S, Cole EL. Intravascular Papillary Endothelial Hyperplasia (Masson's Tumor): Diagnosis the Plastic Surgeon Should Be Aware of. Plast Reconstr Surg Glob Open 2017; 5:e1122. [PMID: 28203491 DOI: 10.1097/GOX.0000000000001122] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2016] [Accepted: 09/16/2016] [Indexed: 12/20/2022]
Abstract
Intravascular papillary endothelial hyperplasia (IPEH) or Masson's tumor is a rare benign entity commonly found on the head, neck, and upper extremities. It usually arises within a blood vessel but is considered to be a nonneoplastic reactive process often associated with vascular injury. Typically, IPEHs cause no symptoms and present as slowly growing soft-tissue masses. Given their prevalent location and indolent clinical presentation, the plastic surgeon should be familiar with this rare entity. We are presenting a case of IPEH of the forehead with unusual clinical and pathologic characteristics. Differential diagnosis, special considerations regarding preoperative work-up, and treatment options are discussed.
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Abstract
Masson tumor (MT, papillary endothelial hyperplasia) is an exaggerated form of thrombus reorganization rarely occurring in the central nervous system (CNS), where it presents as a mass or hemorrhage in parenchyma, meninges, or venous sinuses. MT is subclassified as type 1 arising within a histologically normal vessel, type 2 associated with a ruptured vascular malformation, and extravascular. Limited reports of CNS MT after radiosurgery, or especially external radiation therapy, have emerged. We searched our databases for cases reported from 2008 to present. Nine cases were identified, 6 of which were associated with receipt of therapeutic radiation for known lesions, with intervals of 1 to 25+ years to MT development (4 neoplasms=external beam radiation; 1 neoplasm=external beam radiation+radiosurgery, 1 arteriovenous malformation=radiosurgery). MTs were coassociated with radiation-induced vascular malformations (1 cavernoma-like, 1 massive) only in 2 of 6 irradiated patients, whereas the other 4 had MTs only. The 3 MTs in nonirradiated patients were extravascular, with 1 spontaneously developing in a hemangioblastoma. Seven of 9 MTs were intracerebral, 1 was within the spinal cord, and 1 was subdural. Papillary MT architecture was best appreciated by CD31 or CD34 immunohistochemistry, although ERG verified the endothelial monolayer population. Most CNS MTs at our institution have arisen in patients who have received therapeutic cranial radiation, many of whom received only external beam radiation. Although MTs could conceivably represent early, severe phases in radiation-induced cavernoma development, most were not found coassociated with the latter. This study further extends our knowledge of types of radiation-induced CNS vascular abnormalities.
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22
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Sim SY, Lim YC, Won KS, Cho KG. Thirteen-year follow-up of parasellar intravascular papillary endothelial hyperplasia successfully treated by surgical excision: case report. J Neurosurg Pediatr 2015; 15:384-91. [PMID: 25580513 DOI: 10.3171/2014.9.peds13518] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Intracranial intravascular papillary endothelial hyperplasia (IPEH) is very rare, and to our knowledge long-term follow-up results have not been previously published. An 11-year-old boy presented with a 6-month history of progressive visual impairment in the right eye. Magnetic resonance imaging revealed a well-enhanced, large parasellar mass involving the cavernous sinus, right frontal skull base, and ethmoid and sphenoid sinuses. Frontotemporal craniotomy and subtotal resection were performed, and the diagnosis of IPEH was confirmed. The mass increased in size during the following 3 months. A second operation was performed via frontotemporal craniotomy combined with a transsphenoidal approach, and gross-total resection of the tumor was achieved. Adjuvant radiotherapy (5040 cGy) and chemotherapy with interferon were administered. The patient's visual symptoms improved, and there was no recurrence during a 13-year follow-up period. The results of this case indicate that intracranial IPEH can recur with subtotal resection; however, optimal resection with multimodal adjuvant treatment can control the disease for many years, if not permanently.
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Affiliation(s)
- Sook Young Sim
- Department of Neurosurgery, Inje University Seoul Paik Hospital, Seoul
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23
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Kwon JN, Han WC. Intravascular papillary endothelial hyperplasia as an aneurysm of the brachial artery. Ann Vasc Surg 2015; 29:837.e17-20. [PMID: 25637575 DOI: 10.1016/j.avsg.2014.10.045] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2014] [Revised: 10/29/2014] [Accepted: 10/31/2014] [Indexed: 11/21/2022]
Abstract
Intravascular papillary endothelial hyperplasia (IPEH) is a benign lesion of vascular origin characterized by excessive proliferation of endothelial cells in normal blood vessels or aneurysms. A 51-year-old woman presented with a hard pulsatile mass in the left antecubital fossa. Duplex scan imaging revealed a brachial artery aneurysm with intramural thrombus. At surgery, the aneurysm was resected, and the brachio-radio-ulnar artery was bypassed with a saphenous vein graft. Histopathologic examination revealed papillary endothelial hyperplasia with features of epithelioid hemangioma. We present the first reported case of IPEH associated with a brachial artery aneurysm.
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Abstract
Intravascular papillary endothelial hyperplasia (IPEH) (Masson's tumor) is an unusual benign vascular lesion of the skin and subcutaneous tissue, consisting of papillary formations related to a thrombus and covered by a single layer of plump endothelial cells. The lesion is often mistaken with angiosarcoma and a group of other benign and malignant vascular lesions. The clinical and radiological findings are not specific, and the diagnosis is based on the histological examination. Intracranial lesions are extremely rare with only 32 cases been reported in the literature. Only two cases of IPEH presenting as scalp swelling have been reported in the literature. We report a case of a 3-month-old boy with IPEH of scalp in the left parietal region, which was involving the skull bone and extending intracranially.
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Affiliation(s)
- Harshil C Shah
- Department of Neurosurgery, B. J. Medical College and Civil Hospital, Ahmedabad, Gujarat, India
| | - Divik H Mittal
- Department of Neurosurgery, B. J. Medical College and Civil Hospital, Ahmedabad, Gujarat, India
| | - Jaimin K Shah
- Department of Neurosurgery, B. J. Medical College and Civil Hospital, Ahmedabad, Gujarat, India
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25
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Yu FJ, Zheng JJ, Dong PH, Fan XM. Long non-coding RNAs and hepatocellular carcinoma. Mol Clin Oncol 2015; 3:13-7. [PMID: 25469263 DOI: 10.3892/mco.2014.429] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2014] [Accepted: 09/13/2014] [Indexed: 02/06/2023] Open
Abstract
Recent advances in next-generation sequencing technology in transcriptome analysis have helped identify numerous non-coding RNAs. The long non-coding RNA (lncRNA) is commonly defined as an RNA molecule with a length of 200 bp-100 kbp that lacks protein-coding potential. LncRNAs play a critical role in the regulation of gene expression, including chromatin modification, transcription and post-transcriptional processing. It has been confirmed that dysregulation of lncRNAs is associated with a number of human diseases, particularly tumors. In this study, we focused on the most extensively investigated lncRNAs in hepatocellular carcinoma (HCC). The biological functions and molecular mechanisms of the majority of lncRNAs have yet to be investigated. The improved knowledge on lncRNAs in HCC may help identify lncRNAs that may be used as novel prognostic markers and therapeutic targets.
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26
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Ginat DT, Walcott BP, Mordes D, Schaefer PW, Nahed B. Intracranial organizing hematoma with papillary endothelial hyperplasia features after resection and involved field radiotherapy for cerebellar juvenile pilocytic astrocytoma. Clin Imaging 2014; 38:322-5. [DOI: 10.1016/j.clinimag.2013.12.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2013] [Revised: 12/07/2013] [Accepted: 12/13/2013] [Indexed: 11/20/2022]
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27
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Tedla M, Bežová M, Biró C, Tedlová E, Eng CY, Zeleník K. Intravascular papillary endothelial hyperplasia of larynx: case report and literature review of all head and neck cases. Otolaryngol Pol 2014; 68:200-3. [PMID: 24981303 DOI: 10.1016/j.otpol.2014.03.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2014] [Accepted: 03/27/2014] [Indexed: 11/24/2022]
Abstract
Intravascular papillary endothelial hyperplasia (IPEH) is a benign lesion of a vascular origin that is caused by excessive proliferation of endothelial cells in blood vessels or vascular malformations. It is a rare entity that can present in any region of the body, but with particular predilection to the head and neck region and the extremities. We also present the results of the English literature search, which to our knowledge are all the published cases of IPEH in the head and neck region (No=213). IPEH has not been reported to arise from the glottic region previously. We present a first case of IPEH arising from the vocal fold of a 48-year-old male. Histological differential diagnosis of IPEH includes several entities, most importantly angiosarcoma. Presentation and histology are discussed. The main treatment option is a complete surgical resection. Prognosis of IPEH is excellent, with the exception of some intracranial cases.
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28
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Lee SK, Jung TY, Baek HJ, Kim SK. Destructive radiologic development of intravascular papillary endothelial hyperplasia on skull bone. J Korean Neurosurg Soc 2012; 52:48-51. [PMID: 22993678 PMCID: PMC3440503 DOI: 10.3340/jkns.2012.52.1.48] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2012] [Revised: 05/19/2012] [Accepted: 06/18/2012] [Indexed: 02/08/2023] Open
Abstract
Intravascular papillary endothelial hyperplasia (IPEH) is a rare vascular benign lesion that rarely involves the central nervous system with or without skull invasion. We report a rare case of IPEH on the skull bone, which displayed destructive radiologic development associated with hemorrhage. A 14-year-old male presented with an incidentally detected a small enhancing, left frontal osteolytic lesion. Previously, he underwent operation and received adjuvant chemoradiation therapy for cerebellar medulloblastoma. Follow-up magnetic resonance imaging revealed a left frontal bone lesion, which expanded to an approximately 2 cm-sized well-circumscribed osteolytic lesion associated with hemorrhage for 20 months. Frontal craniectomy and cranioplasty were performed. Destructive change was detected on the inner table and diploic space of the skull. The mass had a cystic feature with hemorrhagic content without dural attachment. Pathologic examination showed the capsule consisted of parallel collagen lamellae representing a vascular wall, vascular lumen, which was pathognomonic for IPEH. Immunohistochemical staining revealed that the capsule was positive for CD34 and factor VIII, which favor the final diagnosis of IPEH. This was the first case of intracalvarial IPEH.
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Affiliation(s)
- Seul-Kee Lee
- Department of Neurosurgery, Chonnam National University Research Institute of Medical Sciences, Chonnam National University Hwasun Hospital and Medical School, Gwangju, Korea
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29
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Park KK, Won YS, Yang JY, Choi CS, Han KY. Intravascular Papillary Endothelial Hyperplasia (Masson tumor) of the Skull : Case Report and Literature Review. J Korean Neurosurg Soc 2012; 52:52-4. [PMID: 22993679 PMCID: PMC3440504 DOI: 10.3340/jkns.2012.52.1.52] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2011] [Revised: 04/30/2012] [Accepted: 07/19/2012] [Indexed: 11/27/2022] Open
Abstract
A 10-year-old female patient presented with a rapidly growing nodular mass lesion on her right frontal area. On skull radiography and computed tomography (CT) imaging, this mass had a well-demarcated punch-out lesion with a transdiploic, exophytic soft tissue mass nodule on the frontal scalp. Magnetic resonance (MR) imaging revealed the presence of a 1.5×1.2×1 cm sized calvarial lesion. This lesion was hypointense on T1 and heterogenous hyperintense on T2 weighted MR images, and exhibited heterogeneous enhancement of the soft tissue filling the punch-out lesion after intravenous administration of gadolinium. En block removal of the tumor with resection of the rim of the normal bone was performed. The pathological diagnosis was intravascular papillary endothelial hyperplasia (IPEH). After surgery, no recurrence was found for 8 months. IPEH is a rare and benign reactive lesion usually found in thrombosed subcutaneous blood vessels. Involvement of skull bone is rare. In this article, we present a case of IPEH involving the calvarium, in a 10-year-old woman.
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Affiliation(s)
- Keuk Kyu Park
- Department of Neurosurgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
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30
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Shih CS, Burgett R, Bonnin J, Boaz J, Ho CY. Intracranial Masson tumor: case report and literature review. J Neurooncol 2012; 108:211-7. [PMID: 22278666 DOI: 10.1007/s11060-012-0799-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2011] [Accepted: 01/09/2012] [Indexed: 12/30/2022]
Abstract
Intravascular papillary endothelial hyperplasia (IPEH) or Masson tumor has only been reported intracranially in 20 cases and can present as a congenital finding. This pathologic entity is an important diagnostic consideration when evaluating an infant with a congenital intracranial mass. We report a third case of a neonate who presented with the appearance of a metastatic brain tumor involving the orbit, sella, and cerebellum that was ultimately proven to be IPEH. A thorough literature review of IPEH is presented and we discuss this clinical entity and its management.
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Affiliation(s)
- Chie-Schin Shih
- Section of Pediatric Hematology/Oncology, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN 46202, USA.
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Verbist BM. Imaging of sensorineural hearing loss: a pattern-based approach to diseases of the inner ear and cerebellopontine angle. Insights Imaging 2012; 3:139-53. [PMID: 22696040 DOI: 10.1007/s13244-011-0134-z] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2011] [Revised: 09/27/2011] [Accepted: 10/11/2011] [Indexed: 11/30/2022] Open
Abstract
An overview is presented of the common and uncommon diseases of the inner ear and of the cochleovestibular nerve within the internal acoustic meatus and cerebellopontine angle cistern causing sensorineural deafness. An imaging-pattern-based approach is used to help detect disease and narrow the differential diagnosis. Main Messages • The most common soft tissue mass lesions in the cerebellopontine angle are schwannoma and meningioma. • Contrast-enhanced MRI may reveal clinically unsuspected inflammatory, auto-immune or tumoural disease. • Hearing loss may be caused by infection, inflammation or, rarely, perineural tumour spread along the cochleovestibular nerve. • Labyrinthitis may lead to rapidly progressive ossification of the labyrinth.
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Karamchandani J, Vogel H, Fischbein N, Gibbs I, Edwards MS, Griffith H. Extravascular Papillary Endothelial Hyperplasia Mimicking Neoplasm After Radiosurgery. Neurosurgery 2011; 70:E1043-8; discussion E1048. [DOI: 10.1227/neu.0b013e31822e81f9] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Abstract
BACKGROUND AND IMPORTANCE:
Papillary endothelial hyperplasia (PEH) is a rare form of exuberant reactive endothelial proliferation that can mimic neoplasm. We report the largest series of patients with histologically confirmed intracranial extravascular PEH developing in the field of previous treatment with stereotactic radiosurgery.
CLINICAL PRESENTATION:
We collected the clinical, radiological, surgical, and pathological findings from 4 patients in whom intracranial extravascular PEH developed after treatment with stereotactic radiosurgery. In all patients, the development of an enlarging hemorrhagic mass lesion at the site of previous radiotherapy on magnetic resonance imaging was radiographically suspicious for neoplasm and prompted biopsy or resection. All 4 patients elected to undergo biopsy or surgical resection. Histological examination of the biopsy and resection specimens in all patients demonstrated the classic features of PEH.
CONCLUSION:
The interval to the development of PEH ranged from 5 months to 6 years, 10 months. Clinical follow-up was available for 3 of the 4 patients. None of these 3 patients have demonstrated evidence of recurrence during a mean follow-up period of 22 months (range, 15–30 months). These patients share common radiological features, potentially allowing preoperative diagnosis and improved guidance of clinical management. These cases suggest a link between radiosurgery and the development of PEH. These findings also suggest that PEH should be considered in the differential diagnosis for patients treated with radiosurgery in whom a hemorrhagic mass lesion subsequently develops at or near the site of previous treatment. We think that complete surgical excision is the best treatment for intracranial PEH.
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Affiliation(s)
- Jason Karamchandani
- Department of Pathology, Stanford University Medical Center, Palo Alto, California
| | - Hannes Vogel
- Department of Pathology, Stanford University Medical Center, Palo Alto, California
| | - Nancy Fischbein
- Department of Radiology, Stanford University Medical Center, Palo Alto, California
| | - Iris Gibbs
- Department of Radiation Oncology, Stanford University Medical Center, Palo Alto, California
| | - Michael S.B. Edwards
- Department of Neurosurgery, Division of Pediatric Neurosurgery, Lucile Packard Children's Hospital, Stanford University, Palo Alto, California
| | - Harsh Griffith
- Department of Neurosurgery, Stanford University Medical Center, Palo Alto, California
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Moriyama S, Kunitomo R, Sakaguchi H, Okamoto K, Sasa T, Tanaka M, Kawasuji M. Intravascular papillary endothelial hyperplasia in an aneurysm of the superficial temporal artery: Report of a case. Surg Today 2011; 41:1450-4. [DOI: 10.1007/s00595-010-4499-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2010] [Accepted: 10/26/2010] [Indexed: 11/24/2022]
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Ong SS, Bruner J, Schellingerhout D, Puduvalli VK. Papillary endothelial hyperplasia presenting as recurrent malignant glioma. J Neurooncol 2010; 102:491-8. [PMID: 20740304 DOI: 10.1007/s11060-010-0338-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2010] [Accepted: 07/27/2010] [Indexed: 11/24/2022]
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.
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Affiliation(s)
- Shirley S Ong
- Department of Neuro-oncology, University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 431, Houston, TX 77030, USA
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35
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Shah AK, Grant I. Intravascular papillary endothelial hyperplasia (Masson's tumour) causing a soft-tissue mass in the upper limb. ACTA ACUST UNITED AC 2010; 15:31-3. [PMID: 20422724 DOI: 10.1142/s0218810410004540] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2008] [Revised: 12/18/2009] [Accepted: 01/15/2010] [Indexed: 11/18/2022]
Abstract
Masson's tumour (intravascular papillary endothelial hyperplasia) is a benign vascular tumour, which can present in a similar manner to a soft-tissue sarcoma. Rapid differentiation between these two differing pathologies is the most important part of the initial management of this problem. We report a case of Masson's tumour presenting in a 32-year-old woman as a painful lump around her elbow.
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Affiliation(s)
- Amit K Shah
- Department of Plastic Surgery, Cambridge University NHS Trust, Box 186, Addenbrooke's Hospital, Hills Road, Cambridge CB2 2QQ, UK
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Velázquez CJ, Font JI, Torres F, Araji O, Barquero JM. Masson Tumor as Humeral Artery Aneurysm. Ann Vasc Surg 2008; 22:127-9. [DOI: 10.1016/j.avsg.2007.07.024] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2006] [Revised: 05/22/2007] [Accepted: 07/15/2007] [Indexed: 11/15/2022]
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Abstract
We describe a pediatric case of primary angiosarcoma of the brain displaying striking intravascular papillary pattern, consistent with the "Dabska tumor," often in continuity with a massive, multifocal intravascular papillary endothelial hyperplasia. The tumor contained small hemangioma and obliterated dysplastic arteries as well as very large thin-walled veins. The surrounding brain tissue showed scattered telangiectasias, conglomerates of calcified dysplastic arteries, old hemorrhages and gliosis. Colocalization of these lesions suggests the development of a papillary angiosarcoma in the pre-existing vascular malformation. Although never reported, the possibility of a malignant transformation of endothelial papillary hyperplasia also should be considered in this case.
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Affiliation(s)
- Boleslaw Lach
- Department of Pathology and Laboratory Medicine, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia.
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Abstract
We report a case of intracranial papillary endothelial hyperplasia (PEH) with subsequent haemorrhage and the possible pathogenesis of bleeding. PEH is a slow growing tumour and for rapid enlargement the process of haemorrhage may be necessary.
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Affiliation(s)
- Tae-Young Jung
- Department of Neurosurgery, Chonnam National University Hwasun Hospital, Chonnam Medical School, Gwangju, Republic of Korea
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Ohshima T, Ogura K, Nakayashiki N, Tachibana E. Intravascular papillary endothelial hyperplasia at the superior orbital fissure: report of a case successfully treated with gamma knife radiosurgery. ACTA ACUST UNITED AC 2005; 64:266-9; discussion 269. [PMID: 16099263 DOI: 10.1016/j.surneu.2004.11.035] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2004] [Accepted: 11/27/2004] [Indexed: 02/07/2023]
Abstract
BACKGROUND An intracranial lesion of intravascular papillary endothelial hyperplasia (IPEH) is extremely rare and often difficult to resect completely. We describe a case in which a lesion at the superior orbital fissure was successfully treated by postoperative radiosurgery. CASE DESCRIPTION A 41-year-old woman presented with progressive left abducens nerve paresis and left facial sensory disturbance over a 1-year period. Radiological examination demonstrated a left middle fossa tumor involved in the cavernous sinus. About a half removal of the tumor was performed. The pathological diagnosis was IPEH. The residual tumor was treated with gamma knife radiosurgery. CONCLUSION Gamma knife radiosurgery was effective to reduce the residual tumor in the present case. During a follow-up period of 2 years, the lesion has not recurred. This report suggests that additional gamma knife radiosurgery after incomplete resection of the lesion could be an alternative therapeutic modality.
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Affiliation(s)
- Tomotaka Ohshima
- Department of Neurosurgery, Kamo Hospital, Toyota 471-0024, Japan
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Zhang R, Zhou LF, Mao Y, Wang Y. Papillary endothelial hyperplasia (Masson tumor) of the petrous and jugulare region: case report and literature review. ACTA ACUST UNITED AC 2005; 64:55-60; discussion 60. [PMID: 15993184 DOI: 10.1016/j.surneu.2004.08.091] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2004] [Accepted: 08/20/2004] [Indexed: 10/25/2022]
Abstract
OBJECTIVE Intracranial papillary endothelial hyperplasia (PEH) is rare, and only 13 cases have been reported intracranially in the literature. In this article, we present a case of PEH involving petrous and jugular foramen region due to the uncommon incidence. CASE DESCRIPTION A 49-year-old female patient with a 4-year history of left-sided hearing loss and facial palsy. Magnetic resonance (MR) imaging disclosed the presence of a 6 x 6 x 5 cm lobular mass occupying the left petrous and jugulare region. This mass was hyperintense on both T1 and T2 weighted MR images and was enhanced strongly with gadolinium. No edema was found around the lesion. Preoperative digital subtraction angiogram examination showed that the lesion had a rich blood supply. Therefore, polyvinyl alcohol embolization was carried out to reduce bleeding during operation. A left-sided suboccipital extreme lateral approach was applied for craniotomy. The lesion was extradural and highly vascular with extension into the petrous bone. It was subtotally removed. Postoperative course of the patient was stable. Her neurologic evaluation was the same as preoperatively. CONCLUSION Surgical excision of the lesion is the main therapy. Radiotherapy should be given to patients whose lesion cannot be totally removed.
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Affiliation(s)
- Rong Zhang
- Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fu Dan University, Shanghai 200040, China.
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42
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Affiliation(s)
- Vivek R Deshmukh
- Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, 350 West Thomas Road, Phoenix, AZ 85013, USA
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Abstract
A 60-year-old housewife presented with a painful and slowly enlarging swelling in the left wrist for 3 months. Plain X-ray showed mild soft tissue swelling and ultrasonography tenosynovitis of the flexor tendons. Exploration revealed a vascular growth involving the synovium of the flexor tendon sheath of the left little finger. Synovectomy and excision of the entire growth led to the diagnosis of synovial haemangioma with areas of recent haemorrhage and florid papillary endothelial hyperplasia. The recent haemorrhage corresponded to the sudden increase in size, while the papillary endothelial hyperplasia accounted for the persistence and gradual enlargement of the lesion. The patient made an uneventful recovery and remained well more than 2 1/2 years after the operation.
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Affiliation(s)
- Louis T C Chow
- Department of Anatomical and Cellular Pathology, Prince of Wales Hospital, Shatin, Hong Kong.
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44
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Cagli S, Oktar N, Dalbasti T, Işlekel S, Demirtaş E, Ozdamar N. Intravascular Papillary Endothelial Hyperplasia of the Central Nervous System-Four Case Reports-. Neurol Med Chir (Tokyo) 2004; 44:302-10. [PMID: 15253546 DOI: 10.2176/nmc.44.302] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Four rare cases of intracranial intravascular papillary endothelial hyperplasia (IPEH) manifesting as cranial nerve disturbances occurred in 16-, 18-, 24-, and 28-year-old females. Magnetic resonance imaging showed all lesions as isointense with strong enhancement on T1-weighted images, and as hyperintense on T2-weighted images. All lesions were removed via craniotomies. Histological examination found vascular structures and papillary spaces lined with endothelial cells showing immunoreactivity for CD31. Complete removal was curative in two cases, whereas incomplete removal resulted in cure in one case and residual deficits in one case. Iatrogenic deficits should be avoided in IPEH treatment by surgery. Differentiation from neoplasm such as angiosarcoma depends on histological characteristics.
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Affiliation(s)
- Sedat Cagli
- Department of Neurosurgery, Ege University, Faculty of Medicine, Bornova, Izmir, Turkey.
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45
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Abstract
Masson's vegetant intravascular hemangioendothelioma has only been reported intracranially in 12 patients. The pathological diagnosis is important given its benign natural history. We report the 13th case in a woman who presented with headaches and dysphasia. A thorough literature review is presented and an appropriate management strategy is proposed.
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Affiliation(s)
- Michael R Stoffman
- Department of Neurosurgery, Yale School of Medicine, New Haven, CT, USA.
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46
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Lesley WS, Kupsky WJ, Guthikonda M. Intravascular papillary endothelial hyperplasia arising within a posteroinferior cerebellar artery aneurysm: case report and review of the literature. Neurosurgery 2000; 47:961-5; discussion 966. [PMID: 11014437 DOI: 10.1097/00006123-200010000-00033] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
OBJECTIVE AND IMPORTANCE Intravascular papillary endothelial hyperplasia (IPEH) is an atypical proliferation of endothelium that results in abnormal organization for thrombus formation. Intracranial IPEH is a rare entity and has not been reported to arise from within an intracranial aneurysm. Furthermore, the elapsed time during which acquired intracranial IPEH develops has not been previously documented. CLINICAL PRESENTATION In this case report, a patient with facial and neck pain was noted to have an enhancing mass lesion lateral to the medulla in magnetic resonance imaging scans. Angiography revealed a vascular mass adjacent to the posteroinferior cerebellar artery. Normal magnetic resonance imaging and magnetic resonance angiographic findings had been obtained for the patient 29 months earlier. INTERVENTION During surgery, a thrombosed, 2.5-cm, posteroinferior cerebellar artery aneurysm was resected and noted to contain florid IPEH. There has been no evidence of recurrence in 1 year of follow-up monitoring. A literature search revealed 13 cases of intracranial IPEH, in which recurrence was observed for incompletely resected lesions. CONCLUSION IPEH can develop in a relatively short time, can present as a hypervascular mass lesion or within an intracranial aneurysm, and should be completely resected to prevent recurrence.
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Affiliation(s)
- W S Lesley
- Department of Radiology, Harper Hospital/Detroit Medical Center and Wayne State University, Michigan, USA.
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