Infratentorial angioleiomyoma: a new location for a rare neoplastic entity

Case report

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Angioleiomyomas are benign neoplasms most often located in the subcutaneous tissue of middle-aged individuals and usually confined to the subcuticular and deep dermal layers of the lower extremities. An intracranial site for this tumor is exceedingly rare, with very few reports documenting locations in the neuraxis. To the authors' knowledge the present case represents the first reported instance of an infratentorial angioleiomyoma. The authors conducted a review of selected English-language papers published since 1960 describing well-documented cases of intracranial vascular leiomyomas, with detailed information on the clinical presentation, radiology, pathology, and particulars of surgical management in each case.

Abbreviations used in this paper: GTR = gross-total resection; IAM = internal auditory meatus.

Article Information

Address correspondence to: Jaime Gasco, M.D., Division of Neurological Surgery, University of Texas Medical Branch, 301 University Boulevard, Galveston, Texas 77555-0517. email: jagascot @utmb.edu.

Please include this information when citing this paper: published online November 14, 2008; DOI: 10.3171/2008.8.17645.

© AANS, except where prohibited by US copyright law.

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    A: Axial noncontrast CT scan showing a left cerebellar lesion with homogeneously increased density compared with surrounding parenchyma. Note the patent fourth ventricle. B: Axial noncontrast CT obtained after GTR. C: Preoperative sagittal T1-weighted MR image revealing a lesion with extensive dural content and in proximity to the transverse sinus. D: Preoperative axial FLAIR image demonstrating no significant edema or mass effect. Some areas of hypointensity within the tumor mass, in retrospect, could be interpreted as vascular channels.

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    A: Photograph of the cut surface of the mass showing numerous blood-filled spaces separated by thick irregular septae. B: Low-magnification photomicrograph further delineating the overall pattern of irregular vascular spaces, some containing blood and surrounded by loose, concentric lamellar tissue in the septae. C: Photomicrograph demonstrating the presence of collagen (yellow) in the central regions of the septae and the total absence of elastin (black) in the walls. D: Photomicrograph demonstrating the presence of smooth muscle in the concentric lamellae surrounding the vascular lumens, made evident by immunohistochemistry using an antibody against smooth muscle actin. E: Higher-magnification photomicrograph clearly showing the immunoreactive thin, elongated muscle cells with bland nuclear morphology in the walls near the lumens. F: Photomicrograph revealing that CD34, an endothelial cell marker, reacts only with the endothelial cells lining the lumens and not with the stroma. H & E (B), Movat stain (C), and immunoperoxidase (D, E, and F). Bar = 0.5 cm (A), 200 μm (B), 100 μm (C), 50 μm (D and F), and 25 μm (E).

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