Department of Radiology, Al-Noor Specialist Hospital, Makkah, Saudi Arabia.
Department of Neurosurgery, Al-Noor Specialist Hospital, Makkah, Saudi Arabia.
BMC Neurol. 2021 Jan 19;21(1):29. doi: 10.1186/s12883-021-02053-7.
Symplastic hemangioma is a benign superficial abnormal buildup of blood vessels, with morphological features which can mimic a pseudo malignancy. A few cases have been reported in the literature. We report here, a unique case of calvarial symplastic hemangioma, which is the first case in the calvarial region.
A 29-year-old male patient, with a left occipital calvarial mass since childhood, that gradually increased in size with age, was associated with recurrent epileptic fits controlled by Levetiracetam (Keppra), with no history of trauma. He presented to the emergency room with a recent headache, vomiting, frequent epileptic fits and a decrease in the level of consciousness 1 day prior to admission. A CT scan showed three diploic, expansile, variable sized lytic lesions with a sunburst appearance; two that were biparietal, and one that was left occipital, which were all suggestive of calvarial hemangiomas. However, the large intracranial soft tissue content, within the hemorrhage of the occipital lesion was concerning. The patient had refused surgery over the years; however, after the last severe presentation, he finally agreed to treatment. The two adjacent, left parietal and occipital lesions were treated satisfactorily using preoperative embolization, surgical resection, and cranioplasty. Histopathology revealed cavernous hemangiomas, in addition to symplastic hemangioma (pseudo malignancy features) on top at the occipital lesion. The right parietal lesion was not within the surgical field; therefore, it was left untouched for follow-up.
Histopathology and radiology examinations confirmed the diagnosis as symplastic hemangioma, on top of a pre-existing cavernous hemangioma. To the best of our knowledge, this is the first case of a calvarial symplastic hemangioma, which we report here.
吻合性血管瘤是一种良性的浅层血管异常增生，具有可模拟假性恶性肿瘤的形态学特征。文献中已有少数病例报道。我们在此报告一例独特的颅骨吻合性血管瘤病例，这是首例发生在颅骨区域的病例。
一名 29 岁男性患者，自幼左枕部颅骨肿块，随年龄增长逐渐增大，曾因癫痫反复发作接受左乙拉西坦（开浦兰）治疗得到控制，无外伤史。他因近期头痛、呕吐、频繁癫痫发作和意识水平下降 1 天就诊于急诊室。CT 扫描显示三个板障、膨胀性、大小不一的溶骨性病变，呈太阳辐射状；两个位于顶骨，一个位于左枕骨，均提示颅骨血管瘤。然而，枕骨病变内的较大颅内软组织内容物伴出血令人担忧。多年来，患者一直拒绝手术；然而，在上次严重发作后，他最终同意接受治疗。通过术前栓塞、手术切除和颅骨成形术，成功治疗了相邻的左顶骨和枕骨病变。组织病理学显示除了在枕骨病变顶部的吻合性血管瘤（假性恶性肿瘤特征）外，还有海绵状血管瘤。右顶骨病变未在手术范围内，因此未进行手术，仅进行随访。
组织病理学和影像学检查证实诊断为吻合性血管瘤，在预先存在的海绵状血管瘤之上。据我们所知，这是首例颅骨吻合性血管瘤病例，我们在此报告。
