REVIEW

Hemangiopericitoma Meníngeo: relato de caso e revisão da literatura

Meningeal Hemangiopericytoma: case report and literature review

  • Isadora Oliveira Nanni (1)
  • Carlos Alexandre Martins Zicarelli (2)
  • João Vitor Guedes Suzze (3)
  • Gabrielli Algazal Marin (3)
  • Mariana Ramos do Nascimento (3)
  • Maria Letícia Nogueira (3)
  • Victor Guilherme Batistela Pereira (4)
  • Franciele Fazoli (4)
  • José Angelo Favoreto Guarnieri (4)
  Views: 284
  Downloads: 28

Resumo

Introdução: Os hemangiopericitomas (HPCs) do Sistema Nervoso Central (SNC) foram descritos primeiramente em 1942 por Stout e Murray como tumores mesenquimais meníngeos que se originam dos pericitos de Zimmermann, ao redor do revestimento endotelial em capilares e vênulas. Metodologia: Os autores apresentam um caso de paciente portador de um hemangiopericitoma meníngeo, operado no Hospital Evangélico de Londrina. Em adendo, foi feita uma revisão da literatura nas bases de dados PubMed, Medline e CAPES, com as palavras-chave: “hemangiopericytoma”; “meningioma”; “Brain Neoplasms”, no intervalo dos últimos seis anos. Foram encontrados 118 artigos, e desses, 47 foram selecionados. Resultados: O HPC possui comportamento agressivo com alto risco de recidiva e metástase. Ressonância magnética não convencional pode ajudar na diferenciação desses tumores como meningioma, sendo os diagnósticos histológico e imuno-histoquímico conclusivos. É recomendada pré-embolização na maioria dos casos, com radioterapia adjuvante para impedir a recidiva do tumor. Discussão: A cirurgia é recomendada em todos os casos com ressecção total da lesão. Ela geralmente é acompanhada por radioterapia adjuvante, na diminuição de recorrência. Conclusão: O diagnóstico é exclusivo por patologia, sendo suscetível a erros. O acompanhamento por anos pós- cirurgia é necessário. A literatura disponível é basicamente composta por relatos de casos, por falta de estudos de acordo com sua raridade.

Palavras-chave

Hemangiopericitoma; Meningioma; Neoplasias cerebrais

Abstract

Introduction: Central Nervous System (CNS) hemangiopericytomas (HPCs) were first described in 1942 by Stout and Murray as meningeal mesenchymal tumors that originate from Zimmermann’s pericytes surrounding the endothelial lining in capillaries and venules. Methodology: The authors present a case of a patient with a meningeal hemangiopericytoma, operated on at the Evangelic Hospital of Londrina. Further, we performed a literature review in the PubMed, Medline, and CAPES databases with the keywords: “hemangiopericytoma”; “meningioma”; “Brain Neoplasms”. A total of 118 papers was found with 47 articles selected, and 71 were excluded. Results: HPC has aggressive behavior with a high risk of recurrence and metastasis. Unconventional MRI can help in differentiating these tumors from meningioma, with a histological and immunohistochemical diagnosis being conclusive. Pre-embolization is recommended in most cases with adjuvant radiotherapy to prevent tumor recurrence. Discussion: Surgery is recommended in all cases with total resection of the lesion. It is usually followed by adjuvant radiotherapy for best results in reducing recurrence and metastasis. Conclusion: Diagnosis is unique by pathology and is susceptible to error. Follow-up for years post-surgery is necessary. The available literature is basically case reports due to its associated rarity.

Keywords

Hemangiopericytoma; Meningioma; Brain neoplasms

References

1. Louis DN, Perry A, Reifenberger G, et al. The 2016 World Health Organization classification of tumors of the central nervous system: a summary. Acta Neuropathol. 2016;131(6):803-20. http://dx.doi. org/10.1007/s00401-016-1545-1. PMid:27157931.

2. Ghose A, Guha G, Kundu R, Tew J, Chaudhary R. CNS Hemangiopericytoma: a systematic review of 523 patients. Am J Clin Oncol. 2017;40(3):223-7. http://dx.doi.org/10.1097/ COC.0000000000000146. PMid:25350465.

3. Rapalino O, Smirniotopoulo JG. Extra-axial brain tumors. Handb Clin Neurol. 2016;135:275-91. http://dx.doi.org/10.1016/B978-0-444- 53485-9.00015-5. PMid:27432671.

4. Ohba S, Murayama K, Nishiyama Y, et al. Clinical and radiographic features for differentiating solitary fibrous tumor/hemangiopericytoma from meningioma. World Neurosurg. 2019;130:e383-92. http://dx.doi. org/10.1016/j.wneu.2019.06.094. PMid:31233926.

5. Chen T, Jiang B, Zheng Y, et al. Differentiating intracranial solitary fibrous tumor/hemangiopericytoma from meningioma using diffusion- weighted imaging and susceptibility-weighted imaging. Neuroradiology. 2020;62(2):175-84. http://dx.doi.org/10.1007/s00234-019-02307-9. PMid:31673748.

6. Aguiar PH, Godinho F, Figueiredo EG, et al. Hemangiopericitoma meníngeo: relato de 7 casos e revisão da literatura. Jornal Brasileiro de Neurocirurgia. 1999;10(1):20-7. http://dx.doi.org/10.22290/jbnc. v10i1.305.

7. Apra C, Mokhtari K, Cornu P, Peyre M, Kalamarides M. Intracranial solitary fibrous tumors/hemangiopericytomas: first report of malignant progression. J Neurosurg. 2018;128(6):1719-24. http://dx.doi. org/10.3171/2017.1.JNS162593. PMid:28644098.

8. Ashwath KG, Aggarwal A, Praneeth K, Singla N, Gupta K. Neutrophil-to-lymphocyte ratio: can it be used as an adjunct tool to predict histopathological grade of brain tumor? J Neurosci Rural Pract. 2019;10(4):648-52. http://dx.doi.org/10.1055/s-0039-3399489. PMid:31831985.

9. Cieśluk M, Pogoda K, Deptuła P, et al. Nanomechanics and histopathology as diagnostic tools to characterize freshly removed human brain tumors. Int J Nanomedicine. 2020;15:7509-21. http:// dx.doi.org/10.2147/IJN.S270147. PMid:33116485.

10. Shankar JJS, Hodgson L, Sinha N. Diffusion weighted imaging may help differentiate intracranial hemangiopericytoma from meningioma.

J Neuroradiol. 2019;46(4):263-7. http://dx.doi.org/10.1016/j. neurad.2018.11.002. PMid:30500359.

11. Wei J, Li L, Han Y, et al. Accurate preoperative distinction of intracranial hemangiopericytoma from meningioma using a multihabitat and multisequence-based radiomics diagnostic technique. Front Oncol. 2020;10:534. http://dx.doi.org/10.3389/fonc.2020.00534. PMid:32509567.

12. Kanesen D, Kandasamy R, Idris Z. Occipital falcine anaplastic hemangiopericytoma mimicking meningioma. J Neurosci Rural Pract. 2016;7(Suppl 1):S95-8. PMid:28163517.

13. Drake-Pérez M, Smirniotopoulos JG. Extraparenchymal lesions in adults. Neuroimaging Clin N Am. 2016;26(4):621-46. http://dx.doi. org/10.1016/j.nic.2016.06.009. PMid:27712797.

14. Wang X, Zhang X, Zhou Q, et al. Hemangiopericytoma arose from the site of meningioma resection. J Craniofac Surg. 2017;28(4):e329-30. http://dx.doi.org/10.1097/SCS.0000000000003576. PMid:28230593.

15. Sweid A, Noureldine MHA, Nasser S, Badra M, Saikali I. A case report of meningeal hemangiopericytoma: a 9-year journey from the brain to the spine. World Neurosurg. 2019;122:459-63. http://dx.doi. org/10.1016/j.wneu.2018.11.028. PMid:30447454.

16. Hasimu A, Fu Q, Wang H, et al. Hepatic metastasis from a meningeal hemangiopericytoma: a case report. Medicine. 2020;99(31):e21605. http://dx.doi.org/10.1097/MD.0000000000021605. PMid:32756216.

17. Yip CM, Lee HP, Fu JH, Hsu SH. Coexistence of intracranial solitary fibrous tumor/hemangiopericytoma and right middle cerebral artery aneurysm. J Surg Case Rep. 2019;2019(1):rjz13. http://dx.doi. org/10.1093/jscr/rjz013. PMid:30740209.

18. Hayenga HN, Bishop AJ, Wardak Z, Sen C, Mickey B. Intraspinal dissemination and local recurrence of an intracranial hemangiopericytoma. World Neurosurg. 2019;123:68-75. http://dx.doi. org/10.1016/j.wneu.2018.11.173. PMid:30503286.

19. Choi J, Park SH, Khang SK, et al. Hemangiopericytomas in the central nervous system: a multicenter study of korean cases with validation of the usage of stat6 immunohistochemistry for diagnosis of disease. Ann Surg Oncol. 2016;23(Suppl 5):954-61. http://dx.doi.org/10.1245/ s10434-016-5414-x. PMid:27444109.

20. Luri Borah AK, Kalita M, Bhattacharyya PPM. Case reports. J Cancer Res Ther. 2018;14(11):912.

21. Kinslow CJ, Bruce SS, Rae AI, et al. Solitary-fibrous tumor/ hemangiopericytoma of the central nervous system: a population-based study. J Neurooncol. 2018;138(1):173-82. http://dx.doi.org/10.1007/ s11060-018-2787-7. PMid:29427152.

22. Sharma M, Thakur P, Fotedar V, Sharma A, Chatterjee D. Malignant intracranial hemangiopericytoma in a 22-year-old male with head injury and implications. Asian Journal of Oncology. 2017;3(84):84-6. http://dx.doi.org/10.4103/2454-6798.209334.

23. Sun Z, Li F, Cai X, Jiang Z. Intracranial primary malignant solitary fibrous tumor/hemangiopericytoma masquerading as meningioma: report of a rare case. Int J Gen Med. 2020;13:963-7. http://dx.doi. org/10.2147/IJGM.S279483. PMid:33149660.

24. Ogasawara C, Philbrick BD, Adamson DC. Meningioma: a review of epidemiology, pathology, diagnosis, treatment, and future directions. Biomedicines. 2021;9(3):319. http://dx.doi.org/10.3390/ biomedicines9030319. PMid:33801089.

25. Liu Y, Wang Q, Zhang T, Yang L, Liang W. MR imaging of intracranial solitary fibrous tumor: a retrospective study of 7 cases. Afr Health Sci. 2018;18(3):799-806. http://dx.doi.org/10.4314/ahs.v18i3.39. PMid:30603014.

26. He W, Xiao X, Li X, et al. Whole-tumor histogram analysis of apparent diffusion coefficient in differentiating intracranial solitary fibroustumor/hemangiopericytoma from angiomatous meningioma. Eur J Radiol. 2019;112:186-91. http://dx.doi.org/10.1016/j.ejrad.2019.01.023. PMid:30777209.

27. El-Ali AM, Agarwal V, Thomas A, Hamilton RL, Filippi CG. Clinical metric for differentiating intracranial hemangiopericytomas from meningiomas using diffusion weighted MRI. Clin Imaging. 2019;54:1-5. http://dx.doi.org/10.1016/j.clinimag.2018.10.018. PMid:30469018.

28. Krivoshapkin AL, Sergeev GS, Kalneus LE, et al. New software for preoperative diagnostics of meningeal tumor histologic types. World Neurosurg. 2016;90:123-32. http://dx.doi.org/10.1016/j. wneu.2016.02.084. PMid:26926798.

29. Boulagnon-Rombi C, Fleury C, Fichel C, Lefour S, Marchal Bressenot A, Gauchotte G. Immunohistochemical approach to the differential diagnosis of meningiomas and their mimics. J Neuropathol Exp Neurol. 2017;76(4):289-98. http://dx.doi.org/10.1093/jnen/nlx008. PMid:28340171.

30. Tariq MU, Din NU, Abdul-Ghafar J, Park YK. The many faces of solitary fibrous tumor; diversity of histological features, differential diagnosis and role of molecular studies and surrogate markers in avoiding misdiagnosis and predicting the behavior. Diagn Pathol. 2021;16(1):32. http://dx.doi.org/10.1186/s13000-021-01095-2. PMid:33879215.


(1) Medical student, State University of Londrina, Londrina, PR, Brazil.

(2) MD, MSc. Neurosurgeon, Pontifical Catholic University of Parana, Londrina, PR, Brazil.

(3) Medical student, Pontifical Catholic University of Londrina, Londrina, PR, Brazil.

(4) MD, MR. Medical Residency in Neurosurgery, Evangelic Hospital, Londrina, PR, Brazil.

 

Received Oct 12, 2021
Corrected Feb 1, 2022
Accepted Mar 27, 2022


JBNC  Brazilian Journal of Neurosurgery

  •   ISSN (print version): 0103-5118
  •   e-ISSN (online version): 2446-6786

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