engleski

Meningeal hemangiopericytoma - radiological and clinopathological report of ten cases

Aim of the study: Meningeal hemangiopericytoma is an uncommon aggressive tumour with a propensity for both local recurrence and extraneural metastases. Roentgenographic observations, clinicopathological findings and therapy of our 10 patients were analysed. Methods used: Between 1988 and 1998 ten patients with pathohistologically confirmed diagnosis of meningeal hemangiopericytoma were under treatment in our institution. Five tumours occurred in men and five in women with median age of 29 yr. (range 4 - 69 yr.). CT scans were performed in all cases, angiography in 4, MRI in 3 and scintigraphy on 1 patient. All patients underwent surgery ; seven received postoperative radiotherapy and only one chemotherapy. Because of the recurrence 4 patients were reoperated. 2 patients had intracranial, 1 intra - and extracranial metastases. To obtain pathohistological diagnosis hemalaun-eozin, Mallory, Gomori and immunohistochemical methods were used. Results obtained: The average time of symptom manifestation (signs of high intracranial pressure and focal neurological signs) was 6 months and they were related to the tumour location. CT and MRI scanning gave no preoperative distinction between meningeal hemangiopericytoma and meningeoma. Angiograms showed a more specific picture but not sufficiently typical. Tumours were 2, 5-6 cm in greatest dimension with moderate perifocal oedema. None had hyperostosis or calcification. Six tumours were supratentorial (2 with bone erosion), 2 in the posterior fossa and 2 in the lumbar spine (1 with erosion arcus and processus spinosus). All 10 unenhanced CT scans showed hyperdense tumours - 7 were heterogenous, 3 homogenous ; contrast enhanced CT scans showed enhancement. Pathohistological features of tumours agreed with common morphological patterns of hemangiopericytoma. The number of mitosis varies and is a helpful prognostic criterion. Immunohistochemically tumours were vimentin and partly S-100 protein positive. Three patients died. Conclusions: Radiological findings (CT, MRI, angiography) of the meningeal hemangiopericytoma are characteristic but not sufficiently typical to permit an unequivocal diagnosis. Unlike in meningeomas, hyperostosis and intratumoral calcification are not present while bone erosion and necrosis are often. The diagnosis must be histologically and immunohistochemically confirmed. Radical surgical management with radiotherapy was crucial in treatment. Chemotherapy was efficient in one our patients during eight years.

meningeal hemangiopericytoma

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