J Korean Neurosurg Soc.  2017 Jan;60(1):102-107. 10.3340/jkns.2015.0707.011.

Collision Tumor Composed of Meningioma and Cavernoma

• Weigel J
• Neher M
• Schrey M
• Wünsch PH
• Steiner HH

• KMID: 2365595
• DOI: http://doi.org/10.3340/jkns.2015.0707.011

Abstract

A true collision tumor is a rare entity composed of two histologically distinct neoplasms coinciding in the same organ. This paper reports a unique case of cerebral collision tumor consisting of two benign components. On the first hand, meningioma which is usually a benign lesion arising from the meningothelial cell in the arachnoidal membrane. On the other, cerebral cavernoma which is a well-circumscribed, benign vascular hamartoma within the brain. To our knowledge, there is no previously documented case of cerebral collision tumor consisting of two benign components. A 56-year-old Caucasian male suffered in 2002 from an atypical meningioma WHO II° located in the left lateral ventricle. Three years after the tumor extirpation, the patient suffered from a hematoma in the fourth ventricle due to a recurrently haemorrhaged cavernoma. In 2008, a recurrence of the tumor in the left lateral ventricle was discovered. Additionally, another tumor located in the quadrigeminal lamina was detected. After surgical resection of the tumor in the left lateral ventricle, the pathological examination confirmed the diagnosis of a collision tumor consisting of components of a meningioma WHO II° and a cavernoma. Postoperatively, no adjuvant treatment was needed and no tumor recurrence is discovered up to the present. A possible explanation for the collision of those two different tumors may be migration of tumor cells mediated by the cerebrospinal fluid. After 5-years of follow-up, there is no sign of any tumor recurrence; therefore, surgical tumor removal without adjuvant therapy seems to be the treatment of choice.

Keyword

Collision tumor; Meningioma; Cavernoma; Tumor intraventricular

MeSH Terms

Arachnoid
Brain
Cerebrospinal Fluid
Diagnosis
Follow-Up Studies
Fourth Ventricle
Hamartoma
Hand
Hematoma
Humans
Lateral Ventricles
Male
Membranes
Meningioma*
Middle Aged
Recurrence

Figure

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  Fig. 1 Atypical menigeoma (Haematoxylin-Eosin [HE] stain).

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  Fig. 2 Mib1-stain.

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  Fig. 3 A : T1-weighted axial MR image after contrast administration showing the tumor before the last operation. B : T2-weighted sagittal MR image showing the tumor before the last operation. MR : magnetic resonance.

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  Fig. 4 A : T1 weighted axial MR image after contrast administration showing the tumor in the quadrigeminal lamina. B : T1 weighted sagittal MR image after contrast administration showing the tumor in the quadrigeminal lamina. MR : magnetic resonance.

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  Fig. 5 Cavernoma. EVG stain. EVG : Elastica-van-Gieson.

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  Fig. 6 EMA stain. EMA : epithelial membrane antigen.

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  Fig. 7 Collision of Cavernoma and Meningeoma, showing positive staining for EMA and EVG stain. EMA : epithelial membrane antigen, EVG : Elastica-van-Gieson.

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  Fig. 8 A : T1 weighted axial MR image after contrast administration after tumor extirpation. B : T1 weighted axial MR image after contrast administration, three year follow up. MR : magnetic resonance.

Reference

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