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Intracranial meningeal hemangiopericytoma metastatic to the scapula
Herrick J Siegel1, Robert Lopez-Ben, J Hunter Sutton
1University of Alabama at Birmingham, Orthopaedic Specialty Bldg, 1313 13th St S, Birmingham, AL 35205, USA. herrick.siegel@ortho.uab.edu
Abstract:
Meningeal hemangiopericytomas are rare vascular tumors that have a propensity for recurrence and metastasis. Intracranial hemangiopericytomas are rare vascular tumors. They account for 0.5% of primary central nervous system tumors and 2% of meningiomas. Unlike usual benign meningiomas, which rarely metastasize extracranially, meningeal hemangiopericytoma has a high rate of local recurrence and distant metastasis. The treatment paradigms for hemangiopericytomas and meningiomas differ based on their biological behaviors. Hemangiopericytomas have higher rates of recurrence and metastasis compared with meningiomas. Intracranial meningeal hemangiopericytoma is characterized by clinically repeated local recurrences at the primary site. Bone, liver, lung, central nervous system, and abdominal cavity are the most commonly reported sites of metastasis in hemangiopericytomas.This article describes a case of bone metastasis with extensive involvement of the scapula from intracranial hemangiopericytoma. Bone metastasis can be seen in a relatively late phase of the disease, with metastasis to other organs. Although radiation therapy is effective in controlling pain from bone metastases in unresectable disease and those with extensive visceral metastases, aggressive local surgical control of a solitary bone metastasis may be an option for patients with limited distant disease. The diagnosis may be initially confused with clear cell meningioma and benign meningiomas. The management of bone metastasis is not well reported in the orthopedic literature.
Insights
Meningeal hemangiopericytomas are rare tumors with high recurrence and metastasis rates. This case highlights scapular bone metastasis from an intracranial hemangiopericytoma, emphasizing varied management strategies.
Area of Science:
- Neuro-oncology
- Orthopedic Oncology
- Pathology
Background:
- Meningeal hemangiopericytomas (HPCs) are rare, aggressive vascular tumors of the central nervous system, accounting for a small percentage of primary brain tumors and meningiomas.
- Unlike typical meningiomas, HPCs exhibit a high propensity for local recurrence and distant metastasis, necessitating distinct treatment approaches.
Observation:
- This article presents a rare case of intracranial meningeal hemangiopericytoma with extensive bone metastasis to the scapula.
- Bone metastasis represents a late-stage manifestation, often occurring alongside or after metastasis to other organs.
Findings:
- Meningeal hemangiopericytomas demonstrate aggressive behavior with frequent local recurrences and a significant rate of distant spread to sites including bone, liver, and lungs.
- Diagnosis can be challenging, with potential confusion with other meningioma subtypes like clear cell meningioma.
Implications:
- The management of bone metastasis from meningeal hemangiopericytoma, particularly in the orthopedic literature, remains underexplored.
- While radiation therapy can palliate pain in unresectable or widespread metastatic disease, surgical intervention for solitary bone metastases may be considered in select cases with limited systemic spread.
