Meningiomas are the most common primary intracranial brain tumor and have been divided into 15 histologic subtypes, which are further classified into 3 grades according to biological behavior. Lymphoplasmacyte-rich meningioma is a rare histologic subtype of benign (grade 1) meningiomas characterized by prominent infiltration of plasma cells and lymphocytes, with a variable proportion of meningothelial elements. These benign meningioma variants usually cause significant peritumoral brain edema and mimic higher-grade lesions, which is believed to represent inflammatory cell infiltration rather than true neoplastic invasion. Bone invasion in these tumors is exceedingly rare and its clinical significance remains elusive. We describe the case of a lymphoplasmacyte-rich meningioma with skull invasion and peritumoral brain edema in a 57-year-old female patient presenting with left hemiparesis. Gross total resection of the lesion and adjacent skull were performed and histophatological examination disclosed a lymphoplasmacyte-rich meningioma. Gradual decrease of the parenchymal edema was seen on postoperative imaging studies and the patient showed progressive improvement of the motor deficit. This case report depicts rare bone invasion by lymphoplasmacyte-rich meningioma and highlights the other imaging features of this rare histologic subtype of benign meningioma. Due to the paucity of cases, gross total resection, and long-term follow-up are warranted as the prognosis of these tumors is still not fully understood.
Glioblastomas multiformes (GBMs), are the most common primary malignant tumors of the Central Nervous System. Frequently located in supratentorial topography, infratentorial location is rare, around 0-3.4% of primary GBMs. The diagnosis of these tumors is uncommon in adults, few cases have been reported, being even more infrequent in elderly patients. The most typical clinical presentation is a rapidly growing posterior fossa lesion, increased intracranial pressure, and cerebellar signs associated with the mass and perilesional edema. Clinical presentation, computed tomography (CT), and magnetic resonance imaging (MRI) provide useful information about the possible diagnosis but are not definitive. We describe a clinical case, 76 years old female with a clinical history of hypertension, depressive syndrome, and dyslipidemia. Started progressively with ataxy, imbalance, and vertigo. Brain CT shows an intra-axial, infiltrative lesion in the superior and middle vermis. MRI presents a heterogeneous lesion in the superior and median vermian region of the cerebellum with ring enhancement and central necrotic area. Was performed a middle suboccipital approach, corticectomy in the superior vermis. The intraoperative histological study reveal a high-grade malignancy astrocytoma, which was released through a subtotal resection. The histological result was a high-grade astrocytoma, grade IV in WHO classification. Four weeks after the surgery the patient started treatment with chemotherapy and radiotherapy. The main point of this case is the atypical location of the tumor. These lesions are rare in this location but they will do considering the differential diagnosis of posterior fossa tumors. However, the most frequent lesions with high percentages of incidence are metastatic lesions.
Chordomas are relatively rare malignant tumors derived from embryonic notochord remnants. Most intracranial chordomas show extradural extension and cause bone erosion. However, a small percentage of these tumors are exclusively intradural and tend to show less aggressive features, although local recurrence and metastatic spread have been described. Intradural chordomas with imaging features similar to epidermoid cysts are exceedingly rare. We describe the case of a nonenhancing and nondestructive intradural prepontine chordoma showing restricted diffusion on magnetic resonance imaging on a 44-year-old man who presented with acute-onset vertigo and vomiting. Subtotal resection of the lesion was performed followed by adjuvant radiation therapy. Histopathological examination revealed a chordoma. This case report highlights the need to include intradural chordomas in the differential diagnosis of a nonenhancing and nondestructive prepontine intradural lesion demonstrating restricted diffusion. Gross total resection, adjuvant radiation therapy in cases of macro/microscopical residual disease and regular follow-up imaging assessment are warranted due to the possibility of local recurrence and metastatic dissemination.
Toxoplasmosis is one of the most common opportunistic infections, mainly reported in patients with acquired immunodeficiency syndrome (AIDS). Patients with rheumatoid arthritis (RA) have also been linked to reactivation of toxoplasmosis due to immunosuppressive treatment, although biologic drugs have seldom been implicated. We present a case of cerebral toxoplasmosis in a 62-year-old female patient with RA after initiation of biologic therapy (adalimumab). The patient had detectable serum IgG antibodies to toxoplasma gondii, was also on chronic treatment with other non-biologic drugs and presented with worsening disorientation, unsteady gait and left hemiparesis. Imaging studies showed a space-occupying lesion in the right basal ganglia with ring-enhancement. Brain biopsy confirmed the diagnosis of toxoplasmosis and the patient was treated with pyrimethamine and sulfadiazine for 6 weeks, showing complete recovery on follow-up. A review of the literature yielded other four case reports of cerebral toxoplasmosis implying biologic drugs; however, data concerning toxoplasmosis serologic testing, prophylaxis and treatment in these patients are lacking. Each case must be carefully evaluated prior to treatment and a high-index of suspicion in seropositive patients is warranted. Since the use of biologic drugs is increasing, further research is needed to establish practical guidelines for seropositive patients receiving immunosuppressive treatment.
Intracranial epidermoid cysts represent ∼ 0.2 to 1.8% of all intracranial tumors. These tumors are most frequently encountered in the cerebellar pontine angle or in the parasellar region. Rarely, they arise from the cranial diploe, being able to affect every flat bone of the cranium.We report a case of a 63-year-old male who presented with progressively worsening headache and vertigo with 6 months of evolution. Neuroimaging identified a probable occipital intradiploic epidermoid cyst with mass effect on the cerebellar hemispheres. This lesion was approached using a suboccipital craniotomy, followed by total resection of the tumor and cranioplasty with titanium plate placement. The histological evaluation confirmed the diagnosis of intraosseous epidermoid cyst. The patient had a successful recovery, without complications or neurologic dysfunction.Being benign lesions, commonly remaining asymptomatic and rarely presenting as a bony lump in the skull bone, it could be straightforward to assume a conservative management with planned follow-up. On the other side, a more aggressive strategy with surgical excision has been advocated, especially in lesions that tend to enlarge and erode the cranial bone with possible consequent epidural extension and mass effect symptoms. A preoperative diagnosis is extremely helpful in proper surgical planning. Diffusion weighted imaging facilitates a straightforward diagnosis.As was observed in our case, the largest reviews on intradiploic epidermoids available in the literature mostly demonstrated a benign clinical course. However, malignant transformation can occur. Some patients develop permanent neurologic deficits from mass effect or tumor infiltration. However, surgical approach of the tumor is curative in most cases. Nonetheless, from our experience, it is important to maintain clinical and imaging follow-up with regular monitoring to prevent possible tumor recurrences.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.