Tumefactive presentation of a supratentorial cavernous hemangioma: A report of two cases
A 14-year-old boy presented with a 7-month history of progressive left-sided hemiparesis and bifrontal, throbbing headache. There was rapid worsening of the weakness and associated headache and vomiting over 5 days preceding his first admission at a local hospital. On examination, he was drowsy, but obeyed commands infrequently. CT of the head revealed a large mass lesion occupying the right parieto-occipital region. As MRI facility was not available nearby and he was not in a position to be shifted for MRI, he was taken up for tumor excision. Intraoperatively, the mass lesion was found to be highly vascular and surgery was abandoned. On arrival at our center, the child was not obeying any commands, had left-sided hemiparesis, and had no vision. A fundoscopy revealed gross papilledema and a massive bulge at the craniotomy site.\nRadiological evaluation at our center included CT and MRI scans, which revealed a well-defined mass in the right parieto-occipital region of size 10 × 8 × 8 cm, extending into the atrium of the right lateral ventricle [Figure –]. On T1 scan, multiple low- to high-signal intensities were observed within the lesion, signaling blood of different ages. Upon administration of contrast, minimal enhancement of the lesion was observed. On T2 scans, multiple hypo- to hyperintense signals within the lesion were noted, with massive edema involving the surrounding brain parenchyma. The lesion had herniated out of the previously performed craniectomy defect, thereby easing ICP.\nWith a provisional diagnosis of malignant neoplasm, the child underwent re-exploration via previously performed craniectomy. The mass lesion was well defined, encapsulated, multilobulated, and extraparenchymal, and had a reddish brown color. The lesion was excised as a single specimen, as there was a good plane of dissection between the tumor and brain parenchyma. The tumor was firm, rubbery, and compressible, with multiple blood-containing cavities. Postoperatively, the patient gradually regained consciousness and the left-sided weakness improved to a near-normal state. The excised specimen showed a relatively circumscribed lesion composed of blood-filled vascular channels of varying sizes. There were thick-walled vascular channels with intervening stroma showing variable fibrosis and moderate lymphomononuclear cell infiltration. Many vessels showed fibrin thrombi. Elastic fibers within the vessel wall were highlighted as black fibers upon Elastic Van Gieson staining. The final histopathological diagnosis was cavernous hemangioma [Figure –].