Demyelinating Disease Versus Tumor in Surgical Neuropathology

Zagzag, David; Miller, Douglas C.; Kleinman, George; Abati, Andrea; Donnenfeld, Hyman; Budzilovich, Gleb N.

doi:10.1097/00000478-199306000-00001

Cited by 141 publications

(77 citation statements)

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“…shown that demyelinating pseudotumor can occur at any age with an increased tendency in young and middle-aged females (8,20). The patient in this report was a 40-year-old female.…”

Section: █ Discussionmentioning

confidence: 68%

Intracranial demyelinating pseudotumor: a case report and review of the literature

Ning

Zhao²,

Wang³

et al. 2014

Turkish Neurosurgery

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ABSTRACTpseudotumor in the clinic is relative low, delayed diagnosis or misdiagnosis may cause delays in treatment of these patients and subsequently may lead to physical and mental damage (14). The differential diagnosis of demyelinating pseudotumor and brain tumors, especially of low-grade astrocytomas, should arouse more attention to exclude the possibility of a demyelinating process. Despite this, only few reported cases of intracranial demyelinating pseudotumor are known in the literature. In this case report, we present the diagnosis and treatment of a demyelinating pseudotumor patient who was misdiagnosed with astrocytoma. █ CASE REPORTA female 40-year-old patient was hospitalized due to a progressive disability of the left limb that severely increased over one week. The patient did not have a recent history █ INTRODUCTION D emyelinating pseudotumor of the brain, also called tumor-like demyelinating lesions (TDLs) or inflammatory demyelinating pseudotumor (IDP), is a rare inflammatory demyelinating disease of the central nervous system (CNS) (3,4,7,8). The exact etiology of demyelinating pseudotumor is unclear, however it may associate with multiple sclerosis (MS) (5). Based on the clinical presentation and computed tomography (CT) and magnetic resonance imaging (MRI) findings, it is difficult to distinguish between brain tumors, abscesses and demyelinating pseudotumors (13). Unlike brain tumors, demyelinating pseudotumors respond well to steroid hormones (6). Therefore, a reliable distinction between brain tumors and intracranial demyelinating pseudotumors is important for a targeted therapy. Although the incidence of demyelinating Demyelinating pseudotumor is a rare inflammatory demyelinating disease of the central nervous system (CNS) that has a similar clinical presentation and computed tomography (CT) and magnetic resonance imaging (MRI) imaging findings as brain tumors or abscesses. Unlike brain tumors, demyelinating pseudotumors respond well to steroid hormones. There are only a few reported cases of intracranial demyelinating pseudotumors in the literature. In this case report, we present the diagnosis and treatment of demyelinating pseudotumor in a patient whose condition was initially misdiagnosed as an astrocytoma. Based on the literature and our case, we formulated an outline for the differential diagnosis of demyelinating pseudotumor and astrocytoma. A timely and correct diagnosis of demyelinating pseudotumor would avoid blind surgery, radiotherapy and chemotherapy, which are used to treat brain tumors.

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“…shown that demyelinating pseudotumor can occur at any age with an increased tendency in young and middle-aged females (8,20). The patient in this report was a 40-year-old female.…”

Section: █ Discussionmentioning

confidence: 68%

Intracranial demyelinating pseudotumor: a case report and review of the literature

Ning

Zhao²,

Wang³

et al. 2014

Turkish Neurosurgery

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“…One of the important biologic differences between TDL and high-grade intracranial tumors is the presence of neoangiogenesis and vascular endothelial proliferation in the latter, whereas TDLs are characterized by intrinsically normal or inflamed vessels without evidence of neovascularity. 36,38,39 TDLs show lower PS and CBV compared with high-grade gliomas, and PCT can be used to differentiate the 2 entities (Fig 6). 40 Similarly, various vasculitis and angiopathies can rarely present as solitary or multiple masslike lesions, mimicking neoplasms on morphologic imaging.…”

Section: Differentiating Gliomas From Other Non-neoplastic Lesions Anmentioning

confidence: 99%

Perfusion CT Imaging of Brain Tumors: An Overview

Jain¹

2010

AJNR Am J Neuroradiol

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SUMMARY: Perfusion imaging of brain tumors has been performed by using various tracer and nontracer modalities and can provide additional physiologic and hemodynamic information, which is not available with routine morphologic imaging. Tumor vascular perfusion parameters obtained by using CT or MR perfusion have been used for tumor grading, prognosis, and treatment response in addition to differentiating treatment/radiation effects and non-neoplastic lesions from neoplasms. This article is an overview of the utility of PCT for assessment of brain tumors and describes the technique, its advantages, and limitations.

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“…5 TDLs can also be confused with high-grade gliomas on histopathologic evaluation because of the presence of hypercellularity and atypical reactive astrocytes with mitotic figures. 6 The presence of demyelination must be confirmed with myelin-and axon-specific staining by demonstrating demyelination and relative axonal preservation, 7 which is not routinely performed in intracerebral masses unless a TDL is considered preoperatively.…”

mentioning

confidence: 99%