Case of primary dural epithelioid angiosarcoma with review of literature and differential diagnosis.

The central nervous system (CNS) is an uncommon site for primary epithelioid angiosarcoma. We report a case of a 25-year-old male who presented with swelling over the head, headache, and weakness of the right side for 6 months. MRI revealed a heterogeneously intense large left parietal dural-based, extra-axial mass with dural tail infiltrating the brain parenchyma, overlying calvaria along with mass effect and vasogenic edema in the left parietal lobe. The patient underwent complete resection of the tumor with adjuvant radiotherapy. Histology revealed a mitotically active vasoformative neoplasm with epithelioid morphology which was immunoreactive for CD31, ERG, FLI-1, and variably for CK. Based on the histomorphological and immunohistochemical profile, a diagnosis of epithelioid angiosarcoma was rendered. The extreme rarity in this location and the highly malignant nature of this tumor makes the clinical diagnosis and management very challenging. These tumors are often considered as meningiomas on prebiopsy imaging due to dural location and dural tail. Further, the misconception may continue on histological examination if only EMA is utilized, since both meningioma and epithelioid angiosarcoma can be positive. There are only 10 previous reports of meningeal angiosarcoma reported in the literature.

Improved Surgery Planning Using 3-D Printing: a Case Study.

The role of 3-D printing is presented for improved patient-specific surgery planning. Key benefits are time saved and surgery outcome. Two hard-tissue surgery models were 3-D printed, for orthopedic, pelvic surgery, and craniofacial surgery. We discuss software data conversion in computed tomography (CT)/magnetic resonance (MR) medical image for 3-D printing. 3-D printed models save time in surgery planning and help visualize complex pre-operative anatomy. Time saved in surgery planning can be as much as two thirds. In addition to improved surgery accuracy, 3-D printing presents opportunity in materials research. Other hard-tissue and soft-tissue cases in maxillofacial, abdominal, thoracic, cardiac, orthodontics, and neurosurgery are considered. We recommend using 3-D printing as standard protocol for surgery planning and for teaching surgery practices. A quick turnaround time of a 3-D printed surgery model, in improved accuracy in surgery planning, is helpful for the surgery team. It is recommended that these costs be within 20 % of the total surgery budget.