A 59-year-old lady with progressive left-sided weakness and escalating headaches over four months was referred for an urgent neurosurgical opinion. MR brain imaging demonstrated recent enlargement of a nodular enhancing lesion arising from the right temporal lobe causing significant mass effect, midline shift and obstructive hydrocephalus. She had suffered with complex partial seizures since the age of 11 with varying frequency and refractory to multiple anti-epileptic agents. EEG and PET in the mid-1990's revealed right temporal epileptic discharges temporal hypometabolism, respectively. MRI imaging showed a shrunken right hippocampus with mesial temporal sclerosis. The patient was offered operative surgery but instead elected for gamma knife radiotherapy aged 44. A year later, surveillance brain imaging demonstrated marked T2 signal change and enhancement within the right temporal lobe. MRI appearances remained largely stable on interval scans over the subsequent 10 years and were felt to represent radiation necrosis rather than neoplastic change with PET repeatedly showing hypometabolism. Now 15 years following the stereotactic radiosurgery it was felt she had an intrinsic brain tumour and underwent craniotomy with debulking surgery. Histopathology subsequently revealed a vascular mass of papillary endothelial hyperplasia, otherwise known as Masson's tumour, a rare but benign pseudoneoplasm seen following radiosurgery. The seizures have ceased post-operatively.
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