Occurrence and long-term outcome of tumefactive demyelinating lesions in multiple sclerosis

Totaro, Rocco; Carmine, Caterina Di; Splendiani, Alessandra; Torlone, Silvia; Patriarca, Lucia; Carrocci, C.; Sciamanna, Samanta; Marini, Carmine; Carolei, Antonio

doi:10.1007/s10072-016-2558-1

Cited by 16 publications

(12 citation statements)

References 27 publications

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“…It has been said that once TDLs relapses happen, their disease progression was identical to that of traditional relapsing-remitting MS ( 6 ). However, only 27.6% of patients in our study ended up in the MS group, which was somewhat different from prior studies ( 19 , 20 ). We classified the etiology of patients with TDLs into six categories: MS, NMOSD, MOGAD, Balo, ADEM, and the other etiology, which is more precise than previous studies, and some subsets might be associated with MS, possibly resulting in a relative decrease in the number of patients in the MS group.…”

Section: Discussioncontrasting

confidence: 99%

Central nervous system tumefactive demyelinating lesions: Risk factors of relapse and follow-up observations

Li¹,

Miao²,

Wang³

et al. 2022

Front. Immunol.

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ObjectiveTo track the clinical outcomes in patients who initially presented with tumefactive demyelinating lesions (TDLs), we summarized the clinical characteristics of various etiologies, and identified possible relapse risk factors for TDLs.MethodsBetween 2001 and 2021, 116 patients initially presented with TDLs in our hospital were retrospectively evaluated. Patients were followed for relapse and clinical outcomes, and grouped according to various etiologies. Demographic information, clinical data, imaging data, and laboratory results of patients were obtained and analyzed. The risk factors of relapse were analyzed by the Log-Rank test and the Cox proportional hazard model in multivariate analysis.ResultDuring a median follow-up period of 72 months, 33 patients were diagnosed with multiple sclerosis (MS), 6 patients with Balo, 6 patients with neuromyelitis optica spectrum disorders (NMOSD), 10 patients with myelin oligodendrocyte glycoprotein antibody-associated demyelination (MOGAD), 1 patient with acute disseminated encephalomyelitis (ADEM), and the remaining 60 patients still have no clear etiology. These individuals with an unknown etiology were categorized independently and placed to the other etiology group. In the other etiology group, 13 patients had recurrent demyelinating phases, while 47 patients did not suffer any more clinical events. Approximately 46.6% of TDLs had relapses which were associated with multiple functional system involvement, first-phase Expanded Disability Status Scale score, lesions morphology, number of lesions, and lesions location (P<0.05). And diffuse infiltrative lesions (P=0.003, HR=6.045, 95%CI:1.860-19.652), multiple lesions (P=0.001, HR=3.262, 95%CI:1.654-6.435) and infratentorial involvement (P=0.006, HR=2.289, 95%CI:1.064-3.853) may be independent risk factors for recurrence. Relapse free survival was assessed to be 36 months.ConclusionsIn clinical practice, around 46.6% of TDLs relapsed, with the MS group showing the highest recurrence rate, and lesions location, diffuse infiltrative lesions, and multiple lesions might be independent risk factors for relapse. Nevertheless, despite extensive diagnostic work and long-term follow-up, the etiology of TDLs in some patients was still unclear. And these patients tend to have monophase course and a low rate of relapse.

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Section: Discussioncontrasting

confidence: 99%

Central nervous system tumefactive demyelinating lesions: Risk factors of relapse and follow-up observations

Li¹,

Miao²,

Wang³

et al. 2022

Front. Immunol.

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“…4,13 Our study identified 24 tumefactive lesions in 293 MS patients (8.21%), a higher proportion than the previous estimate of 0.1%-0.2% of MS patients. 23 However, the higher percentage may be explained by the many MR studies carried out in our MS patients and the high quality currently offered by this technique compared to the past. The true incidence of tumefactive lesions is unknown and Poser's results 24,25 are probably an underestimation.…”

Section: Discussionmentioning

confidence: 95%

Is size an essential criterion to define tumefactive plaque? MR features and clinical correlation in multiple sclerosis

et al. 2016

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Tumefactive multiple sclerosis is an inflammatory demyelinating disease of the central nervous system. It has recently been described as a rare subtype of multiple sclerosis (MS) characterised by the appearance of solitary or multiple space-occupying lesions associated with imaging characteristics mimicking neoplasm. Atypical features include plaque size >2 cm with mass effect, oedema, and/or ring enhancement on magnetic resonance (MR) images.This study is a retrospective review designed to evaluate the prevalence of tumefactive plaques in a selected population of 440 MS patients referred to our MS centre in Southern Italy between 2005 and 2014. We analysed the radiographic features of lesions ranging in size from 0.5 to 2 cm to establish whether smaller plaques with MR characteristics similar to tumefactive plaques present different symptoms, disease evolution and prognosis. We also aimed to ascertain if MR features suggestive of biological aggressiveness could be useful prognostic criteria for a correct diagnosis of the disease and subsequent treatment. Our data suggest that lesions 0.5-2 cm and >2 cm have similar MR features and clinical evolution.

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“…Pathological changes associated with the formation of new inflammatory MS lesions are difficult to study, because such lesions are rarely fatal. Two main strategies can be pursued to understand underlying mechanisms of MS lesion formation: (i) To describe pathological findings in patients who died relatively early after the onset of a new symptomatic lesion, or (ii) to investigate brain biopsies of patients diagnosed with tumefactive MS, also called "pseudotumoral MS", a well-recognized variant of MS (Hardy, Tobin et al 2016, Totaro, Di Carmine et al 2016. Following the first approach, Barnett and Prineas reported that the earliest pathological changes, described as prephagocytic lesions, consist of oligodendrocyte apoptosis and microglial activation associated with few lymphocytes and phagocytes in regions of relative myelin preservation.…”

Section: Discussionmentioning

confidence: 99%

Oligodendrocyte degeneration and concomitant microglia activation directs peripheral immune cells into the forebrain

Chrzanowski

Bhattarai

Scheld

et al. 2019

Neurochemistry International

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Brain-intrinsic degenerative cascades are a proposed factor driving inflammatory lesion formation in multiple sclerosis (MS) patients. We recently showed that encephalitogenic lymphocytes are recruited to the sites of active demyelination induced by cuprizone. Here, we investigated whether cuprizoneinduced oligodendrocyte and myelin pathology is sufficient to trigger peripheral immune cell recruitment into the forebrain. We show that early cuprizone-induced white matter lesions display a striking similarity to early MS lesions, i.e., oligodendrocyte degeneration, microglia activation and absence of severe lymphocyte infiltration. Such early cuprizone lesions are sufficient to trigger peripheral immune cell recruitment secondary to subsequent EAE (experimental autoimmune encephalomyelitis) induction. The lesions are characterized by discontinuation of the perivascular glia limitans, focal axonal damage, and perivascular astrocyte pathology. Time course studies showed that the severity of cuprizone-induced lesions positively correlates with the extent of peripheral immune cell recruitment. Furthermore, results of genome-wide array analyses suggest that moesin is integral for early microglia activation in cuprizone and MS lesions. This study underpins the significance of brainintrinsic degenerative cascades for immune cell recruitment and, in consequence, MS lesion formation.

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Occurrence and long-term outcome of tumefactive demyelinating lesions in multiple sclerosis

Cited by 16 publications

References 27 publications

Central nervous system tumefactive demyelinating lesions: Risk factors of relapse and follow-up observations

Central nervous system tumefactive demyelinating lesions: Risk factors of relapse and follow-up observations

Is size an essential criterion to define tumefactive plaque? MR features and clinical correlation in multiple sclerosis

Oligodendrocyte degeneration and concomitant microglia activation directs peripheral immune cells into the forebrain

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