[Cerebellar hemangioblastoma associated with fatal intratumoral hemorrhage: report of an autopsied case].

Abstract

Intracranial hemorrhage associated with brain tumors is rate, but when present, it is often seen in malignant tumors such as glioblastoma and metastasis, and in meningiomas. Hemangioblastomas, benign vascular tumors, rarely develop fatal intracerebral hemorrhage. We thus documented an uncommon case of cerebellar hemangioblastoma associated with massive hemorrhage, the cause of which was thoroughly examined during autopsy. A 69-year-old man was transferred to our Service because of swallowing disturbance and dysarthria. The patient was known to have a cerebellar hemangioblastoma and hydrocephalus, for which VP shunt had been placed. Two weeks after admission he suddenly became comatose and eventually died of progressive herniation. At autopsy it was shown that the brain was edematous and covered with subarachnoid blood clots. The tumor was found involving the cerebellar vermis and the right hemisphere, protruding upward from the superior surface of the cerebellum. Horizontal sections through the cerebellum disclosed a well circumscribed tumor with adjacent hematomas involving the vermis and brain stem. The pathological diagnosis was hemangioblastoma and varix-like abnormal vessels were observed within the tumor. The sites of hematoma and tumor adjacent to the tentorial incisura and the history of VP shunting may suggest that upward herniation played a significant role in rupture of the abnormal vessels, which then led to the devastating hemorrhage in this particular case.