case_images: PMC10695465_01
case_images: Head computed tomography (CT) and brain magnetic resonance imaging (MRI). (a and b) CT showed that a high-density lesion in the right precentral gyrus indicates intraparenchymal hemorrhage without contrast enhancement. (c and d) MRI T1 and T2-weighted images showed that heterogeneous intensity mass lesion at the precentral gyrus consists of hemorrhagic change. (e-g) MRI T1-weighted image with gadolinium (e: axial view, f: coronal view, g: sagittal view) exhibited a heterogeneous intensity mass with surrounding contrast enhancement. There was no flow void around the lesion.
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case_images: PMC10695465_01_SNI-14-401-g001.jpg
case_images: F1
case_images: A computed tomography (CT) scan revealed a high-density area (3 mL) located in the right motor cortex, suggesting subcortical hemorrhage [Figure 1a]. Contrast-enhanced CT revealed no enhanced lesion [Figure 1b]. Magnetic resonance imaging (MRI), T1 weighted and T2 weighted images displayed a mass with mixed intensity and the abscense of surrounding flow void [Figures 1c and d], and T1 weighted images wigh Gadolinium contrast exhibited a heterogenous intensity mass with surrounding with surrounding contrast enhancement [Figures 1e-g].
case_images: Digital subtraction angiography (DSA). (a) Anteroposterior view of the right internal carotid artery (ICA), (b) Lateral view of right ICA, DSA showed a vascular area consisting of a lesion (yellow circle) and no abnormal vascular structure or tumor stain.
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case_images: PMC10695465_01_SNI-14-401-g002.jpg
case_images: F2
case_images: Cerebral digital subtraction angiography (DSA) indicated the absence of vascular staining, abnormal arteriovenous shunts, or developmental venous malformations adjacent to the subcortical hemorrhagic lesion [Figure 2].
case_images: Intraoperative findings. (a) Upon exposure of the cortex, edema, and swelling were observed, and the brain surface was pale above the lesion (blue circle). (b-d) En-bloc resection was performed. We could see a nonencapsulated mass lesion with hemorrhagic change (b), and the border between the white matter and the lesion was well-defined (c). (e and f) The specimen exhibited a reddish-black color; upon inspection of the lesion, no mulberry formations were identified, suggesting that this lesion might differ from cavernous hemangioma.
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case_images: PMC10695465_01_SNI-14-401-g003.jpg
case_images: F3
case_images: Upon exposure of the cortex, edema, and swelling were observed, and the brain surface was pale above the lesion [Figure 3a]. The border between the white matter and the lesion was well-defined, allowing for complete tumor resection [Figures 3b-e]. The excised specimen exhibited a reddish-black color [Figures 3e and f]. Upon inspection of the lesion, no mulberry formations were identified [Figure 3f], suggesting that this lesion might differ from cavernous hemangioma.
case_images: Micrographs of hematoxylin-eosin (HE) and immunohistochemical findings (CD 31, CD 34, SMA, Ki-67, p53). (a and b) HE staining x10, x40: capillary-like vascular structures with thin-walled endothelial cells displaying irregular anastomoses. There was no blood filling within the vessels as seen in the histopathology of cavernous hemangiomas, and the extravascular area consisted of thick connective tissue; (c and d) immunohistochemical staining: CD 31 x10, x40; (e and f) immunohistochemical staining: CD 34 x10, x40; (g and h) immunohistochemical staining: SMA x10, x40; (i) p53; (j) Ki-67. Immunostaining demonstrated positive expression of CD31 and CD34, indicative of endothelial cells forming irregular lumens.
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case_images: PMC10695465_01_SNI-14-401-g004.jpg
case_images: F4
case_images: Histopathological examination of the lesion revealed the presence of capillary-like vascular structures with thin-walled endothelial cells displaying irregular anastomoses and areas of hemorrhage [Figures 4a and b]. The p53 was negative, and the Ki67 positivity was low (<3%), consistent with a benign hemangioma [Figures 4c-j].
case_images: Immunohistochemical findings (CD 31, CD 34, SMA, Ki-67, p53). (a and b) Cytokeratin AE1/AE3 x10, x40; (c and d) Inhibin x10, x40; (e and f) EMA x10, x40; (g and h) GLUT-1 x10, x40.
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case_images: PMC10695465_01_SNI-14-401-g005.jpg
case_images: F5
case_images: The intercapillary cells were negative for inhibin, epithelial membrane antigen (EMA), and glucose transporter-1 (GLUT1) (red blood cells were positive), excluding hemangioblastoma, meningioma, and hemangiopericytoma [Figures 5a-h].