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Washington University Experience | VASCULAR | Intravascular Papillary Endothelial Hyperplasia (Masson Tumor) | 5A0 Case 5 History
Case 5 History ---- This is a 43-year-old, right-handed male with a history of recurrent glioblastoma multiforme, status post right frontal craniotomy with placement of Gliadel wafers in September, 2009, followed by adjuvant fractionated radiotherapy and concurrent temozolomide, completed around April, 2006, recently status post five courses of fractionated gamma knife stereotactic radiosurgery with the Extend system, completed February 4, 2011, also with a history of focal motor seizures of the left upper and lower extremity, who presents with increased fatigue, weakness, gait instability, increased headache, with increasing episodes of 10 out of 10 right retro-orbital and bifrontal headache pain associated with nausea, vomiting, and photophobia, and worse in the morning, as well as an increase in his seizure frequency since this past August, where he experienced four seizures, last seizure approximately one week ago. He had another right frontal craniotomy for biopsy and tumor debulking 10/2011, after which time he experienced increased left face, arm, and leg weakness. After that surgery, he had inpatient rehab and later outpatient rehab. His medications include Keppra, Lamictal and Valium 15 mg per day. He denies side effects. Seizure triggers have included stress. No EEG is available. A brain MRI with gadolinium on 3/4 at BJH revealed interval decrease of the tumor likely in response to gamma knife. MRI 2/6 showed no evidence of tumor recurrence. MRI 11/26 revealed decreased flair on the right but new increased flair on the left at the margin. MRI 4/23/13 showed no evidence of progression. MRI 4/28/14 at BJH was unchanged from prior. MRI 2/16/16 showed evidence of post-treatment change vs progression. MRI 6/12/17 was unchanged from prior. MRI 11/1/17 showed left frontal bleed. MRI 2/12/18 showed resolving blood and changes concerning for recurrence. Surgery was performed 2 days later and no evidence for recurrence was found only reactive changes including organizing thrombus with papillary endothelial hyperplasia (PEH) accompanied by brain with marked reactive changes, including scattered atypical cells, consistent with effects of radiation therapy.
