Cerebral HAROLD It has

been

duce

Downloaded from www.ajronline.org by 184.10.206.63 on 11/05/15 from IP address 184.10.206.63. Copyright ARRS. For personal use only; all rights reserved

E. OLSSON,

established

vascular

logically

related

Mimicking the Congenital Fusiform

‘ 2 ROBERT

that

lesion,

has

with

not

lipomas

been

at angiognaphy

of a cerebral

and

can

appearance

resem-

at autopsy

were

no

gray

feature

findings

and

no

tion

of

the

that

basilar

a 15 mm saccular

and

vertebral

aneurysm

arteries

had

pnising

that

the

and

small

level

of

length

veins

the

extended

anterior

of the

in the

midline

from

communicating

corpus

callosum.

noted in focal areas portion of the lesion.

the

genu

artery

Granular

along

deposits

of the cerebral

cortex

at

the

in

beneath

correct

subarachnoid

mation

with

tissues

faulty

normally

was classified in the

be defined

embryonal

present except

for

the

meninges. The presence plained by Zettner and originating

from

meninx. lipomas simply

development

in an organ.

as a hamartoma

lesion,

components

abnormal

the

2B)

are

Present

address:

3Department 4

Am

Department

J Roentgenol

of

found

[31, who

of the

of

logic

similarity

other

hand,

of the

[41. It is more after

revision

Rochester

of Radiology.

Rochester

Neurosurgery.

128:1049-1050,

Rochester

June

closely March

Providence

General

Hospital.

General

1977

in the

allowing

ex-

Hospital.

Medical

jim

the

addition,

to

of the

Rochester,

Center.

Rochester.

cal-

it is not

sun-

incorporated branches described

of in

been

identified

at angiography anterior cerebral

fusiform

aneurysm

angiographically

the

anterior fusiform

demon-

cerebral aneurysms

surgery

[61. In our

fusiform However.

aneurysm in the

since

artery tend

experience does presence

differentiation

not of

of a fusiform

of the

New

York New

small

in diameter

of

1049

14621. 14621.

2A),

incon-

caution its histo-

callosum.

On

aneurysm

should

channels, were

the be

measuring

not

visualized

magnification

100-150 these

jim

vessels

structures.

The

will

of localized

reprint

[7] stromal

document

bleeding

in the

aneurysm.

requests

to

at

techniques

extending to the midline although undetected by by computed tomography.

defined

Address

docu-

and

features of the hamat the correct diagnosis.

tomography

98122

well

artery. Similar considering

vascular (fig.

of

angiographically

.

vasculanity

corpus

1 ), current

computed

removal

been

therapy.

multiple

or absence

Washington

York

has

fusiform

histologic in arriving

definition

of surgical

callosum cerebral hamartoma,

surgical

New York 14621

Seattle,

the danger

corpus

bleeding

(fig.

presence

Rochester.

an

the

and minute calcifications along the corpus callosum, graphs. could be recognized

vascular

1. 1977.

require

visualization

permit

related to to call it

General Hospital.

of

to lipomas a true

the

up to 600 angiography

related

the

for

Although

described it as of the primitive

prominence

close

lesions, dilated at or distal to

have

its

111. This is due to its inherent

found

convincingly

differentiation

Department

of Pathology.

normally

has been

Received October 19, 1976; accepted 1 Department of Diagnostic Radiology. 2

and

and

the

corpus

was

recently, of the for

discovered therapy.

Certain characteristic antoma prove useful

case

all elements

may

if possible

a lipoma

mented

medial

cells

here,

In those found

callosum

poration of the anterior may apply to a cerebral

in this

lesion is histologically callosum, we hesitate

because

(fig.

fat,

lesion

of

the

ectasia of been well

and, more oval dilatation

hemorrhage,

be avoided of

malfor-

of

The

because

of fat Netsky

Although this of the corpus a lipoma

as a tumonlike

of

structure

accounts

as it passed conspic-

aneurysm from a cerebral hamartoma becomes important. In the patient with a cerebral hamantoma, surgery should

Discussion

may

normalpuberty,

1 ). In view

lipomas

callosum [2]. were usually

diagnosis

and

considered

A hamartoma

(fig.

vascular

case

of

at angiography.

an incidentally warrant surgical

were

the

our

hypothalamic

in precocious

described

corpus

surgery. smooth

to rupture

entire

of calcium

lesion between

hamartoma

of the

to

composed

[5].

strated fusiform aneurysm of is important because congenital

pro-

mass

this

a dilated

appearance

duced an extensive subarachnoid hemorrhage. The left anterior cerebral artery at the level of the anterior communicating artery was part of a poorly defined firm mass, 6 mm x 1 5 mm, which adhered to the adjacent frontal lobe cortex. Sections of this mass showed a hamartoma including a dilated, thick-walled portion of the anterior cerebral artery (3 mm diameter), multiple small arteries and veins (50-500 pm diameter), smooth muscle bundles, and fibrous and fatty tissue (fig. 2). Fibrous tissue and blood vessels had invaded the adjacent brain. The fatty tissue with

result

lesion, since vascular cerebral artery have

at autopsy, [1, 2]. The artery

than are

anterior cerebral artery was the angiographically

lipomas of the corpus and tortuous vessels

history

at the junc-

ruptured

the

within this the anterior

The showed

of similarity

and

died.

Autopsy

in males

losum

JAVID4

and

uous

pant

ROUHALLAH

callosum

matter

to

of seizures or mental retardation. Grossly bloody cerebral spinal fluid was removed at lumbar puncture. A fusiform aneurysm of the left anterior cerebral artery (fig. 1 ) and a saccular aneurysm orginating from the basilar artery were seen at cerebral angiography. Magnification and subtraction techniques were not used. On the fifteenth hospital day, the patient hemorrhaged and

appearing

dilatation of the the hamartoma

be

of

which

The through

Report

neurologic

corpus

hamartomas

histologic

focal

the

ganglionic predominantly

L. R., a 41-year-old female, noted sudden onset of severe right parietal headache. Nuchal rigidity was found on physical examThere

of

Appearance AND

aneurysm. aneurysm

hamartoma.

Case

nation.

HEGGENESS,3

lipomas

reported

fusiform a fusiform

proved

pro-

a histo-

previously

an angiographic

Angiographic Aneurysm

‘ LUCILLE

hamantoma,

a congenital, nonarteniosclerotic report presents a patient with

shown

M.

intracranial

11, 21. Cerebral

ectasia

to be associated bling This

Hamartoma

R. M.

Spitzer.

would fat and radioIn the

region

1050

CASE

REPORTS

REFERENCES

1 . Wolfson

JJ. Smith

the corpus angiography.

Downloaded from www.ajronline.org by 184.10.206.63 on 11/05/15 from IP address 184.10.206.63. Copyright ARRS. For personal use only; all rights reserved

2. Wolpert

GW,

callosum Stanford

SM.

Hanbery report Med

-

Carter

BL, Ferris

callosum-an angiographic 92-99. 1972 3. Zettner A, Netsky MG: Neuropathol

4. Stehbens Louis,

Exp

WE:

5. Rubinstein Atlas

of

the

U:

Fig.

1.

projection of anterior

-

Left

common

demonstrating cerebral artery

carotid smooth

angiogram fusiform

in

right

dilatation

posterior of

of the

the

of

cerebral

of the corpus

J Roentgeno/

corpus

115:

callosum.

J

1960 Cerebral

Blood

St.

Vessels.

of

the central nervous system. in 2d series, fascicle 6, Washington. Institute of Pathology. 1972, pp

Forces

DG: Aneurysms Diagnosis

in

of Small

Physiology 1973.

pp

and

and

Angiography system.

Morphology, Mosby.

of

Pathology,

Brain:

nervous

Lipoma

Am

Lipoma

with

1957

EJ: Lipoma

19:305-319,

Tumors

Tumor

1965 7. Hilal 5K:

CN: two

1972

D.C., Armed 298-299 6. Pool JL, Potts of

Neurol

Nuttrell

analysis.

Pathology

Mosby.

JC,

of four cases, Bull 15:274-282,

and

Arteriovenous

Treatment.

the

small

Anomalies

New

York,

vessels

of

Vessel

Angiography:

Clinical

Applications.

Hoeber,

the

central Imaging,

St.

Louis,

177-181

oblique

proximal

portion

,

Fig.

2. -A.

Histologic

tissue penetrating to better advantage

section

at low

power

frontal cortex H and E stain. Portion of anterior cerebral

(X6)

showing

B, Slightly artery

included.

dilated more

thick-walled

anterior

medial section showing H and E stain, X6

cerebral ectopic

artery muscle

(arrows). bundles

small

numerous

(arrow)

and

fatty

vessels. tissue

and fibrous (arrowhead)

Cerebral hamartoma mimicking the angiographic appearance of congenital fusiform aneurysm.

Cerebral HAROLD It has been duce Downloaded from www.ajronline.org by 184.10.206.63 on 11/05/15 from IP address 184.10.206.63. Copyright ARRS. For...
403KB Sizes 0 Downloads 0 Views