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Yogendran LV, Kalelioglu T, Donahue JH, Ahmad H, Phillips KA, Calautti NM, Lopes MB, Asthagiri AR, Purow B, Schiff D, Patel SH, Fadul CE. The landscape of brain tumor mimics in neuro-oncology practice. J Neurooncol 2022; 159:499-508. [PMID: 35857249 DOI: 10.1007/s11060-022-04087-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2022] [Accepted: 07/02/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND OBJECTIVE Differentiating neoplastic and non-neoplastic brain lesions is essential to make management recommendations and convey prognosis, but the distinction between brain tumors and their mimics in practice may prove challenging. The aim of this study is to provide the incidence of brain tumor mimics in the neuro-oncology setting and describe this patient subset. METHODS Retrospective study of adult patients referred to the Division of Neuro-oncology for a presumed diagnosis of brain tumor from January 1, 2005 through December 31, 2017, who later satisfied the diagnosis of a non-neoplastic entity based on neuroimaging, clinical course, and/or histopathology evaluation. We classified tumor mimic entities according to clinical, radiologic, and laboratory characteristics that correlated with the diagnosis. RESULTS The incidence of brain tumor mimics was 3.4% (132/3897). The etiologies of the non-neoplastic entities were vascular (35%), inflammatory non-demyelinating (26%), demyelinating (15%), cysts (10%), infectious (9%), and miscellaneous (5%). In our study, 38% of patients underwent biopsy to determine diagnosis, but in 26%, the biopsy was inconclusive. DISCUSSION Brain tumor mimics represent a small but important subset of the neuro-oncology referrals. Vascular, inflammatory, and demyelinating etiologies represent two-thirds of cases. Recognizing the clinical, radiologic and laboratory characteristics of such entities may improve resource utilization and prevent unnecessary as well as potentially harmful diagnostic and therapeutic interventions.
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Affiliation(s)
- Lalanthica V Yogendran
- Division of Neuro-Oncology, Department of Neurology, University of Virginia, P.O. Box 800394, Charlottesville, VA, 22908, USA
| | - Tuba Kalelioglu
- Department of Radiology & Medical Imaging, University of Virginia, Charlottesville, VA, USA
| | - Joseph H Donahue
- Department of Radiology & Medical Imaging, University of Virginia, Charlottesville, VA, USA
| | - Haroon Ahmad
- Department of Neurology, University of Maryland, Baltimore, MD, USA
| | - Kester A Phillips
- Department of Neurology, The Ben and Catherine Ivy Center for Advanced Brain Tumor Treatment at Swedish Neuroscience Institute, Seattle, WA, USA
| | - Nicole M Calautti
- Division of Neuro-Oncology, Department of Neurology, University of Virginia, P.O. Box 800394, Charlottesville, VA, 22908, USA
| | - Maria-Beatriz Lopes
- Department of Pathology, Divisions of Neuropathology and Molecular Diagnostics, University of Virginia, Charlottesville, VA, USA
| | - Ashok R Asthagiri
- Department of Neurosurgery, University of Virginia, Charlottesville, VA, USA
| | - Benjamin Purow
- Division of Neuro-Oncology, Department of Neurology, University of Virginia, P.O. Box 800394, Charlottesville, VA, 22908, USA
| | - David Schiff
- Division of Neuro-Oncology, Department of Neurology, University of Virginia, P.O. Box 800394, Charlottesville, VA, 22908, USA
| | - Sohil H Patel
- Department of Radiology & Medical Imaging, University of Virginia, Charlottesville, VA, USA
| | - Camilo E Fadul
- Division of Neuro-Oncology, Department of Neurology, University of Virginia, P.O. Box 800394, Charlottesville, VA, 22908, USA.
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Casper AC, Stenehjem EA, Gill DM, Evans JD. Streptococcus Intermedius: A Mimicker of Brain Metastases and A Potential Pitfall for Radiation Oncologists. Adv Radiat Oncol 2021; 6:100689. [PMID: 34409201 PMCID: PMC8361051 DOI: 10.1016/j.adro.2021.100689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 03/04/2021] [Accepted: 03/08/2021] [Indexed: 11/29/2022] Open
Affiliation(s)
- Anthony C Casper
- Department of Radiation Oncology, Intermountain Healthcare, Ogden, Utah.,Rocky Vista University College of Osteopathic Medicine, Ivins, Utah
| | - Edward A Stenehjem
- Department of Medicine, Division of Epidemiology and Infectious Diseases, Intermountain Healthcare, Salt Lake City, Utah
| | - David M Gill
- Department of Medical Oncology, Intermountain Healthcare, Salt Lake City, Utah
| | - Jaden D Evans
- Department of Radiation Oncology, Intermountain Healthcare, Ogden, Utah
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Abstract
Nonneoplastic entities may closely resemble the imaging findings of primary or metastatic intracranial neoplasia, posing diagnostic challenges for the referring provider and radiologist. Prospective identification of brain tumor mimics is an opportunity for the radiologist to add value to patient care by decreasing time to diagnosis and avoiding unnecessary surgical procedures and medical therapies, but requires familiarity with mimic entities and a high degree of suspicion on the part of the interpreting radiologist. This article provides a framework for the radiologist to identify "brain tumor mimics," highlighting imaging and laboratory pearls and pitfalls, and illustrating unique and frequently encountered lesions.
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Affiliation(s)
- Joseph H Donahue
- Department of Radiology and Medical Imaging, University of Virginia Health System, PO Box 800170, Charlottesville, VA 22908-0170, USA
| | - Sohil H Patel
- Department of Radiology and Medical Imaging, University of Virginia Health System, PO Box 800170, Charlottesville, VA 22908-0170, USA
| | - Camilo E Fadul
- Department of Neurology, University of Virginia Health System, PO Box 800432, Charlottesville, VA 22908-0170, USA
| | - Sugoto Mukherjee
- Department of Radiology and Medical Imaging, University of Virginia Health System, PO Box 800170, Charlottesville, VA 22908-0170, USA.
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