[PHILIPS 1 case per day] 1 case of parasellar meningeal periangular cell tumor

Case female, 46 years old

Imaging manifestations: CT scan (Figure 1) shows a left parasellar lobular high-density shadow, about 4.

Figure 1 CT flat scan shows a left parasellar lobular high-density shadow, no calcification, CT value 50 HU

Surgically seen: during the operation, the left temporal bone is bitten to the bottom of the middle fossa, and the dura mater is suspended.

Pathological diagnosis: frozen pathology is sent for examination for severe

Fig.

Immunohistochemistry (Figure 5): EMA(-), CD34(+), S-lOO(-), actin (+/-), desmin (+/-), bcl-2(+), ki-67<5%.

Figure 5 Immunohistochemistry: EMA(-), CD34(+), S-lOO(-), actin (+/-), desmin (+/-), bcl-2(+), ki-67<5%.

discuss

HPC occurs mainly in the skin and bone muscle system, is rare intracranial, and accounts for about 0.

The central nervous system HPC is derived from the capillary Zimmerman cell of the interstitial meninge, which is a spindle cell arranged closely against the capillary reticulated fibers, with the potential

Imaging of HPC has certain characteristics

HPC is mostly located next to the saddle and often needs to be distinguished from the following lesions:

(1) Parasellar meningioma: the identification of HPC and meningioma is difficult

(2) Trigeminal schwannoma: the tumor is mostly round or lobular, and the boundary is clear; CT shows equal and low density, MRI T1WI is equal or low mixed signal, T2WI is high signal, and cystic degeneration and necrosis are common in tumors; Uneven lesions and ring-like strengthening after enhancement; Usually no tumor perimeter edema; Trigeminal neuromas grow along the coastal spong sinuses and pre-bridge pools, which can cause resorption of the sphenoid bone, winglets, or rock bone apex bone structures

(3) Cavernous hemangioma, due to the easy to recur bleeding and the lesion MRI signal is complex, depending on the different phases of bleeding, often high and low mixed signals, surrounded by hemosiderin-containing low signals ("iron ring signs") as its characteristic manifestations

(4) Pituitary macroadenoma (involving parasellar): the tumor originates from the pituitary gland, and normal pituitary tissue is often missing and unclear, and there may be "glandular wrapping signs"; T1WI is slightly lower signal, while T2WI is slightly higher signal, there are often cystic changes or microcystic changes in the tumor, and the tumor grows from the saddle inward saddle, which can be seen as a "bundle lumbar sign"; After enhancement, it is delayed strengthening, and the intensity is weaker than that of the normal pituitary gland; The tumor compresses the cavernous sinuses, causing local bone resorption

(5) Carotid aneurysm: CT scan shows a slightly high-density shadow of a parasellar circle, which is strengthened simultaneously with the artery after enhancement (the combined thrombosis is not strengthened), and the CTA can clearly show its tumor-carrying artery

(6) Carotid artery, cavernous sinus fistula: CT shows that the cavernous sinus on the affected side is enlarged and the density is increased, and the contralateral cavernous sinus can also be enlarged, and the CTA can clearly show the vascular mass and the thickened and tortuous superior ophthalmic vein
.
On T1WI and T2WI, there is a low or no signal due to the flow-air effect, and T1WI and T2WI are high signals for intrathrombosis; With enhancement, a disordered vascular mass and drained veins (DCE-MRA)
may be seen.

(7) Chordoma: most of them originate from slope tissue, and the tumor often contains calcification, local bone destruction, and residual crest; Uneven tumor density or signaling; More uneven reinforcement
.
In addition, it needs to be distinguished
from some rare tumors that originate at the bottom of the middle cranial fossa, such as chondroma (sarcoma), bone giant cell tumor, amyloid tumor, etc.

In summary, although HPC is relatively rare, imaging manifestations have certain characteristics, including lobe, uneven signal, vascular enrichment, uneven strengthening, and may have bone destruction, which are helpful in the diagnosis
of HPC.