PMC5682695_01
(a) axial T1 weighted, (b) axial FLAIR, (c) axial post-gadolinium and (d) axial T2 weighted MR images of the CP angle tumor. The lesion is hypointense on T1WI, hyperintense on FLAIR and T2WI, and display enhancement along its periphery and septations. Mass effect on the 4th ventricle is appreciated
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F1
Magnetic resonance (MR) of the brain revealed a lesion demonstrating T1 hypointensity and T2 hyperintensity with peripheral and septal enhancement in the right CPA [Figure 1].
Intraoperative photographs of the CPA tumor, marked with asterisk (*). (a) Microscopic appearance of the tumor. (b) Microscopic view of the tumor with adjacent anterior inferior cerebellar artery (AICA) (arrow). (c) Microscopic view of CPA tumor with adjacent cranial nerve VII and VIII complex (arrows)
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F2
During craniotomy, retraction of the cerebellum revealed the tumor to be extra-axial [Figure 2].
(a) H and E: Tumor composed of epithelioid, slightly foamy stromal cells with mild degree of degenerative atypia and predominant capillary proliferation (reticular variant). No evidence of increased mitotic activity or extramedullary hematopoiesis. x20 magnification with x40 inset; (b) Reticulin, highlights reticular fibres of the dense capillary network of this reticular hemangioblastoma, x20; (c) Inhibin, demonstrates cytoplasmic expression in stromal tumor cells, x20; (d) MIB1, Proliferation index <5%, x40
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F3
The final diagnosis was reticular variant hemangioblastoma [Figure 3].