A 47-year-old man with an unremarkable medical history presented with mild dull occipital headaches for 7 months, without other neurologic changes. Structural MRI showed an extraparenchymal, well-delineated left cerebellar lesion with partial postgadolinium enhancement (Figure). Exploration with T1-weighted perfusion (Video 1) revealed a progressive, centrifugal enhancement pattern with slow contrast filling, rapid near the center but slower toward outer edges, suggesting a benign mesenchymal tumor. The absence of mass effect and cerebellar symptoms further supported a slow-growing tumor. A surgical removal was performed. Neuropathologic examination revealed a well-circumscribed lesion with smooth muscle cells and vascular cavities, indicating dural angioleiomyoma (Figure). Dural angioleiomyoma is a rare benign tumor, with <80 cases reported in a recent literature review1 related to soft tissue angioleiomyomas. Partial and flame-like enhancement arising from the tumor base and extending to its periphery seems to be the most typical imaging characteristic,2 and dynamic contrast-enhanced sequence may aid in envisioning diagnosis preoperatively.
MRI: coronal T2 fluid-attenuated inversion recovery (A) and contrast-enhanced T1-weighted sagittal (B) views. Neuropathology: anfractuous vascular cavities separated by muscular walls (Hematoxylin-Phloxin-Saffron) (C). Immunohistochemical analysis: smooth muscle cells labeled with antiactin antibodies (D).
Author Contributions
T. Leclerc: drafting/revision of the manuscript for content, including medical writing for content; major role in the acquisition of data; study concept or design; analysis or interpretation of data. C. Oppenheim: drafting/revision of the manuscript for content, including medical writing for content; major role in the acquisition of data; study concept or design; analysis or interpretation of data. A. Tauziede-Espariat: major role in the acquisition of data; analysis or interpretation of data. Hélène Charpentier: major role in the acquisition of data. J. Pallud: major role in the acquisition of data; analysis or interpretation of data. J. Benzakoun: drafting/revision of the manuscript for content, including medical writing for content; major role in the acquisition of data; study concept or design; analysis or interpretation of data.
Study Funding
No targeted funding reported.
Disclosure
The authors report no relevant disclosures. Go to Neurology.org/N for full disclosures.
Footnotes
-
Go to Neurology.org/N for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.
-
Submitted and externally peer reviewed. The handling editor was Resident & Fellow Section Editor Whitley Aamodt, MD, MPH.
- Received May 4, 2023.
- Accepted in final form July 6, 2023.
- © 2023 American Academy of Neurology
