Intraspinal Dissemination and Local Recurrence of an Intracranial Hemangiopericytoma

Heather N. Hayenga, Andrew J. Bishop, Zabihullah Wardak, Chandra Sen, Bruce E Mickey

Research output: Contribution to journalArticle

1 Scopus citations

Abstract

Background: Hemangiopericytomas (HPCs) are rare vascular tumors that resemble meningiomas on imaging and have a high rate of local recurrence and metastases. There remains a paucity of data to guide management decisions of intraspinal dissemination of HPCs in the literature, and none specifically related to anaplastic HPCs. Case Description: We report a case of a 34-year-old woman with locally and distantly recurrent anaplastic HPC (World Health Organization grade III). She initially presented with tinnitus in her right ear. A well-circumscribed, contrast-enhancing lesion was identified in the right cerebellopontine angle. Treatment consisted of subtotal resection and postoperative radiation therapy (RT) to a dose of 60 Gy in 30 fractions. After a 3-year disease-free interval, 7 lesions recurred intra- and extracranially. The extracranial lesions were drop metastases of the original HPC through the cerebrospinal fluid into the spinal canal. Of note, fluorodeoxyglucose positron emission tomography (PET)/computed tomography scan was not sensitive enough to detect these new lesions. The intracranial recurrence was on the edge of the prior radiotherapy field, representing a marginal failure having received less than 50 Gy. The intracranial recurrences were treated with salvage gamma knife stereotactic radiosurgery (SRS) with local control. She underwent intradural extramedullary hemilaminectomy of a thoracic spine metastasis followed by fractionated proton beam therapy (PBT) with a boost to unresected lesions. Within a few months of PBT, she became pregnant. Pregnancy did not affect recurrence or ameliorate tumor growth. Conclusions: This case report discusses the role genetics, adjuvant RT, SRS, magnetic resonance imaging, and PET scan played in this unique clinical scenario of anaplastic HPC.

Original languageEnglish (US)
Pages (from-to)68-75
Number of pages8
JournalWorld Neurosurgery
Volume123
DOIs
StatePublished - Mar 1 2019

Keywords

  • Brain
  • Hemangiopericytoma
  • Intradural
  • Metastasis
  • Solitary fibrous tumor
  • Spine

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

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