0709 Case 2
0709 Case 2
0709 Case 2
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C O M J U LY 0 9 C A S E 2
Yun-Ho Lee, Young Seok Park, Dong-Seok Kim, Yong-Gou Park, Kyu-Won Shim
Department of Neurosurgery, Severance Hospital, Brain Korea 21 Project for Medical Science, Yonsei University College of Medicine, Seoul, Korea
Figure 1. Figure 2.
Figure 3.
Figure 4.
Figure 5.
Figure 6. Figure 7.
REFERENCES
DIAGNOSIS
1. Abe M, Misago N, Tanaka S, Masuoka J, Tabuchi K (2005) Capillary
Capillary hemangioma.
hemangioma of the central nervous system: a comparative study with
lobular capillary hemangioma of the skin. Acta Neuropathologica
DISCUSSION 109(2):151–8.
The majority of capillary hemangiomas arise in the skin, scalp, or 2. Abe M, Tabuchi K, Tanaka S, Hodozuka A, Kunishio K, Kubo N,
Nishimura Y (2004) Capillary hemangioma of the central nervous
oral mucosa and typically appear within a few months of birth (9).
system. J Neurosurg 101(1):73–81.
In these areas, such lesions have been reported to occur in 1.1 to 3. Asa SL (1998) Tumors of the Pituitary Gland in Atlas of Tumor
2.6% of full-term neonates, with an estimated frequency of 10 to Pathology, Series 3, Fascicle 22, pp 159–160, Armed Forces Institute
12% within the first year of life. They typically demonstrate rapid of Pathology: Washington DC.
growing up to 6 to 8 months, followed by a plateau phase between 4. Jacobs AH (1957) Strawberry hemangiomas; the natural history of the
8 and 12 months. Occasionally, these lesions are completely untreated lesion. Calif Med 86(1):8–10.
regressed in 5 years (5). The natural history of capillary hemangio- 5. Lasjaunias P (1997) Vascular Diseases in Neonates, Infants and
mas occurring outside the central nervous system has been well Children. In: Interventional Neuroradiology Management, pp
characterized by proliferative and involutional phases (4). Only 14 565–591, Springer: Berlin.
microscopically proven cases have been reported in the literature. 6. Le BH, Boyer PJ, Lewis JE, Kapadia SB (2004) Granular Cell Tumor:
Immunohistochemical Assessment of Inhibin-a, Protein Gene
Capillary hemangiomas are believed pathologically to be hamar-
Product 9.5, S100 Protein, CD68, and Ki-67 Proliferative Index With
tomatous proliferations of vascular endothelial cells. Histologi- Clinical Correlation. Archives of Pathology and Laboratory Medicine
cally, a capillary hemangioma is composed of capillary-size 128(7):771–5.
vessels lined by a single layer of benign endothelial cells (10). 7. Simon SL, Moonis G, Judkins AR, Scobie J, Burnett MG, Riina HA,
Blood vessels vary widely in size from small lumina lined with Judy KD (2005) Intracranial capillary hemangioma: case report and
plump endothelial cells to dilated vessels lined with flattened review of the literature. Surg Neurol 64(2):154–9.
endothelium (1). GFAP immunostaining showed no glial tissue 8. Suess U, Pliska V (1981) Identification of the pituicytes as astroglial
present within the lesions (2). Microscopically, capillary heman- cells by indirect immunofluorescence-staining for the glial fibrillary
giomas in the central nervous system must be distinguished from acidic protein. Brain Res 221(1):27–33.
highly vascular neoplasm, which include hemangioendotheliomas, 9. Tsao MN, Schwartz ML, Bernstein M, Halliday WC, Lightstone AW,
Hamilton MG, Jaywant S, Laperriere N (2003) Capillary
hemangiopericytomas, and hemangioblastomas (7). In this case,
hemangioma of the cavernous sinus. Report of two cases. J Neurosurg
histological examination failed to show large vacuolated stromal 98(1):169–74.
cells characteristic of capillary hemangioblastomas, primitive vas- 10. Uyama A, Kawamura A, Akiyama H, Nakamizo S, Yamamoto K,
cular differentiation characteristic of hemangioendotheliomas and Nagashima T, Uetani T, Takeda H, Yoshida M (2008) A case of
storiform architecture in hemangiopericytomas. Tumors occurring cerebellar capillary hemangioma with multiple cysts. Pediatr
in the infundibular recess or pituitary stalk include pituitary Neurosurg 44(4):344–9.
adenomas, germ cell tumors, pituicytomas, and granular cell
tumors. Pituicytomas are noninfiltrative sellar or parasellar tumors
arising from the neurohypophysis. Pituicytoma is derived from
ABSTRACT
pituicyte, which is a specific glial cell that accounts for the majority
of nucleated cells in the neurohypophysis. Pituicytes have been Intracranial capillary hemangiomas are extremely rare. Only 14
identified as GFAP positive, spindle, or stellate cells (8). Granular histologically proven cases have been reported in the literature. A
cell tumors are composed of densely packed polygonal cells with 59-year-old-female presented with a severe headache for 3 weeks.
eosinophilic, granular, diastase-resistant cytoplasm and perivascu- Brain MRI revealed a homogeneous contrast enhancing round
lar lymphocytic aggregates are a common feature (3). These tumors mass lesion in the pituitary stalk and infundibular recess. We per-
typically express S100 protein and CD68 (KP-1) (6). Only thin- formed endoscopic biopsy. In the operative field, a reddish, well-
walled capillaries were demonstrated in this case that was negative circumscribed mass from the infundibular recess protruded into the
for S100 protein, CD68 (KP-1) and GFAP. In summary, we have third ventricle and it was separated from the optic chiasm. The
reported on a capillary hemangioma in the infundibular recess and tumor appeared a highly vascular. Histopathological examination
pituitary stalk. Capillary hemangiomas should be included as a rare demonstrated an aggregation of thin-walled capillaries, consistent
differential diagnosis in patients with well-enhanced homogeneous with capillary hemangioma.
lesions in the infundibular recess and pituitary stalk.