Radiology-pathology correlation: Giant tumefactive perivascular spaces

Area of Science:

• Neuroradiology
• Neuro-oncology
• Cerebrovascular Diseases

Background:

• Dilated perivascular spaces (PVSs) are common incidental findings on neuroimaging.
• Giant tumefactive PVSs (GTPVSs) are rare variants with complex cystic appearances.
• GTPVSs are frequently misdiagnosed as neoplasms, infarcts, or cysts due to their unusual morphology.

Purpose of the Study:

• To present a case of a resected giant tumefactive perivascular space (GTPVS).
• To elucidate the characteristic radiologic and histologic features of GTPVSs.
• To provide guidance on differentiating GTPVSs from mimicking intracranial lesions.

Main Methods:

• Case report of a surgically resected GTPVS.
• Detailed review of pre-operative imaging findings (MRI/CT).
• Histopathologic examination of the resected lesion.

Main Results:

• The resected lesion demonstrated classic features of a GTPVS.
• Radiologic findings included multilocular cystic components and perivascular location.
• Histology confirmed dilated PVSs lined by endothelium and surrounded by gliosis.

Conclusions:

• GTPVSs, though rare, possess distinct imaging signatures.
• Awareness of GTPVS imaging and pathologic features aids in accurate diagnosis.
• Distinguishing GTPVSs from neoplasms and cysts is crucial for appropriate patient management.