Brain Amyloidoma: Case Report and Literature Review

Abstract

Introduction: Primary deposition of amyloid can take several forms including amyloidoma organ restricted among which is brain. Brain amyloidoma can mimic several lesions and offers a diagnostic challenge to the physician. The present work reports an additional case and summarizes the salient characteristics of previously published cases. Case Report: A 61-year-old, woman experienced paroxystic auditory hallucinations followed at times by generalized tonico-clonic seizures. Examination revealed a mild left pyramidal weakness. Head CT scan and MRI revealed a lobular lesion of the right atrium with contrast enhancement. The diagnosis of amyloidoma Lambda light chain (λLC) type was performed by means of a stereotactic biopsy. The patient was treated by 3 cures of high dose methotrexate (15 mg/m 2 ). At 24 months follow up the patient remains stable clinically and biologically. The 2 years follow-up MRI showed the same findings. Conclusion: No guidelines can be suggested for brain amyloidoma treatment; the "wait and see" was the mind-set in the literature. However, a non-tumour like pattern of a cerebral mass developing near the ventricle with a fine, irregular radiating margin enhancement and lack of oedema, and mass effect are important MRI clues for brain amyloidoma diagnosis. The diagnosis is histological after biopsy or excision.

Primary cerebral immunoglobulin light chain amyloidoma in a patient with multiple sclerosis

“…Multiple sclerosis is a chronic inflammatory demyelinating disease of the CNS where multiple lesions are located in the brain and spinal cord 23. Case series showed involvement of the white matter of the brain in cerebral amyloidoma, and multifocal locations of cerebral AL amyloidoma have been described 6 24. The time between progression of neurological symptoms and diagnosis of cerebral AL amyloidoma was approximately 3–5 years in this case.…”