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Cao X, Yao B, Ma J, Li D, Wang L, Zhang J, Wu Z. Rosai-Dorfman Disease in the Skull Base: A Case Series Study. World Neurosurg 2023; 173:e351-e358. [PMID: 36796628 DOI: 10.1016/j.wneu.2023.02.051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Revised: 02/08/2023] [Accepted: 02/09/2023] [Indexed: 02/16/2023]
Abstract
OBJECTIVE Rosai-Dorfman disease (RDD) is a rare, idiopathic, and non-neoplastic histio-proliferative disease that is uncommon in the central nervous system. Hence, reports of management of RDD in the skull base are scarce and only a few studies on skull base RDD are available. The objective of this study was to analyze the diagnosis, treatment, and prognosis of RDD in the skull base and explore an appropriate treatment strategy thereof. METHODS Nine patients with clinical characteristics and follow-up data from our department between 2017 and 2022 were included in this study. From this information, the clinical profiles, imaging, treatment, and prognosis data were collected. RESULTS There were 6 male and 3 female patients with skull base RDD. These patients ranged in age from 13 to 61 years, with a median age of 41 years. The locations included 1 anterior skull base orbital apex, 1 parasellar region, 2 sellar regions, 1 petroclivus, and 4 foramen magnum regions. Six patients underwent total resection and 3 underwent subtotal resection. Patient follow-up lasted 11-65 months, with a median duration of 24 months. One patient died, 2 experienced recurrence, and the other patients' lesions were stable. The symptoms worsened and new complications occurred in 5 patients. CONCLUSIONS Skull base RDDs are intractable diseases with a high rate of complications. Some patients are at risk of recurrence and death. Surgery may be the basic treatment for this disease, and combined therapy including targeted therapy or radiation therapy may also be a valuable therapeutic strategy.
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Affiliation(s)
- Xiaoyu Cao
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Bohan Yao
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Junpeng Ma
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Da Li
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Liang Wang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Junting Zhang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Zhen Wu
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, People's Republic of China.
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Zhang J, Li D, Cheng R, Zhang N, Ni X, Ge M. Staging surgery for intraventricular bilateral giant Rosai–Dorfman disease in children. Pediatr Investig 2022; 6:50-54. [PMID: 35382423 PMCID: PMC8960918 DOI: 10.1002/ped4.12306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Accepted: 09/28/2021] [Indexed: 11/07/2022] Open
Abstract
Introduction Rosai–Dorfman disease (RDD) is an uncommon, benign, and idiopathic histiocytic proliferative disorder. Multiple intracranial RDD is extremely rare and treatment varies. Case presentation A 9‐year‐old girl was admitted with 3‐month history of blurred vision and facial paralysis, a 2‐month history of recurrent giggle, and cognitive impairment. Computed tomography and magnetic resonance imaging scans revealed bilateral ventricular masses based on the dural membrane and the diameters of the masses were 9.1 cm and 9.2 cm, respectively. The lesions were completely removed with staging surgeries. Fifteen months after operation, blurred vision was still present but facial paralysis and giggle and cognitive impairment disappeared. Imaging examinations suggested that there were no new or recurring lesions. Conclusion For multiple large intracranial masses, surgical treatment is necessary and staged surgery benefits perioperative safety. Active follow‐up with magnetic resonance imaging is necessary.
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Affiliation(s)
- Jiyin Zhang
- Department of Otolaryngology, Head and Neck Surgery Beijing Children's Hospital Capital Medical University National Center for Children's Health Beijing China
| | - Dapeng Li
- Department of Neurosurgery Beijing Children's Hospital Capital Medical University National Center for Children's Health Beijing China
| | - Ran Cheng
- Department of Emergency Surgery Beijing Children's Hospital Capital Medical University National Center for Children's Health Beijing China
| | - Nan Zhang
- Department of Pathology Beijing Children's Hospital Capital Medical University National Center for Children's Health Beijing China
| | - Xin Ni
- Department of Otolaryngology, Head and Neck Surgery Beijing Children's Hospital Capital Medical University National Center for Children's Health Beijing China
| | - Ming Ge
- Department of Neurosurgery Beijing Children's Hospital Capital Medical University National Center for Children's Health Beijing China
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Tatit RT, Raffa PEAZ, de Almeida Motta GC, Bocchi AA, Guimaraes JL, Franceschini PR, de Aguiar PHP. Rosai-Dorfman disease mimicking images of meningiomas: Two case reports and literature review. Surg Neurol Int 2021; 12:292. [PMID: 34221623 PMCID: PMC8247728 DOI: 10.25259/sni_918_2020] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Accepted: 05/11/2021] [Indexed: 11/05/2022] Open
Abstract
Background: Rosai-Dorfman disease (RDD) is a rare non-Langerhans cell histiocytic proliferative disorder classically as a massive cervical lymphadenopathy. However, over the years, extranodal locations were confirmed with the central nervous system involvement in less than 5% of cases, which is marked as a significant differential diagnosis of meningiomas, with which they are widely confused due to the similarity of their radiological images. Case Description: We report a 37-year-old man and 45-year-old man who were diagnosed with intracranial RDD but whose radiological images mimic meningiomas, requiring anatomopathological and tumor’s immunohistochemistry for definitive diagnosis. Moreover, a review of 184 publications with 285 cases of intracranial involvement of this disease was also performed, comparing these findings with those brought in the previous studies. Conclusion: Intracranial Rosai-Dorfman tumors should always be remembered as differential diagnosis of meningiomas since they are similar radiologically and macroscopically. Once remembered and diagnosed, the lesion must be treated following the same pattern of resection done in meningiomas and, treatment’s differences will not occur in the surgical excision technique, but in complementary chemotherapy implementation, radiotherapy, and even with radiosurgery aid, depending on the case. Thus, it is possible to obtain better results than with just the isolated surgical procedure.
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Affiliation(s)
- Rafael Trindade Tatit
- Department of Medicine, Albert Einstein Israeli Faculty of Health Sciences, São Paulo, Brazil
| | | | | | | | - Júlia Loripe Guimaraes
- Department of Medicine, Albert Einstein Israeli Faculty of Health Sciences, São Paulo, Brazil
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Muthiah N, Nowicki KW, Picarsic JL, D’Angelo MP, Marker DF, Andrews EG, Monaco EA, Niranjan A. Three decades of progress from surgery to medical therapy for isolated neuroaxis BRAF V600E–positive Langerhans cell histiocytosis management: illustrative case. JOURNAL OF NEUROSURGERY: CASE LESSONS 2021; 1:CASE2118. [PMID: 35854832 PMCID: PMC9245772 DOI: 10.3171/case2118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Accepted: 01/27/2021] [Indexed: 11/06/2022]
Abstract
BACKGROUND
“Langerhans cell histiocytosis” (LCH) is a term that encompasses single-system or multisystem disorders traditionally characterized by a proliferation of clonal CD1a+/CD207+ myeloid-derived histiocytes. In most cases of LCH, mitogen-activated protein kinase (MAPK) pathway somatic mutations lead to near universal upregulation of phosphorylated extracellular signal-regulated kinase expression. The clinical manifestations of LCH are numerous, but bone involvement is common. Intracranial lesions, especially as isolated manifestations, are rare.
OBSERVATIONS
The authors presented the case of a long-term survivor of exclusive intracranial LCH that manifested with isolated craniofacial bone and intraparenchymal central nervous system recurrences, which were managed with 3 decades of multimodal therapy. The patient was initially diagnosed with LCH at age 2 years, and the authors documented the manifestations of disease and treatment for 36 years. Most of the patient’s treatment course occurred before the discovery of BRAF V600E. Treatments initially consisted of chemotherapy, radiosurgery, and open resections for granulomatous LCH lesions. Into young adulthood, the patient had a minimal disease burden but still required additional radiosurgical procedures and open resections.
LESSONS
Surgical treatments alleviated the patient’s immediate symptoms and allowed for tumor burden control. However, surgical interventions did not cure the underlying, aggressive disease. In the current era, access to systemic MAPK inhibitor therapy for histiocytic lesions may offer improved outcomes.
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Affiliation(s)
| | | | - Jennifer L. Picarsic
- Division of Pathology and Laboratory Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | - Michael P. D’Angelo
- Department of Cardiothoracic Surgery, New York University Langone School of Medicine, New York, New York; and
| | - Daniel F. Marker
- Pathology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | | | - Edward A. Monaco
- Department of Neurological Surgery, Geisinger Commonwealth School of Medicine, Danville, Pennsylvania
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Isolated cerebral Rosai-Dorfman disease presenting as a sole mass protruding into the fourth ventricle: A case report. Radiol Case Rep 2021; 16:1613-1617. [PMID: 33995752 PMCID: PMC8105597 DOI: 10.1016/j.radcr.2021.04.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Revised: 04/06/2021] [Accepted: 04/09/2021] [Indexed: 11/21/2022] Open
Abstract
Rosai–Dorfman disease is a non–Langherans cell histiocytosis typically revealed by a lymphadenopathy. Central nervous system involvement is rare, exceptionally isolated, and usually consists of dural masses mimicking meningioma. Very few reports have described non-dural-based lesions, especially with an intra-ventricular development. We report hereby the case of a Rosai–Dorfman disease in a 30-year-old man presenting as an isolated mass arising from the right cerebellar peduncle and protruding into the fourth ventricle. We provide the results of the MRI examination with a special focus on advanced MRI features. As the diagnosis relies on pathological examination, we also detail the results of the analysis that followed the surgical resection of the mass including the immunohistochemical profile. This report highlights the necessity to consider Rosai–Dorfman disease as a potential diagnosis in case of an infra–tentorial mass and/or intra-ventricular mass.
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Wang C, Zou Y, Zeng Q, Hong H, Zheng C. Isolated Rosai-Dorfman disease with craniocervical junction involvement in the foramen magnum: A case report. Medicine (Baltimore) 2019; 98:e17433. [PMID: 31577761 PMCID: PMC6783247 DOI: 10.1097/md.0000000000017433] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
RATIONALE Rosai-Dorfman disease (RDD) is a rare benign histiocytic proliferative disease. RDD with cranio-spinal involvement in the foramen magnum is extremely rare. To the best of our knowledge, only 4 cases of RDD with craniocervical junction involvement have been reported so far. Herein, we present the fifth case of RDD with craniocervical junction. PATIENT CONCERNS A 26-year-old female presented with a sudden headache, accompanied by nausea and vomiting several times during the past half-month. DIAGNOSES Magnetic resonance imaging (MRI) showed a well-defined, lobulated, homogenous mass in the left foramen magnum. The lesion was isointense on T1-weighted images (T1WI) and hypointense on T2-weighted images (T2WI), and showed homogeneously obvious enhancement following the intravenous administration of gadolinium. It was dural based and extending inferiorly along the spinal dura up to the cervical spinal canal. The brainstem was compressed and deflected to the right side. Initial diagnosis of meningioma with craniocervical junction involvement in the foramen magnum was made according to MRI findings. Final diagnosis of RDD was confirmed by histopathological and immunohistochemical examinations after subtotally surgical resection. INTERVENTIONS The bulk of lesion in the foramen magnum was removed surgically with suboccipital craniectomy because of brainstem compression. OUTCOMES The patient recovered well and was discharged 17 days after the surgery. LESSONS RDD should be considered in patients with dural-based, extra-axial, well-circumscribed, hypo- to isointense on T1WI, hypo- to isointense on T2WI, enhancing intracranial or spinal lesions or both.
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Affiliation(s)
| | - Yi Zou
- Department of Pathology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang
| | | | | | - Congkuan Zheng
- Department of Radiology, Linhai Second People's Hospital, Taizhou, Zhejiang, China
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Radiologic Appearance of Cranial Involvement of Rosai–Dorfman Disease. J Craniofac Surg 2019; 30:e489-e490. [DOI: 10.1097/scs.0000000000005360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Jiang Y, Jiang S. Intracranial Meningeal Rosai-Dorfman Disease Mimicking Multiple Meningiomas: 3 Case Reports and a Literature Review. World Neurosurg 2018; 120:382-390. [DOI: 10.1016/j.wneu.2018.09.060] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Accepted: 09/09/2018] [Indexed: 01/01/2023]
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Park H, Nishino M, Hornick JL, Jacobsen ED. Imaging of Histiocytosis in the Era of Genomic Medicine. Radiographics 2018; 39:95-114. [PMID: 30500304 DOI: 10.1148/rg.2019180054] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Histiocytosis describes a group of diseases that have long been considered enigmatic in the history of medicine. Recently, novel genomic analyses have identified somatic oncogenic driver mutations responsible for the pathogenesis of these entities. These discoveries have led to the recharacterization of histiocytoses as neoplastic diseases and have opened a new era of precision medicine approaches for treatment. The histiocytic disorders demonstrate a variety of imaging manifestations involving multiple organ systems, and radiologists play a major role in diagnosis and monitoring. An up-to-date knowledge of the novel genomic discoveries and their implications is essential for radiologists to understand the new approaches to treating histiocytic disorders and to contribute as key members of the multidisciplinary treatment team. This article provides a cutting-edge review of the novel concepts in histiocytosis, with a focus on recent genomic discoveries and precision medicine approaches to treating the disease, and describes imaging manifestations with correlative histologic and genomic findings, with an emphasis on adult-onset cases and uncommon subtypes. ©RSNA, 2018.
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Affiliation(s)
- Hyesun Park
- From the Departments of Radiology (H.P., M.N.), Pathology (J.L.H.), and Medical Oncology (E.D.J.), Brigham and Women's Hospital and Dana-Farber Cancer Institute, 450 Brookline Ave, Boston, MA 02215
| | - Mizuki Nishino
- From the Departments of Radiology (H.P., M.N.), Pathology (J.L.H.), and Medical Oncology (E.D.J.), Brigham and Women's Hospital and Dana-Farber Cancer Institute, 450 Brookline Ave, Boston, MA 02215
| | - Jason L Hornick
- From the Departments of Radiology (H.P., M.N.), Pathology (J.L.H.), and Medical Oncology (E.D.J.), Brigham and Women's Hospital and Dana-Farber Cancer Institute, 450 Brookline Ave, Boston, MA 02215
| | - Eric D Jacobsen
- From the Departments of Radiology (H.P., M.N.), Pathology (J.L.H.), and Medical Oncology (E.D.J.), Brigham and Women's Hospital and Dana-Farber Cancer Institute, 450 Brookline Ave, Boston, MA 02215
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Yang X, Liu J, Ren Y, Richard SA, Zhang Y. Isolated intracranial Rosai-Dorfman disease mimicking petroclival meningioma in a child: Case report and review of the literature. Medicine (Baltimore) 2017; 96:e8754. [PMID: 29381971 PMCID: PMC5708970 DOI: 10.1097/md.0000000000008754] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
RATIONALE Rosai -Dorfman disease (RDD) is a rare, idiopathic, and non-neoplastic histioproliferative disease with distinctive entity of unknown etiology. Central nervous system (CNS) RDD is uncommon, hence, isolated intracranial RDD is extremely rare. So far only 6 cases of CNS RDD with the lesions originating from petroclival region have been reported. We present a case of isolated intracranial RDD mimicking petroclival meningioma. PATIENT CONCERNS A 14-year-old girl was admitted at our hospital with a 3-month history of dizziness, slowly progressing headache, and 2-month history of instability in walking. Cranial nerve deficits, including left facial paralysis, left facial numbness and left hearing loss, were evident on examination. DIAGNOSES Initial diagnosis of petroclival meningioma was made according to preoperative magnetic resonance imaging. INTERVENTIONS The lesion was resected subtotally and pathology confirmed RDD. The patient received gamma-knife treatment for the residual lesion. OUTCOMES The patient recovered well and the residual lesion significantly retrogressed on follow-up images. LESSONS Preoperative diagnosis of petroclival RDD is full of challenges. Although surgical resection of lesions is an effective treatment option, total resection is not highly recommended because the surgery-related defect must be minimal. Patient with residual lesion can be put on steroid therapy and/or radiotherapy, especially for IgG4 positive subset of RDD.
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Tan S, Ruan L, Jin K, Wang F, Mou J, Huang H, Yang G. Systemic Rosai-Dorfman disease with central nervous system involvement. Int J Neurosci 2017; 128:192-197. [PMID: 28881164 DOI: 10.1080/00207454.2017.1377709] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Rosai-Dorfman disease (RDD) is a rare idiopathic and lymphoproliferative disorder. Central nervous system (CNS) involvement is infrequent and typically manifests as an isolated lesion. In this article, we describe an unusual case of RDD with multiple lesions in the CNS, upper respiratory tract and lymph nodes. A literature review revealed 45 cases (including the one described herein) of systemic RDD with CNS involvement documented to date. Among these cases, 29 (64.4%) presented with intracranial lesions, 10 (22.2%) with spinal lesions and 6 (13.3%) with both. While the condition of most patients was stable, only four died from RDD or for other reasons. Prognosis is good for most patients, even those with extensive lesions. Although there are various treatments for RDD, surgery is preferred. Given the rarity of RDD, multicenter international collaborations are advocated in order to study disease pathogenesis and develop effective treatment strategies.
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Affiliation(s)
- Song Tan
- a Department of Neurosurgery , The First Affiliated Hospital of Chongqing Medical University , Chongqing , China
| | - Lunliang Ruan
- a Department of Neurosurgery , The First Affiliated Hospital of Chongqing Medical University , Chongqing , China
| | - Kai Jin
- a Department of Neurosurgery , The First Affiliated Hospital of Chongqing Medical University , Chongqing , China
| | - Fuchao Wang
- a Department of Neurosurgery , The First Affiliated Hospital of Chongqing Medical University , Chongqing , China
| | - Jiamin Mou
- a Department of Neurosurgery , The First Affiliated Hospital of Chongqing Medical University , Chongqing , China
| | - Hua Huang
- a Department of Neurosurgery , The First Affiliated Hospital of Chongqing Medical University , Chongqing , China
| | - Gang Yang
- a Department of Neurosurgery , The First Affiliated Hospital of Chongqing Medical University , Chongqing , China
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Yang K, Kolakshyapati M, Shrestha T, Lou L, Chen S. Rosai-Dorfman Disease of Isolated Spinal Involvement and Isolated Intracranial Involvement. World Neurosurg 2017; 98:862-863. [PMID: 28235354 DOI: 10.1016/j.wneu.2016.08.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2016] [Accepted: 08/06/2016] [Indexed: 11/17/2022]
Affiliation(s)
- Kaichuang Yang
- Department of Neurosurgery, ZheJiang Provincial People's Hospital, Hangzhou, China
| | - Manish Kolakshyapati
- Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Tejashwi Shrestha
- Department of Clinical Neuroscience and Therapeutics, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Lin Lou
- Department of Neurosurgery, ZheJiang Provincial People's Hospital, Hangzhou, China
| | - Shuda Chen
- Department of Neurosurgery, ZheJiang Provincial People's Hospital, Hangzhou, China.
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Rosai-Dorfman disease involving the central nervous system: seven cases from one institute. Acta Neurochir (Wien) 2015. [PMID: 26210482 DOI: 10.1007/s00701-015-2511-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND Rosai-Dorfman disease (RDD) is a rare, idiopathic, non-neoplastic histioproliferative disease. Central nervous system (CNS) manifestations are extremely rare. Its low incidence and unknown etiology restrict early diagnosis and optimal therapy. METHODS In the 1995-2013 period, seven CNS-RDD patients with intracranial and/or spinal lesions were retrospectively analyzed, including the clinical data, laboratory and imaging results, treatment applied and outcome. All seven case samples were screened for the SLC29A3 gene mutation, and the literature was reviewed. RESULTS Seven RDD patients (6 male/1 female, aged between 7 and 68) with CNS manifestations are reported. Five of the seven patients (71.4 %) had intracranial lesions (1 with skull erosion and 1 with multiple lesions mimicking meningiomas), and two (28.6 %) had spinal subdural lesions. The patients' symptoms included headaches, seizures, visual loss, epileptoid convulsions in the lower legs, fever, spastic paraparesis and paraplegia. An elevated erythrocyte sedimentation rate (ESR) was detected in five of the seven cases. The diagnosis was confirmed by immunohistochemical staining revealing that the characteristic histiocytes were positive for the S100 protein and CD68 and negative for CD1a. All patients were operated on: three recovered completely, two were partially rehabilitated, and two died. No SLC29A3 gene mutations were found in any of the seven samples. CONCLUSION This short series suggests the following: (1) RDD should be included in the differential diagnosis of lesions mimicking intracranial/spinal meningiomas or inflammatory lesions, especially in children; (2) the definitive diagnosis is based on histopathology and immunocytochemistry; (3) surgical resection seems to be the most effective therapy; (4) the exact etiology and adjuvant therapy for relapsing/incompletely resected lesions remain to be established.
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