Intractable Repeated Intracerebral Hemorrhage Due to Primary Dural Leiomyosarcoma: Case Report and Literature Review

Background There are few case reports of primary leiomyosarcoma originating from the dura mater. We herein report a case of primary dural leiomyosarcoma that presented with repeated intracranial hemorrhage. Case Description A 62-year-old man presented with a 4-year history of a temporo-occipital bump. He showed a disturbance with reading words. The sudden onset of occipitalgia occurred 13 days after the onset. Computed tomography revealed a left temporal subcortical hematoma and thin subacute subdural hematoma associated with a temporal osteolytic mass lesion extending into the subcutaneous layer. The hematoma and tumorous mass lesion were removed. The subcutaneous tumor mass penetrating the skull bone originated from the dura mater and extended into the transverse sinus. No invasion into the cortical surface was observed. The lesion adjacent to the transverse sinus was not resected, and the remnant lesion was irradiated with local radiation therapy of 60 Gy. A left subdural hematoma and intrasylvian subarachnoid hemorrhage occurred 3 months after the first surgery, and a second removal was performed. Temporal subcortical hemorrhage repeatedly occurred 2 months after the second surgery, and the patient died. Conclusions In the present case, primary dural leiomyosarcoma may have invaded the dural sinus and repeated intracranial hemorrhage occurred due to a venous circulatory disturbance. The aggressive clinical course observed is rare. A clearer understanding of the route of invasion and a careful evaluation after primary treatment are needed in order to avoid hemorrhagic complications.