Masson's tumor revealed by an intracerebral hematoma. Case report and a review of the literature

We report the case of a 56-year-old woman who underwent total resection of a Masson's tumor or intravascular papillary endothelial hyperplasia (IPEH), which was discovered due to a left temporal intracerebral hematoma revealed by aphasia. IPEH is more often localized on cutaneous and subcutaneous locations, intracranial IPEH are rare and only approximately twenty cases have been published to date. These tumors are a benign vascular lesion composed of papillary intravascular proliferation of epithelial cellular associated thrombosis with fibrin deposits responsible for vascular lumen obliteration. Differential diagnoses of neurological locations of IPEH are more often an angiosarcoma, or meningioma, and metastasis. Magnetic Resonance imaging (MRI) and CT-scan are not specific. On CT-scan the lesion is hypodense without calcification with a peripheral enhancement and on MRI a hyposignal T1 with homogeneous enhancement and a hypersignal T2. Arteriography may reveal a tumoral blush and arterio-venous shunt or arterial pedicles which can be embolized. The age of discovery is between 12 and 70 with a female predominance. IPEH are often localized close to the venous sinus or can be developed in a vascular malformation, thrombus or aneurysm. The curative treatment is total resection but recurrence has been reported, long-term follow-up with MRI is recommended.