Psammomatous Arteriovenous Malformation-Brain: A Rare Histological Presentation Leading to Diagnostic Dilemma
Occurrence of psammoma bodies (PB) in CNS is strongly associated with meningiomas. Its occurrence with arterio-venous malformation (AVM) is rare. We report a case of an unconscious 70 year old male who presented in the emergency department with mass lesion and on histop – athology revealed a lesion composed of variable sized dilated and congested vascular channels which were mainly thin walled but with few thick walled vascular channels as well. Also noted were numerous lamellated calcified bodies (PB) which were present both intra-vascularly in small vascular channels as well as extra-vascular glial tissue. The minimal glial tissue included in the biopsy showed astrocytic prolife – ration showing mild anisonucleosis and hyperc -hromasia. Hence on light microscopy a differential diagnosis of Psammomatous cavernous haemangioma with a possibility of concurrent meningioma was suggested, as the synchronous presence of both the lesions is well documented in literature. A possibility of angiomatous variant of meningioma was also suggested. For confirmation of diagnosis, immunohi – stochemical studies were recommended which confirmed the lesion to be arising from vascular endothelial cells; so thereby conclusively ruling out meningotheliomatous neoplasm. Hence a final diagnosis of psammomatousarteriovenous malfor – mation was rendered. Present case report is worth publishing as it not only documents the presence of PB in setting of AVM, but also highlights the importance of utilizing IHC tool to conclusively diagnose or rule out meningiomas in all such settings. It is important because angiomatous variant of meningioma with presence of PB can closely mimic AVM leading to a wrong diagnosis and further wrong management of the patient.
