Bejjani G K, Stopak B, Schwartz A, Santi R
Department of Neurosurgery, Allegheny General Hospital, Pittsburgh, Pennsylvania 15212, USA.
Neurosurgery. 1999 Jan;44(1):199-202. doi: 10.1097/00006123-199901000-00119.
We report the magnetic resonance imaging, angiographic, and immunohistochemical characteristics of a dural leiomyosarcoma in a patient infected with human immunodeficiency virus.
A 38-year-old homosexual man presented with a recent history of headaches. Magnetic resonance imaging of the brain revealed an enhancing dural based right lateral wing mass that was thought to be a meningioma. The tumor had a signal intensity similar to the adjacent gray matter on T1-, T2-, and proton-weighted images. Angiography revealed that the tumor was vascular, supplied by the middle meningeal artery, but with contrast puddling as if there were small vascular lakes within the tumor. This evoked the possibility of a cavernous hemangioma. A craniotomy was performed, and the mass was resected. The pathological finding was consistent with a leiomyosarcoma. Immunohistochemistry revealed that the tumor was positive for alpha smooth muscle actin. Repeat testing for human immunodeficiency virus 2 months postoperatively was positive. Dural leiomyosarcomas are thought to take origin from the smooth muscles of the blood vessel walls. Another possible source is pluripotential mesenchymal cells. There may be an association with immunosuppression.
Primary dural leiomyosarcomas simulate meningiomas on preoperative magnetic resonance images. They should be included in the differential diagnosis of dural based enhancing lesions.
我们报告了一名感染人类免疫缺陷病毒患者硬脑膜平滑肌肉瘤的磁共振成像、血管造影和免疫组化特征。
一名38岁的同性恋男性近期出现头痛病史。脑部磁共振成像显示右侧翼部有一个基于硬脑膜的强化肿块，最初被认为是脑膜瘤。该肿瘤在T1加权、T2加权和质子加权图像上的信号强度与相邻灰质相似。血管造影显示肿瘤有血管，由脑膜中动脉供血，但有造影剂聚集，提示肿瘤内可能存在小血管湖，这使人联想到海绵状血管瘤。遂行开颅手术并切除肿块。病理检查结果符合平滑肌肉瘤。免疫组化显示肿瘤α平滑肌肌动蛋白呈阳性。术后2个月复查人类免疫缺陷病毒呈阳性。硬脑膜平滑肌肉瘤被认为起源于血管壁的平滑肌。另一个可能的来源是多能间充质细胞。可能与免疫抑制有关。
原发性硬脑膜平滑肌肉瘤在术前磁共振图像上类似脑膜瘤。它们应被纳入基于硬脑膜的强化病变的鉴别诊断中。
