Neoplasm Intracranial capillary hemangioma: case report and review of the literature Scott L. Simon, MD a, * , Gul Moonis, MD b , Alexander R. Judkins, MD c , Janice Scobie, MD d , Mark G. Burnett, MD a , Howard A. Riina, MD e , Kevin D. Judy, MD a a Departments of Neurosurgery, b Neuroradiology, c Pathology, and d Medicine, The Hospital of the University of Pennsylvania, Philadelphia, PA 19104, USA e Department of Neurosurgery, Cornell University, New York, NY 10021, USA Received 9 August 2004; accepted 11 October 2004 Abstract Background: Capillary hemangiomas are benign vascular lesions that commonly present at birth or in early infancy on the face, scalp, back, or chest. The authors present an exceedingly rare case of an intracranial capillary hemangioma arising in an adult. Only 4 biopsy-proven cases have been reported in the pediatric population previous to this case report. Case Description: A 31-year-old pregnant woman presented at 38 weeks of gestation with severe headaches, nausea, and vomiting. Imaging revealed an extra-axial mass lesion arising from the tentorium with both supra- and infratentorial components. The patient underwent a resection of her tumor, which was diagnosed as a capillary hemangioma by histopathologic examination. The patient required 2 further resections after the lesion exhibited a rapid regrowth from residual tumor in the left transverse sinus. The patient has remained free of disease 41 months out from her third surgery. Conclusions: Intracranial capillary hemangiomas are exceedingly rare entities, with a capability for rapid growth. When gross total resection cannot be achieved, these patients should be observed closely, and the use of adjuvant radiotherapy should be considered. D 2005 Elsevier Inc. All rights reserved. Keywords: Capillary hemangioma; Intracranial; Central nervous system 1. Introduction Capillary hemangiomas are benign vascular neoplasms. They commonly present congenitally or in early infancy, with 10% of these tumors presenting in the first year of life [2,20]. Typically, these lesions grow rapidly until their growth plateaus between 8 and 12 months. Often, these lesions undergo complete spontaneous regression by 5 years. When these lesions do not regress, they are usually treated surgically. When these tumors occur in adults [14], they occur more often in women, where these tumors may undergo changes in their size relative to hormonal cycles and pregnancy [6]. They are usually found on the face, scalp, back, or chest, but may appear anywhere in the body. Although capillary hemangiomas are benign tumors, they can recur after partial [25] or even complete [5] resection. Histologically, these tumors are characterized by a low- power lobular architecture with cellular lobules separated by variable degrees of fibrosis, depending on the age of lesion and the extent of regression. Careful inspection reveals plump endothelial cells forming poorly defined capillary channels. Fibroblasts, pericytes, and mast cells are also seen in these lesions. Characteristic features of these lesions, including their vascular nature when densely cellular, may be highlighted by histochemical and immunohistochemical special stains [9]. Capillary hemangiomas involving the nervous system are extremely rare. Cases of capillary hemangiomas arising from the meninges [35], nerve roots [30], cauda equina [11,15,18,28], and spinal cord [1,23,31] have been previ- 0090-3019/$ – see front matter D 2005 Elsevier Inc. All rights reserved. doi:10.1016/j.surneu.2004.10.025 * Corresponding author. Deparment of Neurosurgery, The Hospital of the University of Pennsylvania, Silverstein 5, 3400 Spruce Street, Philadelphia, PA 19104. Tel.: +1 215 349 8325; fax: +1 215 349 5534. E-mail address: ssimonpa@yahoo.com (S.L. Simon). Surgical Neurology 64 (2005) 154 – 159 www.surgicalneurology-online.com