Cavernous hemangioma, also called cavernous angioma, cavernoma, or cerebral cavernous malformation. Asociación entre angioma cavernoso y glioma cerebral. Reporte de dos casos y revisión de la literatura acerca de los llamados angiogliomas. R. Gazzeri; C. De. KEY WORDS. Brain tumor. Glioma. Cavernous angioma. Angioglioma. Asociación entre angioma cavernoso y glioma cerebral. Reporte de dos casos y revisión.
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Association caverboso cavernous angioma and cerebral glioma. Report of two cases and literature review of so-called angiogliomas. University Hospital Virgen de la Arrixaca. The angioam between vascular malformations and cerebral gliomas is unusual.
While the association between cavernous angioma with gliomatous lesions is even more rare, it is considered by certain authors to be a particular pathological entity termed angioglioma.
The authors report on two cases of association of a cavernous angioma with a ganglioglioma and an oligodendroglioma respectively. Subsequent review of the literature on the so-called angiogliomas was conducted.
In the author’s opinion, the entity of angiogliomas represents a general spectrum of angiomatous neoplasms that include gliomatous tumors, in the majority low-grade gliomas, associated with a major vascular component. Councillmann in 3 was the first to report the name of creebral describing a cerebellar tumor with a huge vascular component.
Angioma Alliance — Angioma del Tronco Cerebral
From Councillmann until nowadays, only a few authors have reported this entity along with an attempt of a better definition of such pathology. Indeed, Roussoy and Oberling in 14 classified CNS neoplams and described as well the angioglioma that it was defined as a tumor with a glial part, generally of low-grade, along with a notable vascular component. Although, Rubinstein 15 accepted the term angioglioma; in a more recent publication 16 he suggested the restriction of the term angiogliomas to denote a mixed tumor composed of an hemangioblastoma and astrocitoma.
The presence of two angiogliomas in our own series of low-grade gliomas leaded us to review the literature on this rare pathological condition 2,3,8,12,13, A year-old girl was admitted in our department for progressive bilateral facial palsy. Neurological examination evidenced a central bilateral VII cranial nerve dysfunction.
A brain MRI with and without contrast demonstrated a hypothalamic chiasmatic tumor with disomogenous contrast enhancement, irregular borders and slight perilesional edema Fig 1. A bilateral subfrontal approach was carried xerebral with subtotal resection of the tumor. During surgery, an intracerebral mass with thrombosed vessels and considerable vascular lakes was found. Histological diagnosis was ganglioglioma with glial component of pyloid type and associated vascular component of angiomatous type angioglioma.
The vascular component was observed in some regions of the tumoral mass. It presented itself with hyalinized ectasic vascular channels, perivascular hemosiderin deposits, gliosis and vascular calcifications. The gliomatous nature of the tumor was pathologically obvious, although in some points of the tumoral mass it was nearly cavrenoso from this particular architecture of the vascular component Fig 2abc.
Electron microscopy was not performed. Vascular component of neoplasia evident angiomatous aspect. Interface between vascular component in this case with hyalinized ectasic walls and the glial neoplasia.
Particular of the ganglioglial angiooma one binuclear gangliar cell in the center. Postoperative course was complicated with a pan-hypopituitarism, which improved with pharmacological replacement therapy. Clinical and radiological follow-up of 76 months showed a non growing residual tumor and stable medical condition.
A year-old men was admitted in our department for bifrontal headaches for six months. Neurological exam was normal. A brain MRI with and without contrast demonstrated a right frontal lobe tumor with disomogenous contrast enhancement and areas of hyperintensity surrounded by a hypointense ring due to the paramagnetic effects of hemosiderin Fig.
A right frontal craniotomy was performed with a total removal of the tumor. Histological diagnosis was angioglioma with a glial component of oligodendroglioma with polymorphous aspects; a prominent vascular component was observed in some regions of the tumoral mass.
Hyalinized ecstatic vascular channels, perivascular hemosiderin deposits, gliosis and vascular calcification were noted Fig. Postoperative evolution was uneventful. Clinical and radiological follow-up of 64 months showed a neurologically intact patient without tumoral recurrence on imaging studies.
Interface between vascular and glial component.
Particular of the glial component of type oligodendroglioma with polymorphous aspects. From a consecutive series of low-grade gliomas surgically treated in our department cavrnoso towe found 2 cases with histological diagnosis of “Cerebral Angioglioma”. After revision of these two cases it was evidenced that the vascular part assumed a cavernous-angioma like component, while the gliomatous part were a pyloid type ganglioglioma in one case and an oligodendroglioma in other case.
In Lombardi et al. Some authors 1,5,6,11,20,21 expressed different etiological hypothesis cavernosk Crowel 4Nazek 12 and Lombardi 10suggested that an exaggerated glial proliferation could be a reactive response to any kind of AVM, with subsequent chronic ischemia and white matter changes.
Fisher in 5reporting two cases of cavernous angioma associated with an oligodendroglioma and a pylocitic astrocytoma respectively, considered a viral cause as a possible pathogenesis. Indeed, cavernomas can be induced experimentally in rats after inoculation of Polyoma virus, while the neoplasm can be induced directly after inoculation of SV40 virus of the Papova family.
In our first case the histological diagnosis was ganglioglioma with glial component of pyloid type and associated vascular component of angiomatous type, while in our second case histological examination showed a glial component of oligodendroglioma with polymorphous aspects; in both cases the vascular component was observed in some regions of the tumoral mass. We can include cases of angiogliomas either as an exclusive pathological entity, or as a unique category of angiogliomatous tumors composed of a low-grade glioma associated with an important vascular component.
However, after reviewing the literature and our cases, the following subcategories can be described: These cases did not demonstrated progression to glial neoplasm and have a natural history similar to other AVMs. In our first case follow-up of 76 months showed a nongrowing residual tumor and stable medical condition; in the second case, follow-up of 64 months showed a neurologically intact patient without tumoral recurrence on MR images.
Based on our experience and on the literature review, we imply that the presence of rare cases of any kind of AVM associated with a glioma can be interpreted as a truly compound tumor, less likely to be an exceptional coincidence.
Intracranial cavernous angioma
We suggest that the entity of angiogliomas represents a general spectrum of angiomatous neoplasms that include gliomatous tumors, in the majority low-grade gliomas, associated with a major vascular component.
Mixed capillary hemangioblastoma and glioma. A redefination of the “angioglioma”. Neuropathol Exp Neurol ; Oligondendroglioma and cerebral cavernous angioma. J Neurosurg ; The gliomatous tumors of the brain. Long Island Med J ; 8: Arteriovenous malformation and oligodendroglioma. Cerebral hemangioma with glial neoplasia angioglioma?
Report of two cases. Arteriovenous malformation and glioma: Benign astrocytoma with arteriovenous malformation. Combined neurilloma and angioma.
Tumor ectomesenchyme and a source of bleeding. Management of associated primari cerebral neoplasms and vascular malformations. Acta Neurochir Wien ; Vascular malformations “angiogliomas” of the brain, with special reference to those occurring in the posterior fossa. Oligoden-droglial proliferativeabnormality associated with arteriovenous malformation: Cavernous Angioma associated with Oligo- Astrocytoma-like proliferation: Acta Neurochir ; Les tumeurs angiomateuses des centre nerveux. Presse Med ; Tumors of the Central Nervous System.
Atlas of Tumor Pathology. Series 2, Fascicle 6. Armed Forces Institute of Pathology, Pathology of Tumours of the Nervous System, ed 5. Intracranial vascular malformation and astrocytoma. Pleomorphic Xantoastrocytoma with desmoplastic reaction: Clin Neuropathol ; 9: A study of fifty intracranial vascular tumors found accidentally at necropsy.
J Neuropathol Exp Neurol ; Malignant astrocytoma associated with arteriovenous malformation. Histological typing of tumours of the Central Nervous System.
World Health Organization, El Palmar, Murcia,Spain Email: Introduction Councillmann in 3 was the first to report the name of angimoa describing a cerebellar tumor with a huge vascular component.
Case 1 A year-old girl was admitted in our department for progressive bilateral facial palsy. Case 2 A year-old men was admitted in our department for bifrontal headaches for six months. Discussion From a consecutive series of low-grade gliomas surgically treated in our department from towe found 2 cases with histological diagnosis of “Cerebral Angioglioma”. Conclusions Based on our experience and on the literature review, we imply that the presence of rare cases of any kind of AVM associated with a glioma can be interpreted as a truly compound tumor, less likely to be an exceptional coincidence.