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Neoplastic Ruptured Cerebral Aneurysm Caused by Intimal Sarcoma: A Case Report
Takuya Suematsu1, Tomoaki Murakami1, Yoshiko Sudo2
1Department of Neurosurgery, Kansai Rosai Hospital, Amagasaki, Hyogo, Japan.
NMC Case Report Journal
|October 31, 2022
Summary
Intimal sarcoma (ISA) can metastasize to form neoplastic aneurysms in cerebral arteries, such as the middle cerebral artery. Early detection and periodic cerebral artery screening are crucial for patients diagnosed with ISA.
Area of Science:
- Vascular Surgery
- Neuro-oncology
- Pathology
Background:
- Intimal sarcomas (ISAs) are rare malignant tumors originating in the tunica intima of large blood vessels.
- Cerebral aneurysms are abnormal bulges in brain arteries, often leading to subarachnoid hemorrhage.
Observation:
- A patient with a history of aortic arch intimal sarcoma developed a subarachnoid hemorrhage due to a neoplastic aneurysm in the middle cerebral artery.
- Initial presentation included altered consciousness and anisocoria, with computed tomography revealing diffuse subarachnoid hemorrhage.
Findings:
- Angiography identified a multilobar fusiform aneurysm in the right middle cerebral artery.
- Surgical resection confirmed the aneurysm was formed by atypical spindle-shaped cells, consistent with metastatic intimal sarcoma.
- Immunohistochemistry supported the diagnosis, showing markers like ERG, MDM2, and CDK4.
Implications:
- This case highlights that intimal sarcoma can manifest as a neoplastic cerebral aneurysm.
- Periodic screening of cerebral arteries is recommended for patients diagnosed with intimal sarcoma to detect potential metastases.
- Understanding this rare complication is vital for timely diagnosis and management in neurovascular and oncological care.
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