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Reyes HM, Fiorentino E, Matiasek K, Menchetti M. Intradural-extramedullary inflammatory pseudotumour of the cervical spinal cord of a dog. Vet Radiol Ultrasound 2024. [PMID: 38853369 DOI: 10.1111/vru.13384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 03/14/2024] [Accepted: 05/06/2024] [Indexed: 06/11/2024] Open
Abstract
An 8-year-old mixed-breed dog was presented with cervical hyperesthesia, tetraparesis, and mild proprioceptive ataxia in all four limbs. 3 Tesla MRI showed a dorsal compressive intradural-extramedullary mass at the level of C1-C2, isointense to the gray matter with a hypointense ventral core on T2 weighted images (WI), isointense on T1WI, with a strong and homogeneous contrast enhancement. A C1-C2 partial dorsal laminectomy was performed, and the lesion was removed en bloc. The histopathological and immunohistochemical analysis defined the diagnosis of inflammatory pseudotumor.
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Affiliation(s)
- Henry Mendo Reyes
- Division of Neurology and Neurosurgery, San Marco Veterinary Clinic and Laboratory, Padua, Italy
| | - Erica Fiorentino
- Division of Neurology and Neurosurgery, San Marco Veterinary Clinic and Laboratory, Padua, Italy
| | - Kaspar Matiasek
- Section of Clinical & Comparative Neuropathology, Centre for Clinical Veterinary Medicine, LMU, Munich, Germany
| | - Marika Menchetti
- Division of Neurology and Neurosurgery, San Marco Veterinary Clinic and Laboratory, Padua, Italy
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Warade AG, Kini K, Deshpande RB, Misra BK. Thoracic Epidural Chronic Inflammatory Lesion: A Case Report and Review of Literature. Neurol India 2024; 72:629-631. [PMID: 39041985 DOI: 10.4103/ni.ni_1052_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Accepted: 03/09/2022] [Indexed: 07/24/2024]
Abstract
Chronic inflammatory lesions (CIL) in the body are rare and inflammatory pseudotumor (IPT) is a subtype of CIL. Spine is an uncommon location of CIL, with most cases reported in the thoracic spine. Our objective was to review the current literature on IPT. To the best of our knowledge only about 13 cases are reported till date. A retrospective review of 13 existing cases was done. The etiopathogenesis of CIL is uncertain and total surgical excision remains the mainstay. It's a diagnosis of exclusion after ruling out commonly found lesions, both clinically and radiologically. Only histopathology can confirm the diagnosis. Total surgical resection remains the mainstay of treatment with adjuvant treatment only if there is a residue or a recurrence. CILs are rare lesions in the body with IPT being the commonest. Surgical excision remains the mainstay of treatment and a long-term follow up is warranted.
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Affiliation(s)
- Abhijit G Warade
- Department of Neurosurgery and Gamma Knife Surgery, P. D Hinduja Hospital and MRC, Mahim, Mumbai, Maharashtra, India
| | - Karishma Kini
- Department of Neurosurgery and Gamma Knife Surgery, P. D Hinduja Hospital and MRC, Mahim, Mumbai, Maharashtra, India
| | - Ramesh B Deshpande
- Department of Pathology, P. D Hinduja Hospital and MRC, Mahim, Mumbai, Maharashtra, India
| | - Basant K Misra
- Department of Neurosurgery and Gamma Knife Surgery, P. D Hinduja Hospital and MRC, Mahim, Mumbai, Maharashtra, India
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Chanthong S, Sathitsamitphong L, Natesirinilkul R, Charoenkwan P, Suwansirikul S, Choed-Amphai C. Treatment modalities of ALK-positive relapsed/refractory inflammatory myofibroblastic tumor of the brain and lungs in 7-year-old girl: case-based reviews. Childs Nerv Syst 2023; 39:331-342. [PMID: 36515740 DOI: 10.1007/s00381-022-05789-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 12/08/2022] [Indexed: 12/15/2022]
Abstract
PURPOSE Inflammatory myofibroblastic tumor (IMT) belongs to mesenchymal neoplasm of intermediate malignancy in WHO classification. Primary CNS disease or CNS metastases (CNS-IMT) occur in minority. We describe a case of relapsed/refractory IMT of lungs with multiple brain metastases in young child who achieved long-term complete response after alectinib. This systematic review also summarizes treatment modalities and outcome of children and adolescent with CNS-IMT. METHODS PRISMA 2020 guideline was applied to select an article from PubMed, Scopus, and Cochrane databases without time limits. This review focused on children and adolescent 0-24 years of age with CNS-IMT or inflammatory pseudotumor (CNS-IPT). The clinical characteristics and treatment outcome were explored. RESULTS A total of 51 patients in 49 publications were identified. Median age of patients with CNS-IMT/IPT was 15-year-old and 60.8% were male. The most common location of tumor was cerebral cortex (54.9%). Complete resection of CNS-IMT/IPT was performed in 27 cases with 100% complete response and 18.5% recurrence. Nearly half of patients who received partial resection without adjuvant therapy experienced progressive disease, while the contrast group totally achieved partial response. Overall responses in 7 patients treating with ALK inhibitors were 57.1% durable complete response and 42.9% transient partial response. CONCLUSION First-line treatment of CNS-IMT/IPT is complete resection. Patients who received partial tumor removal might have benefit from adjuvant therapy. ALK inhibitors reveal a promising result in unresectable CNS-IMT/IPT. Our case has shown a success in treating relapsed and refractory CNS-IMT as well as the primary site using 2nd-generation ALK inhibitor.
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Qi Z, Liu J, Li G, Zhang Y. Immunoglobulin G4-Related Spinal Intramedullary Inflammatory Pseudotumor: A Case Report and Literature Review. Front Neurol 2022; 13:878414. [PMID: 35837229 PMCID: PMC9275449 DOI: 10.3389/fneur.2022.878414] [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: 02/25/2022] [Accepted: 05/09/2022] [Indexed: 11/13/2022] Open
Abstract
Immunoglobulin G4-related disease (IgG4-RD) is an autoimmune disease that affects several organs. An inflammatory pseudotumor is a histologically proven benign tumor-like lesion that most commonly involves the lung and orbit. It is rare in the central nervous system, but rarest in the spinal canal. In this report, we present a case of IgG4-related intramedullary spinal inflammatory pseudotumor, along with a literature review. A 29-year-old male was transferred to the Department of Neurosurgery of Lanzhou University Second Hospital with progressive quadriparesis after numbness and weakness in both lower limbs for 50 days. Enhanced magnetic resonance imaging (MRI) of the spine revealed an isointense signal on T1-weighted images and a hyperintense signal on T2-weighted images from an enhanced mass located at the thoracic vertebrae region, for which a schwannoma was highly suspected. Then, a posterior median approach was adopted. The lesion was resected. The patient received further glucocorticoid after the diagnosis of an IgG4-related inflammatory pseudotumor was established, and the patient's symptoms improved, such as quadriparesis and lower limb weakness. This case highlights the importance of considering IgG4-related inflammatory pseudotumor as a differential diagnosis in patients with lesions involving the spinal intramedullary compartment and lower limb weakness when other more threatening causes have been excluded. IgG4-related inflammatory pseudotumor is etiologically unclear and prognostically unpredictable, and imaging may not help establish the diagnosis of IgG4-related inflammatory pseudotumor due to its resemblance to malignant tumors, and total resection might not be warranted. Glucocorticoid and surgery are usually the first-line treatments used.
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Affiliation(s)
- Zhou Qi
- Department of Neurosurgery, Lanzhou University Second Hospital, Lanzhou, China
| | - Jianli Liu
- Department of Medical Imaging, Lanzhou University Second Hospital, Lanzhou, China
| | - Guoqiang Li
- Department of Neurosurgery, Lanzhou University Second Hospital, Lanzhou, China
| | - Yinian Zhang
- Department of Neurosurgery, Lanzhou University Second Hospital, Lanzhou, China
- Neurosurgery Center of Zhujiang Hospital of Southern Medical University, Guangzhou, China
- *Correspondence: Yinian Zhang
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Wang X, Li Y, Wang S, Wang S, Sun S. A rare case of inflammatory pseudotumor located in the ventral of medullocervical junction. A case report and review of literature. Br J Neurosurg 2021; 37:1-3. [PMID: 33688755 DOI: 10.1080/02688697.2021.1895970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Accepted: 02/22/2021] [Indexed: 02/08/2023]
Abstract
Inflammatory pseudotumor is a benign lesion of unknown etiology, which mimics neoplasms clinically and radiographically. It most commonly involves the lungs and orbits and is rarely reported in the central nervous system. We report a rare case of inflammatory pseudotumor located in the ventral junction of the medulla oblangta and cervical cistern, which has not been reported before as far as we know. A 61-year-old male presented with right arm weakness. MRI showed a mass located in the ventral junction of the medulla oblongata and cervical cisten. The patient was diagnosed as inflammatory pseudotumor(IPT) after surgical excision and histopathology. This tumor-like lesion was surrounding the bilateral intracranial segment of the vertebral arteries. No evidence of vascular invasion was observed. Complete surgical resection was achieved.
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Affiliation(s)
- Xiaochen Wang
- Department of Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yingying Li
- Department of Radiology, Beijing Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Sihui Wang
- Department of Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Shu Wang
- Department of Neurosurgery, SanBo Brain Hospital, Capital Medical University, Beijing, China
| | - Shengjun Sun
- Department of Neuroradiology, Beijing Neurosurgical Institute, Affiliated Beijing Tiantan Hospital, Capital Medical University, Beijing, China
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Lin R, Wang S, Lin J, Zhang Z, Chen X. Cross-segment spinal plasma cell granuloma:a case report. BMC Musculoskelet Disord 2020; 21:746. [PMID: 33183250 PMCID: PMC7663890 DOI: 10.1186/s12891-020-03759-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Accepted: 10/30/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Plasma cell granuloma (PCG) is a rare non-neoplastic entity, with the precise etiology remaining unclear. Vertebra-affected spinal PCG has not been reported yet. This report presented a case with cross-segment spinal PCG in thoracolumbar region. CASE PRESENTATION A 32-year-old male patient presented to the authors' hospital since his health check-up results showed osteolytic lesions in the thoracolumbar spine. He felt asymptomatic throughout the course. Radiological examination revealed destructive changes at T12 and L1 vertebrae. Whereas laboratory examination excluded malignant tumor. The results of routine incisional biopsy remained inconclusive, thereby necessitating complete excision of the lesions. Finally, the infiltration of plasma cells observed by pathological examination of the surgical specimen confirmed the diagnosis of PCG. CONCLUSIONS To the authors' knowledge, this was the first case of cross-segment spinal PCG with osteolytic property. The possibility of PCG should be considered for the diagnosis and differential diagnosis of an osteolytic lesion in the spine. Since the etiology of PCG is unknown, the disorder was confirmed based on excluded diagnosis. Surgical resection is recommended both for the definite diagnosis and treatment of spinal PCG.
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Affiliation(s)
- Renqin Lin
- Department of Orthopedic Surgery, the First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, 350005, P.R. China
| | - Shenglin Wang
- Department of Orthopedic Surgery, the First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, 350005, P.R. China
| | - Jianhua Lin
- Department of Orthopedic Surgery, the First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, 350005, P.R. China
| | - Zhenzhen Zhang
- Department of Pathology, the First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, 350005, P.R. China
| | - Xuanwei Chen
- Department of Orthopedic Surgery, the First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, 350005, P.R. China.
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