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LETTER TO EDITOR
Year : 2012  |  Volume : 60  |  Issue : 1  |  Page : 132-133

Angiosarcoma presenting as subdural hematoma


Department of Neurosurgery, K. G. Hospital and Postgraduate Medical Institute, Coimbatore, India

Date of Submission10-Nov-2011
Date of Decision17-Nov-2011
Date of Acceptance21-Nov-2011
Date of Web Publication7-Mar-2012

Correspondence Address:
Mahalingam Natarajan
Department of Neurosurgery, K. G. Hospital and Postgraduate Medical Institute, Coimbatore
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0028-3886.93624

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How to cite this article:
Natarajan M, Devi NS. Angiosarcoma presenting as subdural hematoma. Neurol India 2012;60:132-3

How to cite this URL:
Natarajan M, Devi NS. Angiosarcoma presenting as subdural hematoma. Neurol India [serial online] 2012 [cited 2019 Oct 22];60:132-3. Available from: http://www.neurologyindia.com/text.asp?2012/60/1/132/93624


Sir,

A 41-year-old male was admitted for severe headache, vomiting and left-sided limb weakness of one-day duration. On admission Glasgow Coma Scale (GCS) score was 12 and he had left hemiparesis. Computed tomography (CT) brain scan [Figure 1]a and b and magnetic resonance imaging (MRI) of brain [Figure 2] revealed subacute subdural hematoma (SDH) with masse effect. He rapidly deteriorated and right pupil was dilated within one hour of admission. He had right fronto-parieto-temporal craniectomy and hematoma evacuation. Posterior parietal bone was found to be soft, crumbling, bleeding heavily with underlying vascular soft tissue mass infiltrating the dura and pia arachnoid [Figure 3]a and b. Bone flap was removed as the brain started swelling. Postoperatively the patient recovered well and GCS score was 14. Sections from the lesion showed broad bands of thick dural collagen infiltrated by a vaso-formative lesion consisting of collapsed vascular channels lined by anaplastic endothelial cells. The cells had enlarged irregular hyperchromatic nuclei with prominent nucleoli and occasional binucleation, mitosis and foci of hemorrhages. Lesion was densely cellular in most areas diagnostic of angiosarcoma [Figure 4]b. Immunohistochemistry [Figure 4]a was positive for CD31, CK markers and negative for CD34, S100, and SMA.
Figure 1: (a) SDH with mass effect. (b) Bone erosion

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Figure 2: MRI brain SDH with dural infiltration

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Figure 3: (a) Bony erosion (b) Dural infiltration with SDH

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Figure 4: (a) Immunohistochemistry. (b) H and E stain

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Angiosarcoma is a rare tumor arising from the blood vessels. The common locations are in the scalp, skull, and dura. It is an aggressive tumor and frequently recurs even after surgical excision and radiotherapy. The epitheloid subtype is commonly seen in the meninges. [1],[2],[3]

 
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1.Hurley TR, Whisler WW, Clasen RA, Smith MC, Bleck TP, Doolas A, et al. Recurrent intra cranial epitheliod hemangioendothelioma associated with multicentric diseases of liver and heart: Case report. Neurosurgery 1994;35:148-51.  Back to cited text no. 1
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2.Kleer CG, Unni KK, McLeod RA. Epitheliod haemangioendothelioma of bone. Am J Surg Pathol 1996;20:1301-11.  Back to cited text no. 2
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3.Ladha AM, Guthrie BL, Ewend MG. Youmans. Neurological surgery. In: Winn R, editor. Vol. 2. 6 th ed, Chapter 132. Elsevier, Saunders; 2011. p. 1450-9.  Back to cited text no. 3
    


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