METASTATIC HEMANGIOPERICYTOMA OF THE LUNG M. Mehmood; N. Siddiqui; R. Holladay Department of Internal Medicine, LSU Health Sciences Center - Shreveport Introduction: Hemangiopericytomas are a phenotype of solitary fibrous tumors which are considered malignant tumors of the central nervous system (CNS) and account for less than 1% of all CNS tumors. Patients often present with neurologic symptoms from the mass effect or edema within one year of tumor development due to the rapid onset of these biologically aggressive tumors. Treatment modalities generally include resection, radiation therapy, and adjuvant chemotherapy. However, these tumors have a high rate of local recurrence even after gross complete resection. Hemangiopericytomas also have a high propensity to metastasize along the neuraxis to extracranial structures (e.g. lung, bone) in about a quarter of the cases. Case: Here we describe an interesting case of a 52-year-old female, who was diagnosed with hemangiopericytoma and had a complete resection performed. She was found to have local CNS recurrence nine years after the initial surgery. She underwent repeat resection with adjuvant radiation therapy. At the same time, she was noted to have bilateral pulmonary nodules but was lost to follow up. She presented again with neurological symptoms two years later and was found to have enlarging pulmonary nodules. Navigational bronchoscopy was performed which was non-diagnostic for malignancy. One week after bronchoscopy, she presented with hemoptysis and underwent robot assisted right upper lobectomy as the mass was suspected to be the source. Surgical pathology revealed metastatic hemangiopericytoma with presence of NAB2-STAT6 fusion by immunohistochemistry. Discussion: This case highlights the aggressivenatureofhemangiopericytoma and the ability to metastasize. The rates of extracranial metastases are approximately 28% with about 18%
AN UNKNOWN CASE OF STROKE
of those to lung and pleura. This case was classified as WHO Grade III based on the pathology; however, there is no correlation to metastasis potential based on grade as metastasis is seen in all tumor grades. Despite the acceptance to long term follow up and high clinical suspicion for metastasis, there are no established protocols or guidelines for surveillance. Development of an established protocol is needed as there is currently a wide variation in clinical practice for follow up.
J. Hanawi-Heintze; Y. Ping Lin; J. Jaikishen Department of Internal Medicine, LSU Health Sciences Center - Lafayette Case: A 23-year-old woman with past medical history of bipolar disorder presented with complaints of left-sided weakness, headache, and numbness for 1 week. She initially presented to another facility where she was treated symptomatically. She then presented to our hospital because the above unrelenting symptoms. Left sided weakness was associated with ambulation difficulties. She reported falling several times. She also endorsed having throbbing, migraine-like headaches that began 1 month prior to admission, located in entire frontal region and top of her head with associated photosensitivity and vision changes. She was evaluated in the ED and noted to have left sided weakness, numbness, lethargy and headache. CT head excluded acute intracranial hemorrhage. Due to low grade fever, lethargy and headache, she was started on vancomycin, acyclovir, and ceftriaxone for empiric treatment of meningoencephalitis. MRI brain showed bilateral periventricular white matter foci suggestive of demyelinating disease, with active plaque formation in the area of enhancement on restricted diffusion images. Lumbar puncture showed the presence of oligo clonal bands. CSF cultures were negative at 48 hours. At this point, she was started on high dose steroids. All antimicrobials were rapidly deescalated. She then had complete resolution of symptoms over the next few days and she regained her ability to ambulate. She was discharged with a diagnosis of multiple sclerosis. Multiple Sclerosis (MS) is a heterogeneous disorder with an unknown cause that manifests itself in a variety of ways. Symptoms are often caused by inflammation, demyelination, and axonal degeneration. MS is associated with autoreactive lymphocytes, microglial activation and chronic Discussion: neurodegeneration. Initial manifestation is a clinically isolated symptom that can develop in an acute or subacute manner. However, as the disease can progress in various ways; MS is characterized into subtypes based on progression. This
23 J LA MED SOC | VOL 171 | NO. 1
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