Masson’s tumor presenting as a left frontal intraparenchymal hemorrhage resulting in severe expressive aphasia during pregnancy: case report

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Intravascular papillary endothelial hyperplasia (IPEH), commonly known as Masson’s tumor, is a benign lesion that manifests as an excessive proliferation of endothelial cells within a vessel wall. IPEH is extremely rare in the brain, with only 36 intracranial cases previously described in the literature. It is commonly mistaken for more malignant pathologies, such as angiosarcoma. Careful histopathological examination is required for diagnosis, as no clinical or radiographic features are characteristic of this lesion. In this first published case of intracranial IPEH presenting during pregnancy, the authors describe a 32-year-old female with a left frontal intraparenchymal hemorrhage resulting in complete expressive aphasia at 28 weeks 6 days’ gestation. An MRI scan obtained at a local hospital demonstrated an area of enhancement within the hemorrhage. The patient underwent a left frontoparietal craniotomy for hematoma evacuation and gross-total resection (GTR) of an underlying hemorrhagic mass at 29 weeks’ gestation. This case illustrates the importance of multidisciplinary patient care and the feasibility of intervention in the early third trimester with subsequent term delivery. While GTR of IPEH is typically curative, the decision to proceed with surgical treatment of any intracranial lesion in pregnancy must balance maternal stability, gestational age, and suspected pathology.

ABBREVIATIONS β-hCG = beta–human chorionic gonadotropin; GTR = gross-total resection; IPEH = intravascular papillary endothelial hyperplasia; STR = subtotal resection.
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Correspondence Eric W. Sankey: Duke University Medical Center, Durham, NC. eric.sankey@duke.edu.INCLUDE WHEN CITING Published online November 1, 2019; DOI: 10.3171/2019.8.JNS191767.Disclosures Dr. Friedman has direct stock ownership in astar1.
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  • 1

    ACOG Committee Opinion No. 775: Nonobstetric surgery during pregnancy. Obstet Gynecol 133:e285e2862019

  • 2

    Avellino AMGrant GAHarris ABWallace SKShaw CM: Recurrent intracranial Masson’s vegetant intravascular hemangioendothelioma. Case report and review of the literature. J Neurosurg 91:3083121999

    • Search Google Scholar
    • Export Citation
  • 3

    Bagga VKailaya-Vasan AWharton SBPatel U: Intracerebral Masson’s tumor-slow-filling vascular lesion demonstrated by indocyanine green video angiography. World Neurosurg 101:812.e15812.e192017

    • Search Google Scholar
    • Export Citation
  • 4

    Baylor JEAntonelli PJRojiani AMancuso AA: Facial palsy from Masson’s vegetant intravascular hemangioendothelioma. Ear Nose Throat J 77:408410415–417 1998

    • Search Google Scholar
    • Export Citation
  • 5

    Cagli SOktar NDalbasti TIşlekel SDemirtaş EOzdamar N: Intravascular papillary endothelial hyperplasia of the central nervous system—four case reports. Neurol Med Chir (Tokyo) 44:3023102004

    • Search Google Scholar
    • Export Citation
  • 6

    Charalambous LTPenumaka AKomisarow JMHemmerich ACCummings TJCodd PJ: Masson’s tumor of the pineal region: case report. J Neurosurg 128:172517302018

    • Search Google Scholar
    • Export Citation
  • 7

    Chen MMCoakley FVKaimal ALaros RK Jr: Guidelines for computed tomography and magnetic resonance imaging use during pregnancy and lactation. Obstet Gynecol 112:3333402008

    • Search Google Scholar
    • Export Citation
  • 8

    Chen TJKuo T: Giant intracranial Masson’s hemangioma. Report of a fatal case. Arch Pathol Lab Med 108:5555561984

  • 9

    Clearkin KPEnzinger FM: Intravascular papillary endothelial hyperplasia. Arch Pathol Lab Med 100:4414441976

  • 10

    Cohen-Kerem RRailton COren DLishner MKoren G: Pregnancy outcome following non-obstetric surgical intervention. Am J Surg 190:4674732005

    • Search Google Scholar
    • Export Citation
  • 11

    Crocker MdeSouza REpaliyanage PBodi IDeasy NSelway R: Masson’s tumour in the right parietal lobe after stereotactic radiosurgery for cerebellar AVM: case report and review. Clin Neurol Neurosurg 109:8118152007

    • Search Google Scholar
    • Export Citation
  • 12

    du Plessis DGBalamurali GSmith ETBroome JCPizer BLMallucci CL: Papillary endothelial hyperplasia associated with cortical dysplasia. Acta Neuropathol 105:3033082003

    • Search Google Scholar
    • Export Citation
  • 13

    Duong DHScoones DJBates DSengupta RP: Multiple intracerebral intravascular papillary endothelial hyperplasia. Acta Neurochir (Wien) 139:8838861997

    • Search Google Scholar
    • Export Citation
  • 14

    Edlow JACaplan LRO’Brien KTibbles CD: Diagnosis of acute neurological emergencies in pregnant and post-partum women. Lancet Neurol 12:1751852013

    • Search Google Scholar
    • Export Citation
  • 15

    Elwatidy SJamjoom ZElgamal EAbdelwahab A: Management strategies for acute brain lesions presenting during pregnancy: a case series. Br J Neurosurg 25:4784872011

    • Search Google Scholar
    • Export Citation
  • 16

    Ginat DTWalcott BPMordes DSchaefer PWNahed B: Intracranial organizing hematoma with papillary endothelial hyperplasia features after resection and involved field radiotherapy for cerebellar juvenile pilocytic astrocytoma. Clin Imaging 38:3223252014

    • Search Google Scholar
    • Export Citation
  • 17

    Hagiwara AInoue YShakudo MWakasa KSato KOhata K: Intracranial papillary endothelial hyperplasia: occurrence of a case after surgery and radiosurgery. J Comput Assist Tomogr 23:7817851999

    • Search Google Scholar
    • Export Citation
  • 18

    Isla AAlvarez FGonzalez AGarcía-Grande APerez-Alvarez MGarcía-Blazquez M: Brain tumor and pregnancy. Obstet Gynecol 89:19231997

    • Search Google Scholar
    • Export Citation
  • 19

    Izukawa DLach BBenoit B: Intravascular papillary endothelial hyperplasia in an intracranial cavernous hemangioma. Neurosurgery 21:9399411987

    • Search Google Scholar
    • Export Citation
  • 20

    Kanal EBarkovich AJBell CBorgstede JPBradley WG JrFroelich JW: ACR guidance document on MR safe practices: 2013. J Magn Reson Imaging 37:5015302013

    • Search Google Scholar
    • Export Citation
  • 21

    Kristof RAVan Roost DWolf HKSchramm J: Intravascular papillary endothelial hyperplasia of the sellar region. Report of three cases and review of the literature. J Neurosurg 86:5585631997

    • Search Google Scholar
    • Export Citation
  • 22

    Lee WHui FSitoh YY: Intravascular papillary endothelial hyperplasia in an intracranial thrombosed aneurysm: 3T magnetic resonance imaging and angiographical features. Singapore Med J 45:3303332004

    • Search Google Scholar
    • Export Citation
  • 23

    Lesley WSKupsky WJGuthikonda M: Intravascular papillary endothelial hyperplasia arising within a posteroinferior cerebellar artery aneurysm: case report and review of the literature. Neurosurgery 47:9619662000

    • Search Google Scholar
    • Export Citation
  • 24

    Lynch JCGouvêa FEmmerich JCKokinovrachos GPereira CWelling L: Management strategy for brain tumour diagnosed during pregnancy. Br J Neurosurg 25:2252302011

    • Search Google Scholar
    • Export Citation
  • 25

    Miller TRMohan STondon RMontone KTPalmer JNZager EL: Intravascular papillary endothelial hyperplasia of the skull base and intracranial compartment. Clin Neurol Neurosurg 115:226422672013

    • Search Google Scholar
    • Export Citation
  • 26

    Nagib MGSung JHSeljeskog EL: Neurocutaneous Masson’s vegetant intravascular hemangioendothelioma. Neurosurgery 11:8008031982

  • 27

    Ohshima TOgura KNakayashiki NTachibana E: Intravascular papillary endothelial hyperplasia at the superior orbital fissure: report of a case successfully treated with gamma knife radiosurgery. Surg Neurol 64:2662692005

    • Search Google Scholar
    • Export Citation
  • 28

    Patt SKaden BStoltenburg-Didinger G: Intravascular papillary endothelial hyperplasia at the fissura orbitalis superior: a case report. Clin Neuropathol 11:1281301992

    • Search Google Scholar
    • Export Citation
  • 29

    Perez Prat GSerrano Jimenez MCancela Caro PCardenas Ruiz-Valdepeñas ERivero Garvia MMarquez Rivas FJ: Staged management of intracranial Masson tumor: an unexpected gauntlet: case report and review of the literature. World Neurosurg 114:1942032018

    • Search Google Scholar
    • Export Citation
  • 30

    Salaud CLoussouarn DBuffenoir KRiem T: Masson’s tumor revealed by an intracerebral hematoma. Case report and a review of the literature. Neurochirurgie 63:3273292017

    • Search Google Scholar
    • Export Citation
  • 31

    Shah HCMittal DHShah JK: Intravascular papillary endothelial hyperplasia (Masson’s tumor) of the scalp with intracranial extension. J Pediatr Neurosci 9:2602622014

    • Search Google Scholar
    • Export Citation
  • 32

    Shih CSBurgett RBonnin JBoaz JHo CY: Intracranial Masson tumor: case report and literature review. J Neurooncol 108:2112172012

    • Search Google Scholar
    • Export Citation
  • 33

    Sickler GKLangford LA: Intracranial tumor-forming papillary endothelial hyperplasia—a case report. Clin Neuropathol 9:1251281990

    • Search Google Scholar
    • Export Citation
  • 34

    Sim SYLim YCWon KSCho KG: Thirteen-year follow-up of parasellar intravascular papillary endothelial hyperplasia successfully treated by surgical excision: case report. J Neurosurg Pediatr 15:3843912015

    • Search Google Scholar
    • Export Citation
  • 35

    Steffen C: The man behind the eponym: C. L. Pierre Masson. Am J Dermatopathol 25:71762003

  • 36

    Stoffman MRKim JH: Masson’s vegetant hemangioendothelioma: case report and literature review. J Neurooncol 61:17222003

  • 37

    Tewari KSCappuccini FAsrat TFlamm BLCarpenter SEDisaia PJ: Obstetric emergencies precipitated by malignant brain tumors. Am J Obstet Gynecol 182:121512212000

    • Search Google Scholar
    • Export Citation
  • 38

    Tsuji NTsubokawa TKatayama YYamamoto TNemoto N: Arteriovenous malformation occluded by Masson’s vegetant intravascular haemangioendothelioma and complicated with intracerebral haematoma. Neurol Res 16:1481501994

    • Search Google Scholar
    • Export Citation
  • 39

    Wehbé MAOtto NR: Intravascular papillary endothelial hyperplasia in the hand. J Hand Surg Am 11:2752791986

  • 40

    Wen DYHardten DRWirtschafter JDSung JHHaines SJ: Elevated intracranial pressure from cerebral venous obstruction by Masson’s vegetant intravascular hemangioendothelioma. Case report. J Neurosurg 75:7877901991

    • Search Google Scholar
    • Export Citation
  • 41

    Zhang RZhou LFMao YWang Y: Papillary endothelial hyperplasia (Masson tumor) of the petrous and jugulare region: case report and literature review. Surg Neurol 64:55602005

    • Search Google Scholar
    • Export Citation
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