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Fareez F, Yahya S, Fong C, Moodley J, Provias J, Popovic S, Cenic A, Lu JQ. Spinal calcifying pseudoneoplasm of the neuraxis (CAPNON) associated with facet joint pathologies: CAPNON diagnostic and pathogenic insights. Hum Pathol 2024; 145:16-25. [PMID: 38336278 DOI: 10.1016/j.humpath.2024.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2023] [Revised: 02/04/2024] [Accepted: 02/06/2024] [Indexed: 02/12/2024]
Abstract
Calcifying pseudoneoplasm of the neuraxis (CAPNON) is a rare tumor-like fibro-osseous lesion that can develop anywhere in the neuraxis. Approximately a half of reported CAPNONs developed in the spinal region, mostly close to the facet joint (FJ). The diagnosis of spinal CAPNONs is challenging given the existence of mimics and associated pathologies including calcific degeneration of the FJ ligaments (DFJL) and synovial cysts (SCs). The pathogenesis of CAPNON remains elusive, although there have been a few hypotheses including degenerative, reactive, proliferative and immune-mediated processes. Our present study examined clinical, radiological and pathological features of 12 spinal CAPNONs in comparison to 9 DFJL foci, and diagnostic and pathogenic relationship between CAPNONs and FJ pathologies. On imaging, CAPNONs were all tumor-like and typically bigger than DFJL foci. All CAPNONs showed pathologically diagnostic features including characteristic cores, consistently identifiable core-surrounding/peripheral palisading of macrophages and other cells including multinucleated giant cells, variable infiltration of CD8+ T-cells, and multifocal immunopositivity of neurofilament light chain (NF-L). These features were absent or limited in the DFJL foci with statistically significant differences from CAPNONs, except calcifications. Spinal CAPNONs co-existed with DFJL foci in all cases; some had transitional foci with overlapping focal CAPNON and DFJL-like features. These findings, along with our previously reported relationship between CAPNONs and SCs, suggest that spinal CAPNONs may occur in association with or in transition from calcifying/calcified degenerative lesions of FJ ligaments and/or SCs when a reactive proliferative process is complemented by other pathogenic changes such as immune-mediated pathology and NF-L deposition/expression.
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Affiliation(s)
- Faiha Fareez
- Department of Pathology and Molecular Medicine, McMaster University, Hamilton, ON, Canada
| | - Sultan Yahya
- Department of Radiology, McMaster University, Hamilton, Ontario, Canada
| | - Crystal Fong
- Department of Radiology, McMaster University, Hamilton, Ontario, Canada
| | - Jinesa Moodley
- Department of Pathology, British Columbia Cancer Agency, Vancouver, British Columbia, Canada
| | - John Provias
- Department of Pathology and Molecular Medicine, McMaster University, Hamilton, ON, Canada
| | - Snezana Popovic
- Department of Pathology and Molecular Medicine, McMaster University, Hamilton, ON, Canada
| | - Aleksa Cenic
- Department of Surgery/Neurosurgery, McMaster University, Hamilton, Ontario, Canada
| | - Jian-Qiang Lu
- Department of Pathology and Molecular Medicine, McMaster University, Hamilton, ON, Canada.
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Riviere-Cazaux C, Carlstrom LP, Eschbacher KL, Raghunathan A, Graffeo CS, Meyer FB. Calcifying Pseudoneoplasm of the Neuraxis: An Institutional Series of Ten Cases and Review of the Literature to Date. World Neurosurg 2023; 180:e653-e666. [PMID: 37813339 DOI: 10.1016/j.wneu.2023.10.004] [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: 06/11/2023] [Revised: 10/01/2023] [Accepted: 10/03/2023] [Indexed: 10/11/2023]
Abstract
BACKGROUND Calcified pseudoneoplasms of the neuraxis (CAPNONs) are rare, fibro-osseous lesions with an unknown cause that may present anywhere along the neuroaxis. Little is known about how intracranial CAPNONs present and about patients' long-term outcomes. METHODS A retrospective institutional review of intracranial pathology-confirmed CAPNONs was performed. Presenting clinical features, management, and clinical outcomes are highlighted. A literature review of intracranial CAPNON lesions was also performed to build on our series. RESULTS Ten patients were identified who met the inclusion criteria. Most patients presented with headaches (n = 6; 60%), seizures (n = 5; 50.0%), and neck and facial pain (n = 3; 30.0%). Most lesions were supratentorial (n = 7; 70.0%), with 3 infratentorial origins. Surgical resection was the most common initial management undertaken (n = 7; 70.0%). No new permanent postoperative neurologic deficits were identified. The median clinical and/or radiographic follow-up for all patients was 6.8 years (range, 0.7-23.3 years), with no recurrence of disease for 5 patients who underwent gross total resection. Four of 5 patients with residual or nonresectable lesions showed no interval growth on radiographic follow-up; 1 patient showed progression and worsening of presenting symptoms 2 months after resection. Resection substantially improved seizures and headaches in patients presenting with these symptoms (80% and 83.3%, respectively). CONCLUSIONS Intracranial CAPNONs may present with a wide variety of symptoms characteristic of the site of origin. The outcomes of these symptoms regarding survival and disease control are generally favorable, although resection does not always yield complete resolution of presenting deficits in certain patients, particularly those presenting with headaches or neck/facial pain.
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Affiliation(s)
| | - Lucas P Carlstrom
- Department of Neurological Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Aditya Raghunathan
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA
| | - Christopher S Graffeo
- Department of Neurological Surgery, University of Oklahoma, Oklahoma City, Oklahoma, USA
| | - Fredric B Meyer
- Department of Neurological Surgery, Mayo Clinic, Rochester, Minnesota, USA.
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Graffeo CS, Scherschinski L, Furey CG, Cole TS, Srinivasan VM, Lawton MT. Far Lateral Approach for Resection of a Calcifying Pseudoneoplasm of the Neuroaxis: 2-Dimensional Operative Video. Oper Neurosurg (Hagerstown) 2023; 24:e448. [PMID: 36815782 DOI: 10.1227/ons.0000000000000662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Accepted: 12/18/2022] [Indexed: 02/24/2023] Open
Affiliation(s)
- Christopher S Graffeo
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ, USA
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Ghedira K, Mechergui H, Moujahed R, Bouali S. Like a "stone in my head". J Clin Neurosci 2023; 112:55-57. [PMID: 37084525 DOI: 10.1016/j.jocn.2023.04.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 03/24/2023] [Accepted: 04/10/2023] [Indexed: 04/23/2023]
Affiliation(s)
- Khalil Ghedira
- Department of Neurosurgery, National Institute Mongi Ben Hamida of Neurology, Faculty of Medicine of Tunis, University of Tunis El Manar, Tunisia.
| | - Haïfa Mechergui
- Department of Neurosurgery, National Institute Mongi Ben Hamida of Neurology, Faculty of Medicine of Tunis, University of Tunis El Manar, Tunisia
| | - Rim Moujahed
- Department of Radiotherapy, Abderrahmane Mami Hospital, Faculty of Medicine of Tunis, University of Tunis El Manar, Tunisia
| | - Sofiene Bouali
- Department of Neurosurgery, National Institute Mongi Ben Hamida of Neurology, Faculty of Medicine of Tunis, University of Tunis El Manar, Tunisia
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Domecq Laplace L, Ruella M, Caffaratti G, Villamil F, Monsalve M, Alcorta SC, Cervio A. Posterior Fossa Calcifying Pseudoneoplasm of the Neuraxis (CAPNON): Presentation of Three Surgical Cases. World Neurosurg 2022; 167:e423-e431. [PMID: 35964906 DOI: 10.1016/j.wneu.2022.08.022] [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: 05/30/2022] [Revised: 08/05/2022] [Accepted: 08/06/2022] [Indexed: 11/18/2022]
Abstract
BACKGROUND Calcifying pseudoneoplasm of the neuraxis (CAPNON) is an extremely rare entity with fewer than 150 cases reported in the literature and mostly with a supratentorial or spinal location. Posterior fossa CAPNON has been reported scarcely, and association with perilesional edema is a topic not yet approached which might play a significant role in treatment decision and clinical progression. Our objective is to report, to our knowledge, the first series of 3 posterior fossa CAPNON surgically treated in a single institution and assess features that help provide a systematic approach to diagnosis and timely treatment. METHODS This was a monocentric, retrospective study of surgical patients diagnosed with a posterior fossa CAPNON in the last 5 years. A thorough bibliographic research was conducted. RESULTS Three patients were included. Locations involved IV ventricle, right cerebellopontine angle with extension to foramen magnum, and cerebellar vermis. Two of them presented with symptoms linked to acute hydrocephalus, and the other one presented with progressive cranial nerve palsy and brainstem compression signs. The 3 of them showed radiological signs of perilesional edema on their preoperative magnetic resonance imaging. Gross total resection was accomplished in one case, with near and subtotal resections in the others. There were no complications. The outcome was favorable in all cases. CONCLUSIONS It is essential to contemplate this infrequent diagnosis in cases of calcified lesions involving the posterior fossa. When symptoms manifest, surgery should be considered. Perilesional edema could be associated with symptomatic progression and hence a sign suggesting the need for surgical treatment.
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Affiliation(s)
| | - Mauro Ruella
- Department of Neurosurgery, Fleni, Buenos Aires, Argentina
| | | | | | | | | | - Andres Cervio
- Department of Neurosurgery, Fleni, Buenos Aires, Argentina
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Gamblin A, Gropp J, Fredrickson VL, Baradaran H, Couldwell WT. Calcifying Pseudoneoplasm of the Neuraxis Presenting with Vasogenic Edema and a Perilesional Cyst. Asian J Neurosurg 2022; 17:507-510. [PMID: 36398171 PMCID: PMC9665995 DOI: 10.1055/s-0042-1756628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Calcifying pseudoneoplasms of the neuraxis (CAPNONs) are uncommon benign lesions that are rarely diagnosed radiographically. We report an unusual case of a left middle cerebellar peduncle CAPNON with vasogenic edema and a perilesional cyst. The patient was a 36-year-old woman with a 20-year history of left-sided hearing loss that had recently progressed. Computed tomography and magnetic resonance imaging showed a heterogenous calcified lesion with vasogenic edema and a perilesional cyst in the left middle cerebellar peduncle. Although it is a rare radiographic feature of CAPNON, vasogenic edema should be included as a possible feature of this uncommon tumefactive lesion.
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Affiliation(s)
- Austin Gamblin
- School of Medicine, University of Utah, Salt Lake City, Utah, United States
| | - Jarom Gropp
- School of Medicine, University of Utah, Salt Lake City, Utah, United States
| | - Vance L. Fredrickson
- Department of Radiology, University of Utah, Salt Lake City, Utah, United States
| | - Hediyeh Baradaran
- Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah, United States
| | - William T. Couldwell
- Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah, United States,Address for correspondence William T. Couldwell, MD, PhD Department of Neurosurgery, Clinical Neurosciences Center, University of Utah175 N. Medical Drive East, Salt Lake City, UT 84132United States
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Greco E, Elmandouh O, Desai A, Bhatt A, Vibhute P, Aggarwal A. Calcifying pseudoneoplasms of the neuraxis (CAPNON): The great tumor mimicker. Radiol Case Rep 2022; 17:3157-3161. [PMID: 35801128 PMCID: PMC9253552 DOI: 10.1016/j.radcr.2022.05.082] [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: 05/13/2022] [Revised: 05/25/2022] [Accepted: 05/28/2022] [Indexed: 11/04/2022] Open
Abstract
Calcifying pseudoneoplasms of the neuraxis (CAPNON) are very rare intracranial lesions with less than 50 cases reported in literature. These are non-neoplastic in etiology and despite having unique imaging characteristics, are often misdiagnosed as a neoplastic condition like meningioma, chordoma and gliomas. These do not have any predilection for any age, gender or intracranial location and can be seen in a wide range of age groups. Despite having an imaging overlap with neoplastic conditions, CAPNONs have classic histopathologic findings including chondromyxoid matrix, palisading spindle cells and calcific or ossific metaplasia. As more cases are being described in literature the imaging features are also being better defined. We discuss the clinical, imaging and histopathological findings of 2 cases of CAPNON mimicking posterior fossa meningioma and glial neoplasm.
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Cummins DD, Morshed RA, Tihan T, Kunwar S. Calcifying pseudoneoplasm of the neuraxis within the sellar region: illustrative case. JOURNAL OF NEUROSURGERY: CASE LESSONS 2022; 3:CASE2286. [PMID: 36303491 PMCID: PMC9379716 DOI: 10.3171/case2286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Accepted: 02/25/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND There are numerous atypical lesions of the sellar and suprasellar region that are often mistaken for pituitary adenomas. It is important to consider rare mimics of more common pathologies in this region. OBSERVATIONS The authors detail the case of a 37-year-old woman with hypopituitarism who was found to have an atypical sellar mass with slow growth on interval imaging. The lesion was debulked via a microscopic endonasal transsphenoidal approach and found to be a calcifying pseudoneoplasm of the neuraxis (CAPNON). LESSONS CAPNON is a rare disease entity that may affect the sellar region. CAPNON should be on the differential diagnosis for sellar masses that are associated with T1 and T2 hypointensity on magnetic resonance imaging with minimal enhancement. Although CAPNON is not at risk for malignant progression, these benign lesions can continue to grow after a subtotal resection and require follow-up.
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Affiliation(s)
| | | | - Tarik Tihan
- Pathology, University of California, San Francisco, San Francisco, California
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9
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Lu JQ, Al Mohammadi WJB, Fong C, Yang K, Moodley J, Provias J, Popovic S, Chebib I, Cenic A. Spinal calcifying pseudoneoplasm of the neuraxis (CAPNON) and CAPNON-like lesions: CAPNON overlapping with calcified synovial cysts. Pathology 2022; 54:573-579. [DOI: 10.1016/j.pathol.2022.01.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Revised: 12/25/2021] [Accepted: 01/03/2022] [Indexed: 11/24/2022]
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Dallimore CA, Quelle M, Désir LL, Sham S, Harshan M, Wahl SJ, Zlochower A, Goodman RR, Langer DJ, D'Amico RS. Calcifying Pseudoneoplasm of the Neuraxis in the Posterior Fossa: A Case Report and Literature Review. Cureus 2022; 14:e21562. [PMID: 35228921 PMCID: PMC8873312 DOI: 10.7759/cureus.21562] [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] [Accepted: 01/24/2022] [Indexed: 11/05/2022] Open
Abstract
Calcifying pseudoneoplasm of the neuraxis are rare fibro-osseous lesions that can occur throughout the central nervous system. This paper reports one case of this lesion within the posterior fossa and contains a literature review of all cases documented within the posterior fossa to date. A 53-year-old female patient with a history of epiphora, facial irritation, and headaches was found to have a mass centered in the posterior fossa. The patient underwent surgical resection for removal of the mass. Upon review by pathology, the final diagnosis was consistent with calcifying pseudoneoplasm of the neuraxis.
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11
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Li WQ, Wang SH, Zhang ZW, Chen J, Li YM, Lv ZC, Cao HT, Ma XM, Liu HM, Zhu Z. Calcifying pseudoneoplasms of the neuraxis (CAPNON). A case report. Neuropathology 2021; 41:371-375. [PMID: 34374134 DOI: 10.1111/neup.12743] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 03/26/2021] [Accepted: 04/17/2021] [Indexed: 12/01/2022]
Abstract
Calcifying pseudoneoplasms of the neuraxis (CAPNON) are rare, slow-growing, benign lesions occurring throughout the neuroaxis that are frequently misdiagnosed and overlooked by clinicians. Here, we report a case of a 56-year-old woman who presented with a history of recurrent headache for the previous six years. Magnetic resonance imaging (MRI) revealed a 2.3-cm-sized solid mass in the right frontal lobe that was surrounded by marked edematous areas. The lesion demonstrated dense calcification and avid enhancement. The lesion was initially diagnosed as oligodendroglioma, and then found to be CAPNON based on histopathology of a surgically resected tissue. Genetic analysis revealed a nonsense mutation in the CUL4B gene. The patient's condition appeared to reflect a reactive, rather than neoplastic, process. Clinicians should be prepared to detect such pseudotumors histopathologically in order to avoid unnecessary differential tests of neoplastic or infectious diseases, as well as potentially harmful therapies.
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Affiliation(s)
- Wei-Qing Li
- Department of Pathology, Changzheng Hospital, Naval Medical University, Shanghai, China
| | - Shen-Hao Wang
- Department of Neurosurgery, Changzheng Hospital, Naval Medical University, Shanghai, China
| | - Zheng-Wei Zhang
- Department of Pathology, Changzheng Hospital, Naval Medical University, Shanghai, China
| | - Jun Chen
- Department of Pathology, Changzheng Hospital, Naval Medical University, Shanghai, China
| | - Yi-Ming Li
- Department of Neurosurgery, Changzheng Hospital, Naval Medical University, Shanghai, China
| | - Ze-Chao Lv
- Department of Pathology, Changzheng Hospital, Naval Medical University, Shanghai, China
| | - Hao-Tian Cao
- Department of Pathology, Changzheng Hospital, Naval Medical University, Shanghai, China
| | - Xiao-Mei Ma
- Department of Pathology, Changzheng Hospital, Naval Medical University, Shanghai, China
| | - Hui-Min Liu
- Department of Pathology, Changzheng Hospital, Naval Medical University, Shanghai, China
| | - Zhi Zhu
- Department of Pathology, Changzheng Hospital, Naval Medical University, Shanghai, China
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12
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Skull Base Calcifying Pseudoneoplasms of the Neuraxis: Two Case Reports and a Systematic Review of the Literature. Can J Neurol Sci 2021; 47:389-397. [PMID: 31843039 DOI: 10.1017/cjn.2019.339] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Calcifying pseudoneoplasm of the neuraxis (CAPNON) is a rare tumefactive lesion. CAPNONs can mimic calcified meningiomas at the skull base. METHODS Here, we report two cases of CAPNON and present a systematic review of the literature on skull base CAPNONs, to compare CAPNONs with calcified meningiomas. RESULTS Case 1: A 57-year-old man presented with right-sided lower cranial neuropathies and gait ataxia. He underwent a subtotal resection of a right cerebellopontine angle lesion, with significant improvement of his gait ataxia. However, his cranial neuropathies persisted. Pathological examination of the lesion was diagnostic of CAPNON, with the entrapped nerve fibers identified at the periphery of the lesion, correlating with the patient's cranial neuropathy. Case 2: A 70-year-old man presented with progressive headache, gait difficulty, and cognitive impairment. He underwent a frontotemporal craniotomy for a near-total resection of his right basal frontal CAPNON. He remained neurologically stable 7 years after the initial resection without evidence of disease recurrence. We analyzed 24 reported CAPNONs at the skull base in our systematic review of the literature. Cranial neuropathies were present in 11 (45.8%) patients. Outcomes regarding cranial neuropathies were documented in six patients: two had sacrifice of the nerve function with surgical approaches and four had persistent cranial neuropathies. CONCLUSION While CAPNON can radiologically and grossly mimic calcified meningiomas, they are two distinctly different pathologies. CAPNONs located at the skull base are commonly associated with cranial neuropathies, which may be difficult to reverse despite surgical intervention.
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13
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Li Y, Yang X, Liang Z, Zheng J, Zhou H, Li H. Giant calcified pseudoplasm of the nerve axis of the temporal lobe: a case report and review of the literature. Acta Neurol Belg 2021; 122:1477-1484. [PMID: 33675530 DOI: 10.1007/s13760-021-01641-1] [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: 01/25/2021] [Accepted: 02/26/2021] [Indexed: 02/05/2023]
Abstract
Calcifying pseudoneoplasms of the neuraxis (CAPNONs) are rare and can occur along the neural axis. The pathogenesis of these masses is still unknown, and they are diagnosed by histopathological analysis. We report the largest CAPNON in the temporal lobe reported to date and a review of the literature on all previously reported CAPNON cases located in the temporal lobe. According to the literature review, prior to 2020, the largest CAPNON in the temporal lobe that had ever been reported measured 30 × 30 × 20 mm (Mohapatra et al.). However, we report a larger temporal lobe CAPNON (45 × 35 × 35 mm) in a female patient admitted to our hospital. In addition, among 22 patients with CAPNONs aged from 6 to 62 years, 45.5% were female and 54.5% were male. A total of 72.8% of patients presented with seizures, 9.1% had pituitary dysfunction and 9.1% did not have symptoms. Of the cases in the patients with seizures, 83.2% were completely surgically resected, 5.6% were partially surgically resected, and one was treated medically; one patient refused treatment. Except for one patient who had multiple lesions, all patients who underwent surgery exhibited improved or the disappearance of symptoms of epilepsy. The patient in whom epilepsy resolved had undergone total resection. CAPNON is a rare benign lesion that occurs throughout the nervous system, and the pathogenesis remains unclear. Although the hardness of these lesions vary, surgery is still the preferred treatment and yields good results, and total resection is recommended for patients with epilepsy in the temporal lobe.
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Affiliation(s)
- Yujian Li
- Department of Neurosurgery, West China Hospital, Sichuan University, 37 Guo Xue Xiang, Wu Hou District, Chengdu, 610041, Sichuan, People's Republic of China
| | - Xiang Yang
- Department of Neurosurgery, West China Hospital, Sichuan University, 37 Guo Xue Xiang, Wu Hou District, Chengdu, 610041, Sichuan, People's Republic of China
| | - Zuoyu Liang
- Department of Pathology, West China Hospital, Sichuan University, Chengdu, People's Republic of China
| | - Jun Zheng
- Department of Neurosurgery, West China Hospital, Sichuan University, 37 Guo Xue Xiang, Wu Hou District, Chengdu, 610041, Sichuan, People's Republic of China
| | - Huiqing Zhou
- Department of Intensive Care Unit, Fourth People's Hospital of Sichuan Province, Chengdu, People's Republic of China
| | - Hao Li
- Department of Neurosurgery, West China Hospital, Sichuan University, 37 Guo Xue Xiang, Wu Hou District, Chengdu, 610041, Sichuan, People's Republic of China.
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14
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Yang K, Reddy K, Chebib I, Hammond R, Lu JQ. Calcifying Pseudoneoplasm of the Neuraxis: From Pathogenesis to Diagnostic and Therapeutic Considerations. World Neurosurg 2021; 148:165-176. [PMID: 33508489 DOI: 10.1016/j.wneu.2021.01.076] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2020] [Revised: 01/12/2021] [Accepted: 01/13/2021] [Indexed: 10/22/2022]
Abstract
Calcifying pseudoneoplasm of the neuraxis (CAPNON) is a rare tumefactive lesion that can develop anywhere within the neuraxis. The incidence is likely underreported, given its nonspecific imaging features and because CAPNON has often been overwhelmed by the presence of comorbid disease. CAPNON is typically diagnosed by the histopathological examination findings. However, the histopathological diagnosis is often challenging owing to the existence of similar calcifying pathological entities. Although the pathogenesis of CAPNON has remained elusive, emerging evidence supports a reactive proliferative and immune-mediated process involving the aggregation of neurofilament light chain protein and the infiltration of immune cells. The management of CAPNON is largely dependent on the symptoms, which are mainly related to the location and associated mass effects. Maximal surgical resection will result in excellent patient outcomes with rare recurrence, especially in patients presenting with epilepsy. The discovery of neurofilament light chain protein within CAPNON suggests that neurofilament might be implicated in the pathogenesis of CAPNON, serve as an immunohistochemical marker to improve the diagnostic accuracy of CAPNON, and hold therapeutic potential for the treatment of CAPNON.
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Affiliation(s)
- Kaiyun Yang
- Department of Neurosurgery, University of Toronto, Toronto, Ontario, Canada
| | - Kesava Reddy
- Division of Neurosurgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Ivan Chebib
- Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Robert Hammond
- Department of Pathology and Laboratory Medicine, Western University, London, Ontario, Canada
| | - Jian-Qiang Lu
- Department of Pathology and Molecular Medicine/Neuropathology, McMaster University, Hamilton, Ontario, Canada.
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15
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Lu JQ, Berthelet F, Bojanowski MW. Letter to the Editor Regarding "Case of Calcifying Pseudoneoplasms of the Neuraxis Coexisting with Interhemispheric Lipoma and Agenesis of the Corpus Callosum: Involvement of Infiltrating Macrophages". World Neurosurg 2020; 139:668-669. [PMID: 32689674 DOI: 10.1016/j.wneu.2020.04.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Accepted: 04/01/2020] [Indexed: 12/26/2022]
Affiliation(s)
- Jian-Qiang Lu
- Neuropathology Section, Department of Pathology and Molecular Medicine, McMaster University, Hamilton, Ontario, Canada.
| | - France Berthelet
- Department of Pathology and Cellular Biology, University of Montreal, Montreal, Quebec, Canada
| | - Michel W Bojanowski
- Division of Neurosurgery, Department of Surgery, University of Montreal, Montreal, Quebec, Canada
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16
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Immunohistochemical Markers in the Diagnosis of Calcifying Pseudoneoplasm of the Neuraxis. Can J Neurol Sci 2020; 48:259-266. [PMID: 32800010 DOI: 10.1017/cjn.2020.175] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Calcifying pseudoneoplasm of the neuraxis (CAPNON) is a rare tumor-like lesion with unknown pathogenesis. It is likely under-reported due to diagnostic challenges including the nonspecific radiographic features, lack of diagnostic markers, and often asymptomatic nature of the lesions. METHODS We performed detailed examination of 11 CAPNON specimens diagnosed by histopathology, with the help of electron microscopy and immunohistochemistry. RESULTS Electron microscopy revealed the presence of fibrillary materials consistent with neurofilaments. In addition to some entrapped axons at the periphery of CAPNONs, we discovered that all specimens stained positive for neurofilament-light (NF-L) within the granular amorphous cores, but not neurofilament-phosphorylated (NF-p). CAPNONs also showed variable infiltration of CD8+ T-cells and a decreased ratio of CD4/CD8+ T-cells, suggesting an immune-mediated process in the pathogenesis of CAPNON. CONCLUSION NF-L and CD4/CD8 immunostains may serve as diagnostic markers for CAPNON and shed light on its pathogenesis.
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17
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Lu JQ, Popovic S, Provias J, Cenic A. Collision Lesions of Calcifying Pseudoneoplasm of the Neuraxis and Rheumatoid Nodules: A Case Report With New Pathogenic Insights. Int J Surg Pathol 2020; 29:314-320. [PMID: 32666850 DOI: 10.1177/1066896920941939] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Calcifying pseudoneoplasm of the neuraxis (CAPNON) is a rare tumor-like lesion with unclear pathogenesis. Collision lesions of CAPNONs with neoplasms are occasionally reported. In this article, we report the first case of collision lesions between CAPNON and rheumatoid nodules (RNs) in a patient with systemic lupus erythematosus. The patient was a 51-year-old female who presented with lower back pain and subsequently a lower back mass over 2 years. Spinal magnetic resonance imaging demonstrated a heterogeneous, partially calcified mass centered in the L3-4 paravertebral regions. A biopsy of the mass was diagnostic of CAPNON. As the mass grew over the following 5 months, it was resected en bloc. Its pathological examination revealed collision lesions of RNs at different histopathological stages and CAPNON lesions, and transitional lesions exhibiting combined RN and CAPNON features, with immune cell infiltrates. Our findings provide new evidence for an immune-mediated reactive process and insights into the pathogenies of CAPNON.
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Affiliation(s)
| | | | - John Provias
- 3710McMaster University, Hamilton, Ontario, Canada
| | - Aleksa Cenic
- 3710McMaster University, Hamilton, Ontario, Canada
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Ho ML, Eschbacher KL, Paolini MA, Raghunathan A. New insights into calcifying pseudoneoplasm of the neuraxis (CAPNON): a 20-year radiological-pathological study of 37 cases. Histopathology 2020; 76:1055-1069. [PMID: 31955449 DOI: 10.1111/his.14066] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Revised: 01/14/2020] [Accepted: 01/16/2020] [Indexed: 11/28/2022]
Abstract
AIMS Calcifying pseudoneoplasm of the neuraxis (CAPNON) is a rare entity that can occur anywhere within the central nervous system. Histologically, CAPNON has been characterised as a benign, calcified, fibro-osseous lesion with a characteristic chondromyxoid fibrillary matrix with dense calcification and varying degrees of spindle, epithelioid, fibrous, meningothelial and giant cells. The underlying aetiology of CAPNON is controversial and incompletely understood. The aim of this study was to perform a comprehensive radiological and histological review to further characterise this entity. METHODS AND RESULTS In this article, we review our institutional 20-year experience including 37 cases of CAPNON with detailed pathological analysis, evaluation of concurrent lesions, correlation with radiological imaging, and critical review of the literature. The classic histological finding of chondromyxoid matrix was present in one-third of cases. Underlying or dual pathologies were frequent, and included diverse underlying conditions. Radiologically, dense calcification and dural attachment were the most common features. Enhancement was often low, but was more prominent in the setting of inflammatory changes, aggressive growth, and dual pathology. CONCLUSION Our results suggest that CAPNON represents a spectrum of reactive processes that can arise in association with diverse underlying pathologies, including inflammatory, degenerative, vascular and neoplastic lesions.
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Affiliation(s)
- Mai-Lan Ho
- Department of Radiology, Nationwide Children's Hospital, Columbus, OH, USA
| | - Kathryn L Eschbacher
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Michael A Paolini
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Aditya Raghunathan
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
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Calcifying pseudoneoplasm of the neuroaxis presenting with refractory seizures: Case report and literature review. J Clin Neurosci 2020; 78:439-443. [PMID: 32387256 DOI: 10.1016/j.jocn.2020.05.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Accepted: 05/01/2020] [Indexed: 02/06/2023]
Abstract
Calcifying pseudoneoplasms of the neuraxis (CAPNON) are rare benign lesions that can arise anywhere within the central nervous system. The etiology of these lesions remains unknown and diagnosis is made on pathohistological analysis. We present the case of a 35-year-old male patient with a history of epilepsy since childhood who was evaluated for refractory seizures. MRI revealed a small lesion in the left-posterior temporal lobe suspected to be a cavernoma. A gross total resection of the lesion was achieved via a left temporal craniotomy and pathological analysis revealed CAPNON. At 6 months follow-up, the patient remained neurologically intact and his seizures had ceased.
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Lu JQ, Yang K, Reddy KKV, Wang BH. Incidental multifocal calcifying pseudoneoplasm of the neuraxis: case report and literature review. Br J Neurosurg 2020:1-8. [PMID: 32162556 DOI: 10.1080/02688697.2020.1738342] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Calcifying pseudoneoplasm of the neuraxis (CAPNON) is thought to be a rare tumefactive lesion with unknown pathogenesis. Its prevalence is questionable with few previously reported cases of incidental CAPNON, and likely underdiagnosis. We report a unique case of incidental multifocal CAPNON. A 64-year-old female was admitted with loss of consciousness due to a ruptured right middle cerebral artery aneurysm with subarachnoid and intraventricular hemorrhage. She has a craniotomy and clipping. At time of operation, numerous small dural-based nodules were found, and one was excised for biopsy and was diagnosed as CAPNON. Retrospective review of her CT images identified nodules that were all ipsilateral to the ruptured aneurysm. A literature review revealed that incidental and/or multifocal CAPNONs are rare but likely underreported. Our case suggests a reactive process in the pathogenesis of CAPNON.
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Affiliation(s)
- Jian-Qiang Lu
- Neuropathology Section, Department of Pathology and Molecular Medicine, Hamilton Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Kaiyun Yang
- Division of Neurosurgery, Department of Surgery, Hamilton Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Kesava K V Reddy
- Division of Neurosurgery, Department of Surgery, Hamilton Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Bill Hao Wang
- Division of Neurosurgery, Department of Surgery, Hamilton Health Sciences, McMaster University, Hamilton, ON, Canada
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Inukai M, Shibahara I, Hotta M, Miyasaka K, Sato S, Hide T, Saegusa M, Kumabe T. Case of Calcifying Pseudoneoplasms of the Neuraxis Coexisting with Interhemispheric Lipoma and Agenesis of the Corpus Callosum: Involvement of Infiltrating Macrophages. World Neurosurg 2020; 134:635-640.e1. [DOI: 10.1016/j.wneu.2019.10.182] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Revised: 10/28/2019] [Accepted: 10/29/2019] [Indexed: 10/25/2022]
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Tanoue Y, Uda T, Nakajo K, Nishijima S, Sasaki T, Ohata K. Surgically treated intracranial supratentorial calcifying pseudoneoplasms of the neuraxis (CAPNON) with drug-resistant left temporal lobe epilepsy: A case report and review of the literature. EPILEPSY & BEHAVIOR CASE REPORTS 2019; 11:107-114. [PMID: 30963026 PMCID: PMC6434061 DOI: 10.1016/j.ebcr.2019.02.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Revised: 02/18/2019] [Accepted: 02/26/2019] [Indexed: 04/20/2023]
Abstract
Calcifying pseudoneoplasms of the neuraxis (CAPNON) are rare pathological lesions that can present anywhere in the central nervous system. Symptoms vary depending on the location, though they often include seizures, especially in intracranial and supratentorial lesions. A case of intracranial supratentorial CAPNON presenting with drug-resistant left temporal lobe epilepsy is reported. The patient had a history of drug-resistant focal seizures for over 36 years. The lesion was located in the left mesial temporal lobe, but hippocampal sclerosis and hippocampal invasion were not apparent. The lesion was removed without hippocampectomy, and the patient has been seizure-free for one year.
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