Cerebral HAROLD It has
been
duce
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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.
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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)