Hemangiopericytoma

Findings:

A complex irregular strongly enhancing mass is present in the right parietal parasagittal region with significant mass effect and surrounding vasogenic edema. The mass has a broad base of contact to the dura and a dural tail. The mass demonstrates spotty hemorrhagic changes or calcifications on susceptibility weighting. Marked hyperperfusion as seen on the ASL sequence. The lesion does not cause dural sinus occlusion.

Differential Diagnosis/Discussion:

An aggressive lesion is certain due to the degree of edema and mass effect as well as the hypervascularity. One of the primary diagnostic dilemmas in this patient is differentiating extraaxial from intraaxial. If intra-axial, a high-grade malignant lesion such as GBM or metastasis could be considered. The broad base of contact to the dura and dural tail indicates that this mass more likely extra axial but still aggressive. Of the aggressive extraaxial lesions, hemangiopericytoma, aggressive/malignant meningioma, and metastasis could be indistinguishable. Gliosarcoma with dural invasion can also appear similar.

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