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Dural cavernous hemangioma: an under-recognized lesion mimicking meningioma
J R Perry1, W S Tucker, M Chui
1Division of Neurology, St. Michael's Hospital, Toronto, Ontario, Canada.
Abstract:
We report a 77-year-old woman who presented with partial seizures and was found to have an enhancing dural-based parietal convexity mass. The lesion enlarged on serial examination by computed tomography (CT) over a one year period. The clinical features and radiologic appearance were compatible with a pre-operative diagnosis of meningioma; however, pathologic findings were typical of a dural cavernous hemangioma. Accumulating evidence suggests that these lesions are an uncommon but distinct type of vascular malformation most often arising from the cavernous sinus, tentorium, or cerebello-pontine angle. With CT, magnetic resonance imaging and angiography, these lesions can closely resemble meningioma in terms of signal characteristics, enhancement pattern, and location. This is of importance both in the practical management of meningiomas where the diagnosis is often based on radiologic studies alone, and in clinical trials where incorrect entry diagnosis should be avoided.
Insights
Dural cavernous hemangiomas can mimic meningiomas on imaging, presenting a diagnostic challenge. Accurate radiologic differentiation is crucial for patient management and clinical trial integrity.
Area of Science:
- Neurology
- Radiology
- Pathology
Background:
- Meningiomas are common dural-based tumors often diagnosed via imaging.
- Dural cavernous hemangiomas are rare vascular malformations that can resemble meningiomas.
Observation:
- A 77-year-old woman presented with partial seizures and a parietal convexity mass.
- The lesion showed growth on serial computed tomography (CT) scans over one year.
- Initial imaging suggested meningioma, but pathology revealed a dural cavernous hemangioma.
Findings:
- Dural cavernous hemangiomas share imaging characteristics (signal, enhancement, location) with meningiomas.
- Advanced imaging like CT, MRI, and angiography may not definitively distinguish these entities.
- Pathological examination is essential for definitive diagnosis.
Implications:
- Misdiagnosis can impact patient management strategies.
- Accurate pre-operative diagnosis is vital to avoid incorrect enrollment in clinical trials.
- Increased awareness of dural cavernous hemangiomas is needed for improved diagnostic accuracy.