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A 27-year-old women was referred to our hospital because of abnormal subpleural nodule in her right thoracic cavity. Chest computed tomography demonstrated an 11 mm nodule with smooth and clear boundary adjacent to the right first rib. Chest magnetic resonance imaging revealed an iso-intensity area on T1-weighted images, a high-intensity on T2-weighted images, and enhanced homogeneously on contrast-enhanced images. Tumor extirpation was performed using a 2.7 mm grasp fine needlescopic forceps, a 3 mm thoracoscope and a 5 mm vascular sealing device. The histological diagnosis was cavernous hemangioma. Thoracoscopic surgery using fine needlescopic forceps and thin thoracoscope is useful in considering esthetic purposes.

A 66-year-old male with hypertension was referred for evaluation of abnormal find chest X-ray. A computed tomography (CT) scan revealed a solitary pericardial mass with a diameter of 5 cm, located in the left atrioventricular groove. It showed solid but unevenly enhanced contents suggesting a well vascularized tumor originating in either a part of the left heart or the pericardium. As magnetic resonance imaging showed a clear boundary between the tumor and the pericardium, cardiac origin was suspected. Surgical removal of the tumor was performed via median sternotomy. The tumor originated from the lateral aspect of the left atrial appendage, having a base of 10 mm in diameter. The tumor was fully excised with an associated left atrial cuff under cardiopulmonary bypass. The postoperative course was uneventful. The tumor was histopathologically diagnosed as cavernous hemangioma originating in the left atrial wall. There has been no sign of recurrence for four years following surgery.

We report a case of retroperitoneal cavernous hemangioma. A 77-year-old woman complaining of nausea was admitted to a different hospital in September 2013. Computed tomography (CT) detected a retroperitoneal mass in the left pararenal space. Three years later, repeated CT showed that the tumor had gradually grown in size. On dynamic contrast-enhanced magnetic resonance imaging (MRI), the tumor demonstrated radiographic signs of a liposarcoma. Resection of the mass with left nephrectomy was performed in June 2016, and histopathology showed cavernous hemangioma. Clinical diagnosis of cavernous hemangioma is difficult, and imaging modalities, including CT and MRI, may not be conclusive. The final diagnosis in most cases is established through surgery. This is the 29th case of retroperitoneal cavernous hemangioma to be reported in Japan.

We encountered a case of a cardiac hemangioma protruding into the inner cavity of the right ventricle from the right ventricular free wall. The tumor gradually enlarged over 11 years (from 35 mm to 78mm) without presenting any symptoms. However, when it extended to the right ventricular outflow tract, non-sustained ventricular tachycardia occurred, and emergency surgery was required. The tumor was diagnosed as a cavernous benign hemangioma. Complete resection was not possible, and the part involving the right ventricle remained. This residual tumor caused postoperative ventricular arrhythmia, and an implantable cardioverter defibrillator was required. We concluded that non-surgically treated cardiac hemangiomas carry the risk of non-resectability, regardless of malignancy.

A 35-year-old female presented with a cavernous angioma of the septum pellucidum manifesting as headache and nausea. Computed tomography and magnetic resonance imaging revealed a mass at the septum pellucidum with intraventricular hemorrhage and mild hydrocephalus. Digital subtraction angiography showed no abnormal finding and thallium-201 single photon emission computed tomography showed no uptake in the lesion. The preoperative diagnosis was intraventricular tumor, such as subependymoma. The lesion was completely resected through the transcallosal approach. The histological diagnosis was cavernous angioma. Cavernous angiomas are usually located in the cerebral parenchyma and rarely occur in the cerebral ventricles. In particular, cavernous angioma at the septum pellucidum is very rare. If magnetic resonance imaging does not clearly show the typical peripheral hypointense rim, neuroimaging diagnosis will be difficult. Surgical resection should be considered to confirm the histopathology, in particular if bleeding and hydrocephalus are present.

Focal nodular hyperplasia(FNH) is a benign tumor-like lesion of the liver. The telangiectatic type is an atypical histologic variant of FNH, and descriptions of its radiologic findings are rare. We report a case of telangiectatic FNH. A 26-20 mm round lesion was found in the lateral segment of the liver. Although this lesion appeared similar to cavernous hemangioma with rapid intratumoral contrast material enhancement on cross-sectional images, its signal intensity decreased on T2-weighted imaging after the administration of superparamagnetic iron oxide(SPIO), and its appearance differed from that of cavernous hemangioma.

Familial occurrence of intracerebral cavernous angioma has been rarely reported. We report two histologically verified cases of cavernous angioma among brothers and review relevant cases in the literature. Case 1 is that of a 3-year-old boy who suffered front acute onset of headache, vomiting, and tonic-clonic type seizure. CT revealed a well-demarcated tumor with partial hemorrhage in the left frontal lobe which was strongly enhanced with contrast Medium. Complete excision was carried out and the patient had a satisfactory clinical course and was able to be followed up for 13 years after the Surgery. Case 2 is that of a 17-year-old boy who was the elder brother of case 1 and presented with gradually increasing episodes of a psychomotor seizure which started at the age of 16. CT and MRI revealed a well-demarcated tumor in the left subcortical temporal lobe and an asymptomatic small calcified lesion in the left subcortical parietal lobe. The temporal tumor was totally excised and histologically diagnosed as cavernous angioma. The seizures gradually decreased and eventually disappeared one year after the surgery. This report reviews 13 previously reported cases, and surgical indication for asymptomatic cases.

Twelve patients with 25 hepatic cavernous "hemangiomas of less than 2 cm in diameter received spiral volumetric CT (SVCT) examination using the special scanning programs named "double-phase return scan" or "triple-phase scan", which referred to arterial-, portal-dominant and/or late phases. Twenty-three lesions were not only detected, but characterized by applying these programs, although it has been difficult to detect such smaller lesions with the single level dynamic CT because of respiratory misregistration or multi-spreading lesions. SVCT made it possible to scan the whole liver during single breath-hold without any misregistrations. SVCT should become an indispensable procedure to assess subcentimeter lesions in the liver.

We reported a case of cavernous angioma in the middle cranial fossa, which was diagnosed with magnetic resonance imaging (MRI) and magnetic resonance angiography (MRA). The patient was a 56-year-old female, who presented with sudden onset right-sided headache with nausea. Her neurological findings were normal. On CT scan a high density area with a surrounding thin low density area was shown in the right posterior temporal region without contrast enhancement. Cerebral angiography of the left vertebral artery revealed only a small stain at the end of the right posterior temporal artery. On T2-weighted MRI after one month, the same region exhibited a central area of mixed signal intensities surrounded by a rim of decreased signal. MRA showed an area with remarkable 10mm mass with some contiguous vessels in the right posterior temporal region. That mass was resected operatively. It's pathological diagnosis was cavernous angioma. For diagnose of cavernous angioma, MRI and MRA were very useful. The specificity of these methods are superior to better than CT or angiography.

A case of cavernous angioma of the pons which was surgically and successfully excised was reported. A 36 year-old man complained of progressive headache, double vision and tinnitus. Neurologic examination revealed left fifth, sixth and seventh cranial nerve palsies. He had left limb ataxia and right sided hemisensory deficit. A computed tomographic (CT) scan on admission disclosed a hematoma in the left lateral portion of the pons. Serial CT scans demonstrated progressive increase of hematoma. MRI scans revealed an area of mixed signal intensity in T1 weighted images. These findings were thought to be consistent with a cavernous angioma. Three months after the onset, surgery was performed using a lateral suboccipital approach. Histological examination disclosed cavernous angioma. After surgery, the patient's neurological deficits improved, and after 3 months, all symptoms except the mild limb ataxia had disappeared.

Ultrasonography using a 5-MHz sector-scanning probe was performed in 4 patients with intraventricular or periventricular lesions. All patients underwent craniotomy, and the lesions included an intraventricular cyst (Case 1, Fig. 1), a subependymoma (Case 2, Figs. 2 and 3), a hypothalamic glioma (Case 3, Fig. 4) and a periventricular cavernoma (Case 4, Fig. 5). The lesion was approached in the former 3 cases via the transcallosal route and in the last via the transcortical route. Preoperative MRI was performed in such a way that both the lesion and the anticipated operative route to it were shown on the image, so that the approach angle and surrounding structures could be assessed. During craniotomy, intraoperative ultrasonographic examination was performed while the dura was still closed. By frequently changing the probe direction, we were able to obtain an image similar to that shown on the preoperative MRI, and we then initiated intradural operative procedures at an angle parallel to the axis of the probe. Since MRI provides detailed anatomical information about the approach to the lesion and the tissue around it, it has become an indispensable tool in the planning of neurosurgical operations. Although ultrasonography generally provides poorer resolution than does MRI, especially for deep structures, it does provide convenient, real-time images of any slice. Because the interhemispheric fissure, lateral ventricle, and choroid plexus have distinctive shapes and echogenicity and, hence, can be readily recognized, we found that they can be good landmarks in the imaging of periventricular or intraventricular lesions.(ABSTRACT TRUNCATED AT 250 WORDS)

Authors reported an autopsy case of extracerebral cavernous hemangioma in the middle fossa and discussed the effect of irradiation therapy on it. A 72-year-old woman was admitted due to progressive deterioration of consciousness and the right hemiparesis. CT scan revealed a slightly high density mass, which was markedly heterogeneously enhanced with contrast media, in the left middle cranial fossa. Angiogram with prolonged injection demonstrated a faint tumor stain. Craniectomy and partial temporal lobectomy for decompression were performed, but the tumor could not be removed due to uncontrollable hemorrhage. Her level of consciousness further deteriorated, and in addition heart failure developed. And finally she became vegetative in spite of effective irradiation therapy of 46Gy. CT scan taken three months and seven years after the irradiation showed marked regression of the tumor. After the vegetative state for 8 years, the patient died of acute pancreatitis, and autopsy was performed. The cavernous hemangioma with markedly proliferated interstitial connective tissue and thrombosed vessels was verified by microscopical examination. Although the treatment was not successful in this patient, we confirmed that irradiation is useful in the management of the extra-axial cavernous hemangioma in the middle fossa as a pre- or postoperative adjunct therapy.

Clinical features and surgical indication of cavernous malformation (CVM) of the brain stem are reviewed, based on the analysis of five personally encountered cases and nineteen previously reported cases. Nineteen out of these twenty four cases presented sudden onset of neurological deficits suggesting brain stem hemorrhage. Although the majority of those patients with acute onset improved gradually within a couple of weeks, all cases, except for six cases treated with radical removal following their first bleeding episodes, presented recurrent hemorrhages, and one third of them died due to the repeated hemorrhages. The other six cases presented progressive neurological deficits with insidious onset. They were first diagnosed as brain stem gliomas or multiple sclerosis. All except two cases treated with radical removal of the CVM died within a year. Surgical indication of the cerebral CVM is still controversial, because its clinical presentations and natural history have been unclear. Recent clinical application of magnetic resonance imaging enables us not only to make a preoperative diagnosis accurately, but also to evaluate the operability in relation to its anatomical location. Because of an apparent disposition towards repeated hemorrhages, surgical removal should be considered for the symptomatic CVM in the brain stem, on which microsurgical manipulation would be possible with an acceptable risk in many cases.

A 55-year-old woman with a giant cavernous hemangioma in the liver with hemoperitoneum due to blunt abdominal trauma was reported. CT findings of the liver at first thought to be hepatic injuries. But serial studies revealed that the CT findings were dependent on giant cavernous hemangioma and apart from hepatic injury.

A 6-year-old boy had an abnormal shadow on the chest X-ray film. It showed a tumor shadow with calcification on the right hilum. The plain CT scan showed an anterior mediastinal mass and its density was similar to that of large vessels. On the angio CT scan the lesion displayed a much lower enhancement than large vessels. The tumor was resected completely by median sternotomy. It was 5.6 X 3.6 X 3.0 cm in size and contained a phlebolith 5 mm in diameter. The histological diagnosis was cavernous hemangioma.

The authors report a case of parasellar cavernous hemangioma having grown to the suprasellar region within 3 year's period and showing acute visual disturbance caused by intratumoral hemorrhage. A 44-year-old woman, who had experienced spontaneous intracerebral hematoma in the left inferior frontal lobe 3 years ago and then obtained good recovery in the post-operative period had suddenly developed decreased visual acuity of the left eye without other neurological deficit. CT scan revealed an irregular mass lesion in the chiasmal region, which had a crown-like high density area over the suprasellar low density. Carotid angiogram showed a suprasellar avascular mass and the left A1 segment showed marked narrowing. Neither tumor nor venous pooling was visible in the capillary and venous phase. Surgery disclosed a reddish dark tumor with thin capsular wall, extending from the left cavernous sinus to the suprasellar region, and it was accompanied by intratumoral hemorrhage compressing the left optic nerve. The tumor was subtotally removed. High density area on the precontrast scan was confirmed to be intratumoral hemorrhage and the low density area was of organized tissue due to thrombosis. Histological finding was compatible to cavernous hemangioma. Postoperatively visual acuity of the patient was well recovered, but left 3rd and 6th cranial nerve palsy followed. The authors discussed the mechanism of acute onset and CT findings of the cavernous hemangioma arising in the chiasmal region with a review of literature.

Cavernous angioma is a rare but important clinical entity because of its potential curability. We experienced with 6 cases of cavernous angiomas located in the subcortical region and summarized with special respect on clinical symptoms, CT scan, angiographic manifestations and operative findings. In all of these 6 cases, the diagnosis is confirmed as cavernous angioma histologically. The age in these cases ranged from 16 to 45 years and sex distribution was 3 males and 3 females. Initial symptoms of 6 cases were long-standing epilepsy in 4 cases and attack of unconsciousness in 2 cases. Plain craniogram revealed calcification in only one patient. On the other hand, plain CT scan showed high density areas in all cases. Among these, 3 patients showed slight contrast enhancement. Perifocal low density areas were noted in all cases and these low density areas extended to the cortical region. The most important lesion to differentiate from cavernous angioma is low-grade astrocytoma with calcification on CT scan. We misdiagnosed in one patient with cavernous angioma as contusional hemorrhage, because the patient fell unconscious and hit the occiput. Angiographically, most cavernous angiomas are represented as avascular masses with displacement of adjacent vessels. In contrast to this general acceptance, 4 out of the present 6 cases showed abnormal findings such as feeding artery, capillary blush and draining vein. The draining veins were encountered in 4 cases. It must be emphasized that these angiographic manifestations are very small and caution has to be paid not to be overlooked. From the operative view, there are several characteristic findings.(ABSTRACT TRUNCATED AT 250 WORDS)

A case of multiple cavernous hemangiomas of the lung is presented. A 61-year-old woman was suffering from mitral stenosis and insufficiency. On the chest roentgenogram, multiple tumor shadows were revealed at all the lobes of the lung. She had been followed up for about 10 years under the diagnosis of the metastatic carcinoma of the lung. But no tumor lesion had been found at any other organs. Throughout this period, the tumor shadows had not changed in size or number. She died of congestive heart failure, and an autopsy was performed. Histologically, the tumors were diagnosed as cavernous hemangiomas and differentiated from arteriovenous fistula or sclerosing hemangioma.

A 32-year-old male, who had had temporal lobe seizure for the past 10 years, was admitted to the neurosurgical institute of Tenri Hospital on March 10, 1981. Physical examination on admission revealed some memory disturbance, neuroasthenic tendency and a purplish nevus in the left foot. Plain x-ray series of the skull showed several nodular calcified lesions in the medial aspect of the left temporal lobe. Electroencephalography showed sporadic negative spikes and irregular slow waves dominant in the left anterior quadrant of the head. CT scan showed a high-density area in the left hippocampal gyrus with slight enhancement by contrast medium. Under stereotactic consideration, a left temporal osteoplastic craniotomy and total removal of the mass were performed on March 20, 1981. The histological examination proved it to be calcified cavernous hemangioma or hemangioma calcificans after Penfield and Ward (1948). Postoperative course was uneventful; even 4 weeks after surgery, electroencephalogram became normalized, and memory and anxiety scores became better. At present, in spite of decreased anticonvulsant, the patient has had no more seizure since surgery, and has returned to his business without any complaint. The authors have emphasized the necessity of active operation for hemangioma calcificans even for the one located in the depth of the dominant cerebral hemisphere. Stereotactic consideration can make the surgical risk minimize. CT scan especially with its contour plot of the images is helpful precisely to locate the lesion. For the nevus in the left foot, the biopsy was refused by the patient, which might have connection with the intracerebral cavernous angioma.

We report three cases of extracerebral cavernous hemangiomas in the middle fossa all of which had received radiotherapy. Follow-up study with serial computed tomography during and after irradiation were presented. In Case 1, radiotherapy after partial removal of the tumor reduced the tumor's size and CT number, and facilitated total removal. In Case 2 as well, irradiation was started before the operation. The tumor responded very well to irradiation and showed significant reduction in the size and CT number of the tumor with a dose of about 3,000 rads. Subtotal removal was possible. In Case 3, the tumor responded very well clinically to irradiation, and vertigo were much improved with a dose of about 3,000 rads, and CT scan at that time showed significant reduction in the size and CT number of the tumor, therefore she only received radiation therapy, no surgical intervention. It is concluded that in cases of extracerebral cavernous hemangioma with massive hemorrhage, radiation of up to 3,000 rads was a method of choice. The treatment results in an increased probability of total removal of the tumor, and moreover the possibility of eliminating surgery.

A case of convexity cavernous hemangioma associated with sellar meningioma with parasellar extension is presented. A 61-year-old female who had complained of left blepharoptosis and diplopia was admitted to our hospital. On admission she showed left oculomotor nerve palsy. Plain CT revealed an isodense mass in the sellar and parasellar region. Computed angiotomography demonstrated that this mass was enhanced heterogeneously and filled the sellar turcica and extended superiorly. And homogeneously enhanced mass in the convexity without mass effect was observed. Angiogram revealed no tumor stain in any phase. With these findings, this case was diagnosed as the multiple meningiomas preoperatively. Left frontotemporal craniotomy was carried out, and subtotal removal of sellar and parasellar tumor and total removal of convexity tumor were performed. Pathologically the sellar and parasellar tumor was diagnosed as meningioma, convexity tumor as cavernous hemangioma derived from dura mater. Convexity cavernous hemangioma derived from dura mater is very rare, only one case was reported previously. Only 2 cases of cavernous hemangioma associated with meningioma have been reported in the literature. Correlation between cavernous hemangioma and meningioma is discussed. It is possible to owe this complication to the developmental abnormality concerning with inner factor like genetic factor and so on, because both tumors are mesodermal origin. However it is proper to regard that this complication occurred by chance.

A 44-year-old woman was admitted to our department because of a painless lump on her forehead. Physical examinations were normal except for this lump. Both laboratory data and neurological findings were normal. Plain skull radiograph showed a 4.5 X 5.0 cm honeycombed radiolucent defect in the frontal bone. CT scan demonstrated this lucent defect as a reticular pattern by means of changing the window levels. Moreover, invasive lesion of the inner table which could not be identified in the plain radiographs, was also demonstrated on CT. A left common carotid angiogram showed irregular pooling of contrast material in the radiolucent area of the frontal bone. Angiographically, blood supplies to this tumor were mainly contributed by the frontal branches of the middle meningeal artery and a meningeal branch of the anterior falx artery from the terminal portion of the ophthalmic artery. A bone scintigram revealed accumulation of radioisotope in the lesion. A highly vascular tumor, which was partially adherent to the underlying dura, was removed as en bloc. Postoperative course was uneventful. The histology revealed thin-walled dilated vessels between the trabeculae, and it was diagnosed as cavernous hemangioma of the bone. Hemangioma of the calvarium is estimated to constitute 0.2% of all osseous neoplasms and 10% of primary benign neoplasms the of the skull. Hemangioma of the skull frequently involves the frontal bone. The condition is often found in middle-aged females. The symptom is only a slowly growing, painless lump in most of the cases.(ABSTRACT TRUNCATED AT 250 WORDS)

A rare case of Maffucci's syndrome with intracranial chondroma was reported and the literature reviewed. A 16-year-old female high-school student was reffered to our service with 2 month history of diplopia and headache. She had been noticed to have multiple subcutaneous blueish nodules in the lower extremities and multiple body deformities in the four extremities since 6 months old. A biopsy of a skin lesion revealed cavernous hemangioma with calcified thrombi. Another biopsy from the deformed right femur showed it to be enchondroma. Skull series, carotid and vertebral arteriographies, and CT scan revealed a left parasellar mass, which had brought her sensory impairment of the left V1 and the left abducens palsy. The biopsy of the extradural mass in the medial portion of the left middle fossa proved it to be chondroma identical with the right femur lesion. So far as one year postoperative follow-up, she has been doing well with the postoperative sequela of mild left oculomotor paresis, having no evidence of malignant degeneration.

A case of cavernous angioma at the lateral wall of the third ventricle which was totally removed with interhemispheric trans-lamina terminalis approach is reported. A 40-year-old male had a slowly progressive onset of partial diabetes insipidus and headache with no neurological deficit . CT scan revealed a high density area at anterior third ventricle. The tumor was diagnosed ectopic pinealoma because of CT findings and clinical symptoms. Irradiation and chemotherapy ( RAFP therapy) was performed to this lesion. After two months, his clinical symptoms disappeared. CT scan showed decrease of the density of the region at this point. He was discharged with no symptom. After a half year, he suddenly complained of right homonymous hemianopsia with headache. CT scan showed that the high density area became larger to left posterior than that of half year before. Left carotid angiogram showed no mass lesion and no abnormal vessel. Operation was performed with interhemispheric trans-lamina terminalis approach using bifrontal craniotomy. Operative findings revealed that the tumor situated at the lateral wall of the third ventricle, had rough surface with reddish colour, and old and fresh blood clots inside the tumor. The tumor was carefully dissected without brain damage and was totally removed. The histological findings was compatible with cavernous angioma. Post-operative CT scan showed no high density area. He was discharged with no neurological deficit without right homonymous hemianopsia. Cavernous angioma of anterior third ventricle is very rare.(ABSTRACT TRUNCATED AT 250 WORDS)