PMC3640234_01
Comparative clinical photograph of the patient. At the time of presentation (a), after preoperative radiotherapy (b), after surgery (c), and after postoperative radiotherapy (d)
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F1
C1-C2 dermatomes [Figure 1]. Computed tomography (CT) scans of both the head and neck revealed a moderately enhancing 10-12 cm lesion (in greatest diameter) extending from skull base to the thyroid gland.
Computed tomography scan of head and neck sagittal (a), axial (c), and coronal (d) view showing moderately enhancing soft tissue lesion in the nape of neck, extending from skull base to thyroid gland level. Bone window (b) shows erosion of the posterior arch of atlas and occipital bone
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F2
It additionally involved the posterior cervical muscles, eroded through the posterior arch of atlas and occipital bone, where it exhibited both extradural/intraspinal, and intracranial extension [Figure 2].
Photomicroscopy of the excised tumor showing vascular neoplasm consisted of sheets and groups of spindle and oval shaped cells (pericytes) in between thin wall blood vessels in some areas with stag horn pattern (a-low power, b-high power view)
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F3
Histopathology revealed a vascular neoplasm characterized by sheets/groups of spindle/oval cells with a stag horn pattern consistent with HPC located in between plentiful of thin-walled vessels [Figure 3].
Immunohistochemistry demonstrating CD34 (a) and Vimentin (b) positive tumor cells
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F4
On immunohistochemistry, consistent with the diagnosis of HPC, the tumor cells were positive for both cluster of differentiation 34 (CD34) [Figure 4a] and vimentin [Figure 4b].
Computed tomography scan done at 2 month, sagittal (a) and axial (b) view demonstrating near total decompression of the craniovertebral junction with minimal residual tumor
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F5
The postoperative CT scan documented only a minimal amount of residual tumor (near the atlanto-occipital junction) with near complete decompression of the craniovertebral (CV) junction [Figure 5].