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Shukla S, Karbhari A, Rastogi S, Agarwal U, Rai P, Mahajan A. Bench-to-bedside imaging in brain metastases: a road to precision oncology. Clin Radiol 2024; 79:485-500. [PMID: 38637186 DOI: 10.1016/j.crad.2024.02.015] [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: 12/02/2022] [Revised: 02/08/2024] [Accepted: 02/12/2024] [Indexed: 04/20/2024]
Abstract
Radiology has seen tremendous evolution in the last few decades. At the same time, oncology has made great strides in diagnosing and treating cancer. Distant metastases of neoplasms are being encountered more often in light of longer patient survival due to better therapeutic strategies and diagnostic methods. Brain metastasis (BM) is a dismal manifestation of systemic cancer. In the present scenario, magnetic resonance imaging (MRI), computed tomography (CT) and positron emission tomography (PET) are playing a big role in providing molecular information about cancer. Lately, molecular imaging has emerged as a stirring arena of dynamic imaging techniques that have enabled clinicians and scientists to noninvasively visualize and understand biological processes at the cellular and molecular levels. This knowledge has impacted etiopathogenesis, detection, personalized treatment, drug development, and our understanding of carcinogenesis. This article offers insight into the molecular biology underlying brain metastasis, its pathogenesis, imaging protocols, and algorithms. It also discusses disease-specific molecular imaging features, focusing on common tumors that spread to the brain, such as lung, breast, colorectal cancer, melanoma, and renal cell carcinoma. Additionally, it covers various targeted treatment options, criteria for assessing treatment response, and the role of artificial intelligence in diagnosing, managing, and predicting prognosis for patients with brain metastases.
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Affiliation(s)
- S Shukla
- Department of Radiodiagnosis and Imaging, Mahamana Pandit Madan Mohan Malaviya Cancer Centre and Homi Bhabha Cancer Hospital, Tata Memorial Hospital, Varanasi, 221 005, Maharashtra, India; Department of Radiodiagnosis and Imaging, Homi Bhabha National Institute, Tata Memorial Hospital, Mumbai, 400 012, Maharashtra, India
| | - A Karbhari
- Department of Radiodiagnosis and Imaging, Homi Bhabha National Institute, Tata Memorial Hospital, Mumbai, 400 012, Maharashtra, India
| | - S Rastogi
- Department of Radiodiagnosis and Imaging, Homi Bhabha National Institute, Tata Memorial Hospital, Mumbai, 400 012, Maharashtra, India
| | - U Agarwal
- Department of Radiodiagnosis and Imaging, Homi Bhabha National Institute, Tata Memorial Hospital, Mumbai, 400 012, Maharashtra, India
| | - P Rai
- Department of Radiodiagnosis and Imaging, Homi Bhabha National Institute, Tata Memorial Hospital, Mumbai, 400 012, Maharashtra, India
| | - A Mahajan
- Department of Imaging, The Clatterbridge Cancer Centre NHS Foundation Trust, L7 8YA Liverpool, UK; Faculty of Health and Life Sciences, University of Liverpool, L7 8TX, Liverpool, UK.
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Adji NK, Putri KYW, Indreswari L, Rayyan MIR, Athoillah N, Alfiani L. Grade III en-plaque meningioma mimicking subacute subdural hematoma: A case report. Int J Surg Case Rep 2024; 121:109913. [PMID: 38959613 DOI: 10.1016/j.ijscr.2024.109913] [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: 04/29/2024] [Revised: 06/11/2024] [Accepted: 06/15/2024] [Indexed: 07/05/2024] Open
Abstract
INTRODUCTION En-plaque meningioma (EPM) presents preoperative diagnostic challenges due to its atypical radiologic features. This case report describes the preoperative diagnostic challenges in identifying EPM that affected its operative management. CASE REPORT A 58-year-old female patient presented to the emergency department with decreased consciousness and a history of a fall on the head two months earlier. For the past year, the patient also complained of worsening headaches. One week before, the patient also complained of nausea, vomiting, and fluctuating fever. Although a CT scan of the head showed a mass in the left temporoparietal region, the patient was initially diagnosed with subacute subdural hematoma (saSDH) and planned for SDH evacuation surgery using the burr hole technique. However, intraoperative findings revealed an extradural intracranial tumor, so the procedure was switched to tumor excision craniotomy, and based on histopathological examination, it was confirmed to be an anaplastic malignant meningioma, WHO grade III. DISCUSSION EPM is one of the rare subtypes of meningioma with an atypical and radiologically variable appearance that often presents challenges in preoperative diagnosis. In this case, the patient's history of falling on the head and the CT scan of the head that resembles saSDH may obscure the preoperative diagnosis and affect the patient's management. CONCLUSION EPM can manifest like other intracranial disorders. In this case, the patient's fall history may obscure the clinicians' diagnosis of the meningioma, leading to preoperative misdiagnosis with saSDH. Therefore, meticulous preoperative diagnosis is essential to determining the patient's medical treatment and outcome.
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Affiliation(s)
- Novan Krisno Adji
- Department of Neurosurgery, Faculty of Medicine, University of Jember/dr. Soebandi Regional Hospital, Jember, Indonesia.
| | - Komang Yunita Wiryaning Putri
- Department of Neurology, Faculty of Medicine, University of Jember/dr. Soebandi Regional Hospital, Jember, Indonesia.
| | - Laksmi Indreswari
- Department of Surgery, Faculty of Medicine, University of Jember/dr. Soebandi Regional Hospital, Jember, Indonesia.
| | | | - Nabil Athoillah
- Faculty of Medicine, University of Jember/dr. Soebandi Regional Hospital, Jember, Indonesia
| | - Leni Alfiani
- Faculty of Medicine, University of Jember/dr. Soebandi Regional Hospital, Jember, Indonesia
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Iqbal Z, Albuquerque K, Chan KL. Magnetic Resonance Spectroscopy for Cervical Cancer: Review and Potential Prognostic Applications. Cancers (Basel) 2024; 16:2141. [PMID: 38893260 PMCID: PMC11171343 DOI: 10.3390/cancers16112141] [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: 05/07/2024] [Revised: 05/28/2024] [Accepted: 06/04/2024] [Indexed: 06/21/2024] Open
Abstract
This review article investigates the utilization of MRS in the setting of cervical cancer. A variety of different techniques have been used in this space including single-voxel techniques such as point-resolved spectroscopy (PRESS) and stimulated echo acquisition mode spectroscopy (STEAM). Furthermore, the experimental parameters for these acquisitions including field strength, repetition times (TR), and echo times (TE) vary greatly. This study critically examines eleven MRS studies that focus on cervical cancer. Out of the eleven studies, ten studies utilized PRESS acquisition, while the remaining study used STEAM acquisition. These studies generally showed that the choline signal is altered in cervical cancer (4/11 studies), the lipid signal is generally increased in cervical cancer or the lipid distribution is changed (5/11 studies), and that diffusion-weighted imaging (DWI) can quantitatively detect lower apparent diffusion coefficient (ADC) values in cervical cancer (2/11 studies). Two studies also investigated the role of MRS for monitoring treatment response and demonstrated mixed results regarding choline signal, and one of these studies showed increased lipid signal for non-responders. There are several new MRS technologies that have yet to be implemented for cervical cancer including advanced spectroscopic imaging and artificial intelligence, and those technologies are also discussed in the article.
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Affiliation(s)
- Zohaib Iqbal
- Department of Radiation Oncology, UT Southwestern Medical Center, Dallas, TX 75235, USA;
| | - Kevin Albuquerque
- Department of Radiation Oncology, UT Southwestern Medical Center, Dallas, TX 75235, USA;
| | - Kimberly L. Chan
- Advanced Imaging Research Center, UT Southwestern Medical Center, Dallas, TX 75235, USA;
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de Godoy ES, de Oliveira JRM. Exploring the Biological Overlapping Between Brain Calcifications and Tumorgenesis. J Mol Neurosci 2024; 74:54. [PMID: 38760510 DOI: 10.1007/s12031-024-02230-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2024] [Accepted: 05/10/2024] [Indexed: 05/19/2024]
Abstract
This article discusses a rare case of coexistent meningiomas and Primary familial brain calcification (PFBC). PFBC is a neurodegenerative disease characterized by brain calcifications and a variety of neuropsychiatric symptoms and signs, with pathogenic variants in specific genes. The study explores the potential link between PFBC and meningiomas, highlighting shared features like intralesional calcifications and common genes such as MEA6. The article also revisits PFBC patients developing other brain tumors, particularly gliomas, emphasizing the intersection of oncogenes like PDGFB and PDGFRB in both calcifications and tumor progression. In recent investigations, attention has extended beyond brain tumors to breast cancer metastasis, unveiling a noteworthy connection. These findings suggest a broader connection between brain calcifications and tumors, encouraging a reevaluation of therapeutic approaches for PFBC.
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Affiliation(s)
- Enrico Souza de Godoy
- Medical Science Center, Federal University of Pernambuco (UFPE), Av. da Engenharia, 531-611, Cidade Universitária, Recife, 50670-901, Pernambuco, Brazil.
| | - João Ricardo Mendes de Oliveira
- Medical Science Center, Federal University of Pernambuco (UFPE), Av. da Engenharia, 531-611, Cidade Universitária, Recife, 50670-901, Pernambuco, Brazil
- Keizo Asami Institute-UFPE, Av. Prof. Moraes Rego, Cidade Universitária, Recife, Pernambuco, Brazil
- Neuropsychiatric Department, Federal University of Pernambuco (UFPE), Av. Professor Moraes Rego, 1235, Cidade Universitária, Recife, 50670-901, Pernambuco, Brazil
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Dahal P, Parajuli S. Magnetic resonance imaging findings in central nervous system tuberculosis: A pictorial review. Heliyon 2024; 10:e29779. [PMID: 38699716 PMCID: PMC11063446 DOI: 10.1016/j.heliyon.2024.e29779] [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] [Received: 10/27/2023] [Revised: 04/13/2024] [Accepted: 04/15/2024] [Indexed: 05/05/2024] Open
Abstract
Central nervous system (CNS) tuberculosis is a post-primary form of tuberculosis. It has high mortality and morbidity rates despite early diagnosis and treatment. CNS tuberculosis can manifest as subacute/chronic meningitis, parenchymal tuberculous lesions, and spinal tuberculosis. Hematogenous spread of tuberculous bacilli to the brain results in the development of so called "rich foci" on the pial surface, ependyma, and grey-white matter junction. Rupture of these "rich foci" into the subarachnoid space triggers an intense granulomatous inflammatory reaction. Tuberculous meningitis can manifest as leptomeningitis or pachymeningitis. Intracranial parenchymal tuberculous lesions may present as tuberculoma, tuberculous abscess, cerebritis, rhombencephalitis, and encephalopathy, with atypical presentations not uncommon. Complications of CNS tuberculosis encompass hydrocephalus, syrinx formation, vasculitis, infarcts, neuritis, and enduring neurological deficits. Post-contrast 3D fluid-attenuated inversion recovery (FLAIR) and post-contrast T1 spin-echo sequences excel in detecting tuberculous meningitis compared to other conventional magnetic resonance imaging (MRI) sequences. In proton magnetic resonance spectroscopy (PMRS), the presence of a lipid peak at 1.3 ppm is indicative of tuberculous lesions. Magnetization transfer (MT) imaging enhances the detection of tuberculous lesions, as the magnetization transfer ratio (MTR) of tuberculous pathologies, owing to their high lipid content, is lower than that in bacterial or fungal pathologies and higher than that in viral pathologies. This review article delves into the various typical and atypical imaging presentations of CNS tuberculosis in MRI, along with recent advances in imaging techniques.
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Affiliation(s)
- Prajwal Dahal
- Department of Radiology and Imaging, Grande International Hospital, Kathmandu, Nepal
| | - Sabina Parajuli
- Resident PGY-1 Pathology, Department of Pathology, Bir Hospital, Kathmandu, Nepal
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Eddin AS, McNeely P, Saad Eldine M, Lai L, Shariftabrizi A. Dural involvement in central nervous system langerhans cells histiocytosis (LCH) on FDG PET/CT: Case report and review of CNS manifestations of LCH on PET/CT. Radiol Case Rep 2024; 19:1391-1396. [PMID: 38268737 PMCID: PMC10803779 DOI: 10.1016/j.radcr.2023.12.044] [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] [Received: 11/26/2023] [Revised: 12/21/2023] [Accepted: 12/23/2023] [Indexed: 01/26/2024] Open
Abstract
We report a case of multisystem Langerhans cell histiocytosis in a pediatric patient with central nervous system involvement, highlighting F-18(FDG) uptake characteristics of dural sites of disease. We also highlight the advantages of functional data offered by FDG-PET as a useful follow-up tool to assess viability and, therefore, treatment response of previously known central nervous system lesions. The utility of recognizing characteristic patterns of FDG uptake in dural disease is also applicable in cases of diagnostic uncertainty, such as when evaluating isolated dural lesions or when distinguishing between Langerhans cell histiocytosis and similar appearing lesions such as meningiomas.
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Affiliation(s)
- Assim Saad Eddin
- University of Iowa Hospitals and Clinics; Department of Radiology; Iowa city, IA 52242, USA
| | - Parren McNeely
- University of Iowa Hospitals and Clinics; Department of Radiology; Iowa city, IA 52242, USA
| | - Mothana Saad Eldine
- University of Iowa Hospitals and Clinics; Department of Radiology; Iowa city, IA 52242, USA
| | - Lillian Lai
- University of Iowa Hospitals and Clinics; Department of Radiology; Iowa city, IA 52242, USA
| | - Ahmad Shariftabrizi
- University of Iowa Hospitals and Clinics; Department of Radiology; Iowa city, IA 52242, USA
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Pienaar JA, Varghese J. Intracranial meningiomas at a tertiary hospital: Spectrum of MRI findings with histopathologic correlation. SA J Radiol 2024; 28:2812. [PMID: 38628266 PMCID: PMC11019068 DOI: 10.4102/sajr.v28i1.2812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2023] [Accepted: 01/10/2024] [Indexed: 04/19/2024] Open
Abstract
Background Intracranial meningiomas consist of a heterogenous group of histological subtypes, some of which are rare. Data that may play an important role in neurosurgical decision-making regarding the incidence and MRI features of these histological subtypes in the South African population groups, are lacking. Objectives This study aimed to assess the spectrum of MRI findings and histological subtypes of meningiomas in the South African context, with the goal of improving the paucity of literature on the topic. Method A retrospective review of the MRI features of 41 cases of histologically confirmed intracranial meningiomas was performed at a tertiary hospital level. Imaging features were audited and correlated with histological subtypes during statistical analysis. Results Eleven different histological subtypes of meningioma were encountered. World Health Organization (WHO) Grade I meningothelial meningiomas were the most common histological subgroup. Overall, meningiomas were found to be predominantly isointense to grey matter on T1-weighted imaging, irrespective of the histological subtype, with greater signal variability on T2-weighted imaging. Morphologies of specific subtypes are in keeping with the literature. Conclusion Analysis of this series of intracranial meningiomas did not demonstrate statistically significant differences in MRI features between histological subtypes to allow for accurate preoperative prediction of meningioma subtype or WHO grade. This highlights the importance of definitive histopathological diagnosis rather than over-reliance on presumed benign imaging features. Contribution This original research article discusses the impact of histological subtype on the MRI appearance of intracranial meningiomas, with the aim to improve the paucity of literature on the subject in the context of the South African population.
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Affiliation(s)
- Jacobus A Pienaar
- Department of Diagnostic Radiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Department of Diagnostic Radiology, Klerksdorp/Tshepong Hospital Complex, Klerksdorp, South Africa
| | - Jacob Varghese
- Department of Diagnostic Radiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Department of Diagnostic Radiology, Klerksdorp/Tshepong Hospital Complex, Klerksdorp, South Africa
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8
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Feng Y, Chiou CA, Stagner AM, Chang YS, Freitag SK. Distinguishing spheno-orbital metastatic prostate cancer mimicking a meningioma using novel 18F-PSMA PET/CT imaging. Orbit 2024:1-6. [PMID: 38526143 DOI: 10.1080/01676830.2024.2318769] [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: 11/07/2023] [Accepted: 02/07/2024] [Indexed: 03/26/2024]
Abstract
A 78-year-old man presented with acute-onset left temporal pain, eyelid swelling, and double vision. Computed tomography (CT) demonstrated a left sphenoid wing mass with extra-osseous intra-orbital and intracranial extension, thought to be a typical sphenoid wing meningioma by the primary team. The patient was admitted for an urgent craniotomy, which was planned for the following day. However, upon consultation with ophthalmic plastic surgery, concern was raised for an alternative diagnosis given the atypical timeline, inflammatory changes, and uncharacteristic imaging findings of mixed lytic and sclerotic bony changes without hyperostosis on CT and extensive peri-lesional dural thickening and enhancement on magnetic resonance imaging. A serum prostate-specific antigen was elevated to 206 ng/mL. Subsequent positron emission tomography (PET)/CT using 18F-fluorodeoxyglucose radiotracer was negative for metastatic disease. A prostate-specific membrane antigen (PSMA) PET/CT was then obtained and demonstrated extensive metastases. An orbital biopsy revealed poorly differentiated prostatic adenocarcinoma. The significant incongruence between the standard PET/CT and PSMA PET/CT highlights the value of this novel advanced radiographic modality in narrowing the differential diagnosis and determining the extent of disease. Findings of widespread metastasis on the PSMA PET/CT ultimately helped to avoid a large, morbid neurosurgical intervention in this patient, allowing for a minimally invasive orbital biopsy to characterize the tumor for therapeutic targeting.
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Affiliation(s)
- Yilin Feng
- Department of Ophthalmology, Ophthalmic Plastic Surgery, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA
| | - Carolina A Chiou
- Department of Ophthalmology, Ophthalmic Plastic Surgery, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA
| | - Anna M Stagner
- David G. Cogan Laboratory of Ophthalmic Pathology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA
| | - Yuh-Shin Chang
- Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Suzanne K Freitag
- Department of Ophthalmology, Ophthalmic Plastic Surgery, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA
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Malecki A, Pawloski J, Anzalone A, Shaftel K, Fadel HA, Lee I. Compressive myelopathy from diffuse spinal dural calcifications in a patient with end-stage renal disease: illustrative case. JOURNAL OF NEUROSURGERY. CASE LESSONS 2024; 7:CASE23641. [PMID: 38408341 PMCID: PMC10901115 DOI: 10.3171/case23641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Accepted: 12/13/2023] [Indexed: 02/28/2024]
Abstract
BACKGROUND Diffuse spinal dural calcification is a rare disorder associated with hyperparathyroidism, including the secondary forms associated with renal failure, osteodystrophy, and chronic hypocalcemia. Here, the authors report a rare case of diffuse dural calcification causing spinal cord compression with myelopathy, requiring decompressive surgery with duraplasty to achieve adequate decompression. OBSERVATIONS A 46-year-old male with a history of renal failure on dialysis presented with 2 months of progressive neuropathic pain, lower-extremity weakness, and nonsustained clonus. Spine imaging showed severe renal osteodystrophy with multilevel compression fractures and diffuse dural calcifications with areas of invagination causing severe spinal cord compression. Decompressive surgery was recommended. In surgery, a thickened and calcified dura was encountered with areas of buckling causing spinal cord compression. The invaginated area of the dura was resected and reconstructed with patch duraplasty. The patient's neurological status remained unchanged postoperatively, and at the 6-month follow-up, the patient reported significant improvement in pain and muscle spasms. LESSONS Diffuse dural calcifications are a rare complication of prolonged dialysis and secondary hyperparathyroidism. When there is resultant spinal cord compression, this condition requires an intradural approach that addresses the thickened, calcified dura directly to obtain adequate spinal cord decompression.
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Affiliation(s)
- Alexis Malecki
- Wayne State University School of Medicine, Detroit, Michigan; and
| | - Jacob Pawloski
- Department of Neurosurgery, Henry Ford Health, Detroit, Michigan
| | - Anthony Anzalone
- Department of Neurosurgery, Henry Ford Health, Detroit, Michigan
| | - Kelly Shaftel
- Department of Neurosurgery, Henry Ford Health, Detroit, Michigan
| | - Hassan Ali Fadel
- Department of Neurosurgery, Henry Ford Health, Detroit, Michigan
| | - Ian Lee
- Department of Neurosurgery, Henry Ford Health, Detroit, Michigan
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Maireche A, Bendjama O, Slimani D, Gatel I, Arab A, Lebcir A, Seddiki K. Imaging features of primary dural lymphoma: A report of 3 cases. Radiol Case Rep 2024; 19:802-811. [PMID: 38111553 PMCID: PMC10726341 DOI: 10.1016/j.radcr.2023.11.029] [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] [Received: 11/01/2023] [Revised: 11/08/2023] [Accepted: 11/10/2023] [Indexed: 12/20/2023] Open
Abstract
Primary dural lymphoma (PDL) constitutes a rare subgroup within central nervous system lymphomas, defined by its exclusive confinement to the dura mater, without a concurrent brain or systemic lymphatic involvement. This distinctive localization presents diagnostic challenges. In this report, we present a series of 3 cases where initial radiological presentations resembled meningiomas. We meticulously analyze key differentiating imaging characteristics, in CT, morphological MRI, and spectroscopy imaging. And show that recognizing and understanding these nuanced features are pivotal in enabling accurate differentiation of PDL and facilitating timely clinical intervention.
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Affiliation(s)
- Ammar Maireche
- Central Military Hospital, Ain Naadja, 16205, Algiers, Algeria
| | | | - Damya Slimani
- Central Military Hospital, Ain Naadja, 16205, Algiers, Algeria
| | - Imad Gatel
- Université d'Alger Faculté des Sciences Médicales. 02 Rue Didouche Mourad, 16000, Algiers, Algeria
| | - Anis Arab
- Université d'Alger Faculté des Sciences Médicales. 02 Rue Didouche Mourad, 16000, Algiers, Algeria
| | | | - Karima Seddiki
- Central Military Hospital, Ain Naadja, 16205, Algiers, Algeria
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Nyalundja AD, Mugisha F, Karekezi C. The Natural History and Treatment of Meningiomas: An Update. Semin Neurol 2024; 44:1-15. [PMID: 38052237 DOI: 10.1055/s-0043-1777352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/07/2023]
Abstract
Meningiomas are the most frequent nonmalignant tumors of the central nervous system (CNS). Despite their benign nature and slow-growing pattern, if not diagnosed early, these tumors may reach relatively large sizes causing significant morbidity and mortality. Some variants are located in hard-to-access locations, compressing critical neurovascular structures, and making the surgical management even more challenging. Although most meningiomas have a good long-term prognosis after treatment, there are still controversies over their management in a subset of cases. While surgery is the first-line treatment, the use of fractionated radiotherapy or stereotactic radiosurgery is indicated for residual or recurrent tumors, small lesions, and tumors in challenging locations. Advances in molecular genetics and ongoing clinical trial results have recently helped both to refine the diagnosis and provide hope for effective biomolecular target-based medications for treatment. This article reviews the natural history and current therapeutic options for CNS meningiomas.
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Affiliation(s)
- Arsene Daniel Nyalundja
- Faculty of Medicine, Center for Tropical Diseases and Global Health, Université Catholique de Bukavu, Kadutu, Bukavu, South Kivu, Democratic Republique of Congo
| | - Fabrice Mugisha
- Neurosurgery Unit, Department of Surgery, Rwanda Military Hospital, Kigali, Rwanda
| | - Claire Karekezi
- Neurosurgery Unit, Department of Surgery, Rwanda Military Hospital, Kigali, Rwanda
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Piscopo AJ, Chowdhury AJ, Teferi N, Lee S, Challa M, Petronek M, Eschbacher K, Bathla G, Buatti JM, Hitchon P. Surgical Management of Craniospinal Axis Solitary Fibrous Tumors: A Single-Institution Case Series and Comprehensive Review of the Literature. Neurosurgery 2024; 94:358-368. [PMID: 37747216 DOI: 10.1227/neu.0000000000002692] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2023] [Accepted: 08/16/2023] [Indexed: 09/26/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Meningeal solitary fibrous tumors (SFTs) comprise 0.4% of primary central nervous system neoplasms and carry metastatic potential. Disease course and optimal management are largely unknown, and there is currently no literature rigorously describing neurological outcomes in surgically managed SFTs. We present one of the largest craniospinal SFT series, analyze patient outcomes, and extensively review the associated literature. METHODS All surgically managed SFTs at our institution between January 2005 and March 2023 were retrospectively reviewed. Patient demographics, tumor and radiographic features, treatment, and clinical outcomes were collected. Neurological function was quantified using Frankel grade and Neurologic Assessment in Neuro-Oncology scores. Descriptive statistics, multivariate analysis, log-rank test, and Kaplan-Meier survival analysis were performed. RESULTS Twenty-one patients satisfied inclusion criteria. Tumor locations included 15 supratentorial, three infratentorial, and three spinal. All patients underwent surgical resection, and 16 (76.2%) underwent radiation. Six (28.6%) patients had tumor recurrence, and three (14.3%) developed metastasis. Younger age and higher postoperative Frankel grade were significantly associated with increased overall survival (OS) ( P = .011, P = .002, respectively). All patients symptomatically improved or stabilized after surgery, and Neurologic Assessment in Neuro-Oncology score ( P = .001) and functional status significantly improved postoperatively (Karnofsky Performance Status: 65.2 ± 25.2 vs 91.4 ± 13.5, P = .001). Sex, adjuvant radiation, and extent of resection were not significantly associated with OS. CONCLUSION SFT of the central nervous system is a rare entity with a variable clinical course. Surgical resection was associated with improved postoperative functional and neurological status. Higher postoperative neurological function was significantly associated with OS. Further studies are warranted to validate a standardized treatment algorithm and investigate the efficacy of adjuvant radiation in SFT.
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Affiliation(s)
- Anthony J Piscopo
- Department of Neurosurgery, University of Iowa Hospital and Clinics, Iowa City , Iowa , USA
| | - A J Chowdhury
- Department of Neurosurgery, University of Iowa Hospital and Clinics, Iowa City , Iowa , USA
| | - Nahom Teferi
- Department of Neurosurgery, University of Iowa Hospital and Clinics, Iowa City , Iowa , USA
| | - Sarah Lee
- Department of Neurosurgery, University of Iowa Hospital and Clinics, Iowa City , Iowa , USA
| | - Meron Challa
- University of Iowa, Carver College of Medicine, Iowa City , Iowa , USA
| | - Michael Petronek
- Department of Radiation Oncology, University of Iowa Hospital and Clinics, Iowa City , Iowa , USA
| | - Kathryn Eschbacher
- Department of Pathology, University of Iowa Hospital and Clinics, Iowa City , Iowa , USA
| | - Girish Bathla
- Department of Radiology, Mayo Clinic, Rochester , Minnesota , USA
| | - John M Buatti
- Department of Radiation Oncology, University of Iowa Hospital and Clinics, Iowa City , Iowa , USA
| | - Patrick Hitchon
- Department of Neurosurgery, University of Iowa Hospital and Clinics, Iowa City , Iowa , USA
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De Stefano FA, Morell AA, Smith G, Warner T, Soldozy S, Elarjani T, Eichberg DG, Luther E, Komotar RJ. Unique magnetic resonance spectroscopy profile of intracranial meningiomas compared to gliomas: a systematic review. Acta Neurol Belg 2023; 123:2077-2084. [PMID: 36595196 DOI: 10.1007/s13760-022-02169-8] [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: 07/11/2022] [Accepted: 12/27/2022] [Indexed: 01/04/2023]
Abstract
BACKGROUND AND PURPOSE The goal of this study was to systematically review the metabolic profile of meningiomas using magnetic resonance spectroscopy in comparison to gliomas, as measured by mean metabolite ratios. METHODS Following the PRISMA guidelines, a systematic literature review was performed using the PubMed, Ovid Embase, Web of Science, and the Cochrane databases from inception to May 2021. Studies were selected based on predetermined inclusion and exclusion criteria. RESULTS Eight studies were ultimately selected with 207 patients included. Fifty-nine patients were diagnosed with meningioma (age = 48.4, 66.7% female) and 148 patients diagnosed with glioma (age = 56.4, 49.2% female). Three studies reported elevated Cho/Cr in meningiomas compared to gliomas (5.71 vs. 1.46, p < 0.05, 7.02 vs. 2.62, p < 0.05, and 4.64 vs. 2.52, p = 0.001). One study reported Ala/Cr to be significantly elevated in meningiomas compared to gliomas (1.30 vs. undetectable, p < 0.001). One study reported myo-Inositol/Cr to be significantly elevated in meningiomas in comparison to gliomas (1.44 vs. 1.08, p < 0.05). One study reported Glu/Cr to be significantly elevated in meningiomas in comparison to gliomas (3.47 vs. 0.89, p = 0.002). Two studies reported Cho/NAA to be significantly elevated in meningiomas in comparison to gliomas (4.46 vs. 2.6, p = 0.004, and 5.8 vs. 2.55, p < 0.05). Two studies reported NAA/Cr was significantly elevated in gliomas compared to meningiomas (undetectable vs. 1.54, p < 0.001 and undetectable vs. 0.58, p < 0.05). CONCLUSIONS Significant differences in metabolite ratios between tumor types were reported in Cho/Cr, Ala/Cr, Glu/Cr, Cho/NAA, myoI/Cr and NAA/Cr between meningiomas and gliomas.
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Affiliation(s)
- Frank A De Stefano
- Department of Neurological Surgery, University of Kansas Medical Center, 3901 Rainbow Blvd # MS 3021, Kansas City, KS, USA.
| | - Alexis A Morell
- Department of Neurological Surgery, University of Miami, Miami, FL, USA
| | - Grace Smith
- School of Medicine, Morehouse College, Atlanta, GA, USA
| | - Tyler Warner
- Department of Neurological Surgery, University of Miami, Miami, FL, USA
| | - Sauson Soldozy
- Department of Neurological Surgery, University of Miami, Miami, FL, USA
| | - Turki Elarjani
- Department of Neurological Surgery, University of Miami, Miami, FL, USA
| | - Daniel G Eichberg
- Department of Neurological Surgery, University of Miami, Miami, FL, USA
| | - Evan Luther
- Department of Neurological Surgery, University of Miami, Miami, FL, USA
| | - Ricardo J Komotar
- Department of Neurological Surgery, University of Miami, Miami, FL, USA
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14
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Campion A, Iv M. Brain Tumor Imaging: Review of Conventional and Advanced Techniques. Semin Neurol 2023; 43:867-888. [PMID: 37963581 DOI: 10.1055/s-0043-1776765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2023]
Abstract
Approaches to central nervous system (CNS) tumor classification and evaluation have undergone multiple iterations over the past few decades, in large part due to our growing understanding of the influence of genetics on tumor behavior and our refinement of brain tumor imaging techniques. Computed tomography and magnetic resonance imaging (MRI) both play a critical role in the diagnosis and monitoring of brain tumors, although MRI has become especially important due to its superior soft tissue resolution. The purpose of this article will be to briefly review the fundamentals of conventional and advanced techniques used in brain tumor imaging. We will also highlight the applications of these imaging tools in the context of commonly encountered tumors based on the most recently updated 2021 World Health Organization (WHO) classification of CNS tumors framework.
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Affiliation(s)
- Andrew Campion
- Department of Radiology (Neuroradiology), Stanford University, Stanford, California
| | - Michael Iv
- Department of Radiology (Neuroradiology), Stanford University, Stanford, California
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15
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Kim H, Kim HG, Oh JH, Lee KM. Deep-learning model for diagnostic clue: detecting the dural tail sign for meningiomas on contrast-enhanced T1 weighted images. Quant Imaging Med Surg 2023; 13:8132-8143. [PMID: 38106283 PMCID: PMC10722041 DOI: 10.21037/qims-23-114] [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] [Received: 01/30/2023] [Accepted: 09/06/2023] [Indexed: 12/19/2023]
Abstract
Background Meningiomas are the most common primary central nervous system tumors, and magnetic resonance imaging (MRI), especially contrast-enhanced T1 weighted image (CE T1WI), is used as a fundamental imaging modality for the detection and analysis of the tumors. In this study, we propose an automated deep-learning model for meningioma detection using the dural tail sign. Methods The dataset included 123 patients with 3,824 dural tail signs on sagittal CE T1WI. The dataset was divided into training and test datasets based on specific time point, and 78 and 45 patients were comprised for the training and test dataset, respectively. To compensate for the small sample size of the training dataset, 39 additional patients with 69 dural tail signs from the open dataset were appended to the training dataset. A You Only Look Once (YOLO) v4 network was trained with sagittal CE T1WI to detect dural tail signs. The normal group dataset, comprised of 51 patients with no abnormal finding on MRI, was employed to evaluate the specificity of the trained model. Results The sensitivity and false positive average were 82.22% and 29.73, respectively, in the test dataset. The specificity and false positive average were 17.65% and 3.16, respectively, in the normal dataset. Most of the false-positive cases in the test dataset were enhancing vessels, misinterpreted as dural thickening. Conclusions The proposed model demonstrates an automated detection system for the dural tail sign to identify meningioma in general screening MRI. Our model can facilitate and alleviate radiologists' reading process by notifying the possibility of incidental dural mass based on dural tail sign detection.
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Affiliation(s)
- Hyunmin Kim
- Department of Radiology, Kyung Hee University Hospital, Kyung Hee University College of Medicine, Seoul, Republic of Korea
| | - Hyug-Gi Kim
- Department of Radiology, Kyung Hee University Hospital, Kyung Hee University College of Medicine, Seoul, Republic of Korea
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16
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Feng JJ, Cheok SK, Shiroishi MS, Zada G. Tumor characteristics guiding selection of channel-based versus open microscopic approaches for resection of atrial intraventricular meningiomas: patient series. JOURNAL OF NEUROSURGERY. CASE LESSONS 2023; 6:CASE23558. [PMID: 37992312 PMCID: PMC10664629 DOI: 10.3171/case23558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 10/23/2023] [Indexed: 11/24/2023]
Abstract
BACKGROUND Atrial intraventricular meningiomas (AIMs) are relatively rare and typically deep-seated tumors that can mandate resection. Compared with transsulcal or transcortical open microscopic approaches, port- or channel-based exoscopic approaches have facilitated a less invasive alternative of tumor access and resection. The authors present a case series of seven patients with AIMs who underwent open microscopic versus channel-based exoscopic resection by a senior neurosurgeon at their institution between 2012 and 2022 to understand patient and tumor features that lent themselves to selection of a particular approach. OBSERVATIONS In the patients harboring three AIMs selected for channel-based resection, the average AIM diameter (2.9 vs 5.2 cm) was smaller, the AIMs were deeper from the cortical surface (2.5 vs 1.1 cm), and the patients had a shorter average postoperative length of stay (3.3 vs 5.8 days) compared with the four patients who underwent open resection. Gross-total resection was achieved in all cases. Complications for both groups included transient homonymous hemianopsia and aphasia. No recurrences were identified over the follow-up period. LESSONS The authors demonstrate that channel-based exoscopic resection is safe and effective for AIMs 3 cm in diameter and over 2 cm deep. This may help guide neurosurgeons in future approach selection based on tumor features, including size/volume, location, and depth from cortical surface.
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Affiliation(s)
- Jeffrey J Feng
- 1Departments of Neurological Surgery
- 2Western Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo, Michigan; and
| | - Stephanie K Cheok
- 1Departments of Neurological Surgery
- 3Department of Neurological Surgery, Medical College of Wisconsin Milwaukee, Wisconsin
| | - Mark S Shiroishi
- 4Radiology, Keck School of Medicine of USC, Los Angeles, California
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17
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Matias TB, Cordeiro RA, Duarte JA, de Jarry VM, Appenzeller S, Villarinho L, Reis F. Immune-Mediated Hypertrophic Pachymeningitis and its Mimickers: Magnetic Resonance Imaging Findings. Acad Radiol 2023; 30:2696-2706. [PMID: 36882352 DOI: 10.1016/j.acra.2023.01.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2022] [Revised: 01/08/2023] [Accepted: 01/13/2023] [Indexed: 03/08/2023]
Abstract
Hypertrophic pachymeningitis (HP) is a rare and chronic inflammatory disorder presenting as localized or diffuse thickening of the dura mater. It can be idiopathic or an unusual manifestation of immune-mediated, infectious, and neoplastic conditions. Although some cases may remain asymptomatic, HP can lead to progressive headaches, cranial nerve palsies, hydrocephalus, and other neurological complications, which makes its recognition a fundamental step for prompt treatment. Regarding the diagnosis workup, enhanced MRI is the most useful imaging method to evaluate dural thickening. This article addresses the MR imaging patterns of immune-mediated HP, including immunoglobulin G4-related disease, neurosarcoidosis, granulomatosis with polyangiitis, rheumatoid pachymeningitis, and idiopathic HP. The main infectious and neoplastic mimicking entities are also discussed with reference to conventional and advanced MR sequences.
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Affiliation(s)
- Thiago Bezerra Matias
- Department of Radiology, Faculty of Medical Sciences, State University of Campinas (UNICAMP), Campinas, SP, Brazil
| | - Rafael Alves Cordeiro
- Rheumatology Division, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Juliana Avila Duarte
- Department of Internal Medicine, Federal University of Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil
| | - Vinicius Menezes de Jarry
- Department of Radiology, Faculty of Medical Sciences, State University of Campinas (UNICAMP), Campinas, SP, Brazil
| | - Simone Appenzeller
- Department of Orthopedics, Rheumatology and Traumatology, Faculty of Medical Sciences, State University of Campinas (UNICAMP), Campinas, SP, Brazil
| | - Luciano Villarinho
- Department of Radiology, Rhode Island Medical Imaging, Brown University, USA
| | - Fabiano Reis
- Department of Radiology, Faculty of Medical Sciences, State University of Campinas (UNICAMP), Campinas, SP, Brazil.
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18
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Arcuri PP, Aiello V, Antonelli S, Cascini GL, Rossi M, Laganà D. Primary large B-cell lymphoma involving the cerebellopontine angle mimic acoustic schwannoma: Role of MR Spectroscopy in differential diagnosis. A case report. Radiol Case Rep 2023; 18:3729-3734. [PMID: 37636538 PMCID: PMC10447925 DOI: 10.1016/j.radcr.2023.07.069] [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] [Received: 05/01/2023] [Revised: 07/24/2023] [Accepted: 07/28/2023] [Indexed: 08/29/2023] Open
Abstract
Primary central nervous system (CNS) lymphoma is a very rare aggressive non-Hodgkin disease that originates in CNS (brain, leptomeninges, spinal cord, or eyes). It seems to have increased over the last two decades in both immunocompromised and immunocompetent patients. Primary large B-cell lymphoma involving the cerebellopontine angle (CPA) is extremely rare: only 15 cases of large B-cell lymphoma of the CPA have been reported worldwide; based on our knowledge, no cases studied with MR Spectroscopy. Primary large B-cell lymphoma of the CPA must be differentiated from other cerebellopontine angle diseases, such as acoustic neuroma and meningioma. An early and accurate diagnosis of this neoplasm is necessary for the best management because it is a radiosensitive and chemosensitive tumor. Herein, we report a rare case of B-cell lymphoma involving the left CPA in a 65-year-old man who presented with 3 months of hearing loss on the left, illustrated by MR and TC imaging, highlighting how the MR Spectroscopy, thanks to their greater specificity, is decisive in achieving the correct diagnosis of primary lymphoma and differentiating it from acoustic schwannoma or meningioma. Therefore, in the suspicion of a malignant heteroplastic lesion of the CPA, we suggest including Spectroscopy in the MR study protocol.
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Affiliation(s)
- Pier Paolo Arcuri
- Radiology Unit “De Lellis”, Department of Radiology, Dulbecco University Hospital, 88100, Catanzaro, Italy
| | - Vincenzo Aiello
- Rheumatology Clinic “Madonna dello Scoglio” Cotronei, Crotone, Italy
| | - Simonetta Antonelli
- Radiology Unit “De Lellis”, Department of Radiology, Dulbecco University Hospital, 88100, Catanzaro, Italy
| | - Giuseppe Lucio Cascini
- Nuclear Medicine Unit, Dulbecco University Hospital, 88100, Catanzaro, Italy
- Department of Experimental and Clinical Medicine, 'Magna Graecia' University of Catanzaro, Catanzaro, Italy
| | - Marco Rossi
- Department of Hematology-Oncology, Dulbecco University Hospital, 88100 Catanzaro, Italy
| | - Domenico Laganà
- Department of Experimental and Clinical Medicine, Magna Graecia University of Catanzaro, 88100 Catanzaro, Italy
- Radiology Unit, Dulbecco University Hospital, 88100 Catanzaro, Italy
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19
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Krečak I, Šupe M, Petričević Krečak O. The great mimicker of dural pathology: primary dural diffuse large B-cell lymphoma. Wien Klin Wochenschr 2023; 135:496-498. [PMID: 37069406 DOI: 10.1007/s00508-023-02190-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Accepted: 03/02/2023] [Indexed: 04/19/2023]
Affiliation(s)
- Ivan Krečak
- Department of Internal Medicine, General Hospital of Šibenik-Knin County, Šibenik, Croatia.
- Faculty of Medicine, University of Rijeka, Rijeka, Croatia.
| | - Marijana Šupe
- Department of Internal Medicine, General Hospital of Šibenik-Knin County, Šibenik, Croatia
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20
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Kurokawa R, Kurokawa M, Baba A, Nakaya M, Kato S, Bapuraj J, Nakata Y, Ota Y, Srinivasan A, Abe O, Moritani T. Neuroimaging of hypophysitis: etiologies and imaging mimics. Jpn J Radiol 2023; 41:911-927. [PMID: 37010787 PMCID: PMC10468747 DOI: 10.1007/s11604-023-01417-y] [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: 02/22/2023] [Accepted: 03/24/2023] [Indexed: 04/04/2023]
Abstract
Hypophysitis is an inflammatory disease affecting the pituitary gland. Hypophysitis can be classified into multiple types depending on the mechanisms (primary or secondary), histology (lymphocytic, granulomatous, xanthomatous, plasmacytic/IgG4 related, necrotizing, or mixed), and anatomy (adenohypophysitis, infundibulo-neurohypophysitis, or panhypophysitis). An appropriate diagnosis is vital for managing these potentially life-threatening conditions. However, physiological morphological alterations, remnants, and neoplastic and non-neoplastic lesions may masquerade as hypophysitis, both clinically and radiologically. Neuroimaging, as well as imaging findings of other sites of the body, plays a pivotal role in diagnosis. In this article, we will review the types of hypophysitis and summarize clinical and imaging features of both hypophysitis and its mimickers.
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Affiliation(s)
- Ryo Kurokawa
- Division of Neuroradiology, Department of Radiology, University of Michigan, 1500 E Medical Center Dr, Ann Arbor, MI, 48109, USA.
- Department of Radiology, Graduate School of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan.
| | - Mariko Kurokawa
- Division of Neuroradiology, Department of Radiology, University of Michigan, 1500 E Medical Center Dr, Ann Arbor, MI, 48109, USA
- Department of Radiology, Graduate School of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Akira Baba
- Division of Neuroradiology, Department of Radiology, University of Michigan, 1500 E Medical Center Dr, Ann Arbor, MI, 48109, USA
| | - Moto Nakaya
- Department of Radiology, Graduate School of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Shimpei Kato
- Department of Radiology, Graduate School of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Jayapalli Bapuraj
- Division of Neuroradiology, Department of Radiology, University of Michigan, 1500 E Medical Center Dr, Ann Arbor, MI, 48109, USA
| | - Yasuhiro Nakata
- Department Or Neuroradiology, Tokyo Metropolitan Neurological Hospital, 2-6-1 Musashidai, Fuchu, Tokyo, 183-0042, Japan
| | - Yoshiaki Ota
- Division of Neuroradiology, Department of Radiology, University of Michigan, 1500 E Medical Center Dr, Ann Arbor, MI, 48109, USA
| | - Ashok Srinivasan
- Division of Neuroradiology, Department of Radiology, University of Michigan, 1500 E Medical Center Dr, Ann Arbor, MI, 48109, USA
| | - Osamu Abe
- Department of Radiology, Graduate School of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Toshio Moritani
- Division of Neuroradiology, Department of Radiology, University of Michigan, 1500 E Medical Center Dr, Ann Arbor, MI, 48109, USA
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21
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Navarro-Ballester A, Aleixandre-Barrachina M, Marco-Doménech SF. Update on meningioma: Clinical-radiological and radio-pathological correlation. RADIOLOGIA 2023; 65:458-472. [PMID: 37758336 DOI: 10.1016/j.rxeng.2023.09.002] [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] [Accepted: 02/07/2023] [Indexed: 10/03/2023]
Abstract
Meningiomas are tumors that originate in the arachnoid villi and are the most common non-glial neoplasm in the central nervous system. The clinical manifestations associated with meningioma depend, fundamentally, on its location. The location in the cerebral convexity is the most frequent, especially in the frontal lobes, manifesting with headache, motor disturbances, seizures and even neurocognitive disorders. There are 15 histologic subtypes of meningioma and three histologic grades. Within these, grades two and three have a worse prognosis and a higher rate of recurrence, as well as a radiological behavior that is generally more aggressive. Although there are some imaging features that can suggest a specific subtype, the definitive diagnosis will always require histological/molecular confirmation.
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Affiliation(s)
- A Navarro-Ballester
- Servicio de Radiodiagnóstico, Hospital General Universitario de Castellón, Castellón de la Plana, Castellón, Spain.
| | - M Aleixandre-Barrachina
- Servicio de Anatomía Patológica, Hospital General Universitario de Castellón, Castellón de la Plana, Castellón, Spain
| | - S F Marco-Doménech
- Servicio de Radiodiagnóstico, Hospital General Universitario de Castellón, Castellón de la Plana, Castellón, Spain
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22
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Matejka M, Moreno Beredjiklian C, Rezai A, Kraus TFJ, Pizem D, Klausner F, Pöppe JP, Griessenauer CJ, Schwartz C. Extra- and Intracranial Diffuse Large B-Cell Lymphoma (DLBCL) Mimicking Meningioma: A Case Report and Literature Review. Cureus 2023; 15:e42500. [PMID: 37637562 PMCID: PMC10456976 DOI: 10.7759/cureus.42500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/25/2023] [Indexed: 08/29/2023] Open
Abstract
Primary central nervous system lymphomas (PCNLSs) are malignant non-Hodgkin lymphomas solely affecting the central nervous system (CNS). Here, we present a rare case of extra- and intracranial manifestation without adjacent calvarial infiltration. We report a 67-year-old woman who presented with right leg paresis and hypoesthesia, facial hypoesthesia, focal epileptic seizures, and an indolent tumor on the left parietal scalp. MRI showed a left paramedian extra- and intracranial contrast-enhancing tumor with infiltration of the superior sagittal sinus, but without osseous infiltration on CT. The tumor was radiologically suspected to be a meningioma and resection was performed. Histological examination, however, revealed a diffuse large B-cell lymphoma (DLBCL). Thus, the patient received adjuvant treatment according to the MATRix protocol. We provide a detailed analysis of this rare case with a focus on preoperative radiological findings and differential diagnoses. To the best of our knowledge, this is one of only four published cases of DLBCL with extra- and intracranial manifestation without bone affection.
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Affiliation(s)
| | | | - Arwin Rezai
- Neurosurgery, University Hospital Salzburg, Salzburg, AUT
| | - Theo F J Kraus
- Pathology, University Hospital Salzburg, Paracelsus Medical University, Salzburg, AUT
| | - Dominik Pizem
- Neuroradiology, University Hospital Salzburg, Salzburg, AUT
| | - Fritz Klausner
- Neuroradiology, University Hospital Salzburg, Salzburg, AUT
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23
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Wogram E, Schlunk F, Shah MJ, Prinz M, Urbach H, Erny D, Taschner CA. Freiburg Neuropathology Case Conference : A 51-year-old Patient Presenting with Epistaxis and Occasional Headaches 16 Years after Diagnosis of a Grade 1 Chondrosarcoma of the Left Petrous Apex. Clin Neuroradiol 2023; 33:569-575. [PMID: 37171609 DOI: 10.1007/s00062-023-01294-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/17/2023] [Indexed: 05/13/2023]
Affiliation(s)
- E Wogram
- Department of Neuropathology, Medical Centre, University of Freiburg, Freiburg, Germany
- Faculty of Medicine, Medical Centre, University of Freiburg, Freiburg, Germany
| | - F Schlunk
- Department of Neuroradiology, Medical Centre, University of Freiburg, Breisacherstraße 64, 79106, Freiburg, Germany
- Faculty of Medicine, Medical Centre, University of Freiburg, Freiburg, Germany
| | - M J Shah
- Department of Neurosurgery, Medical Centre, University of Freiburg, Freiburg, Germany
- Faculty of Medicine, Medical Centre, University of Freiburg, Freiburg, Germany
| | - M Prinz
- Department of Neuropathology, Medical Centre, University of Freiburg, Freiburg, Germany
- Faculty of Medicine, Medical Centre, University of Freiburg, Freiburg, Germany
| | - H Urbach
- Department of Neuroradiology, Medical Centre, University of Freiburg, Breisacherstraße 64, 79106, Freiburg, Germany
- Faculty of Medicine, Medical Centre, University of Freiburg, Freiburg, Germany
| | - D Erny
- Department of Neuropathology, Medical Centre, University of Freiburg, Freiburg, Germany
- Faculty of Medicine, Medical Centre, University of Freiburg, Freiburg, Germany
| | - C A Taschner
- Department of Neuroradiology, Medical Centre, University of Freiburg, Breisacherstraße 64, 79106, Freiburg, Germany.
- Faculty of Medicine, Medical Centre, University of Freiburg, Freiburg, Germany.
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24
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Huynh KN, Kong MJ, Nguyen BD. Anatomic and Functional Imaging of Immunoglobulin G4-related Disease and Its Mimics. Radiographics 2023; 43:e220097. [PMID: 36821510 DOI: 10.1148/rg.220097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
Abstract
Immunoglobulin G4 (IgG4)-related disease (IgG4-RD) is an immune-mediated fibrosclerosing disease with tumefactive lesions infiltrated by IgG4-positive plasma cells. Initially described as autoimmune pancreatitis, IgG4-RD is now recognized as a discrete entity and is found to affect virtually any organ in the body. Common extrapancreatic sites include the biliary tree, salivary glands, periorbital tissue, lungs, kidneys, lymph nodes, aorta, retroperitoneum, and thyroid gland. Diagnosis-which relies on histopathologic, serologic, and radiologic features-can be challenging with the disease underdiagnosed, as IgG4-RD often mimics malignancy, infectious processes, or other immune-mediated conditions. Patients may present with signs of compression of nearby structures due to mass effect or with organ failure when the disease is left untreated. The clinical course is complex, with single- or multiorgan involvement and metachronous or synchronous occurrence of lesions. IgG4-RD responds well to glucocorticoid therapy, disease-modifying antirheumatic drugs, and B-cell-depleting biologic agents; prompt diagnosis is important to avoid delay in treatment and unnecessary pharmacologic or surgical intervention. While imaging features may not be specific for IgG4-RD, functional whole-body imaging with fluorine 18-fluorodeoxyglucose PET/CT is a useful adjunct for localizing extrapancreatic sites for biopsy, monitoring therapeutic response, and demonstrating disease relapse. The authors describe the pancreatic and extrapancreatic sites of involvement in IgG4-RD, with imaging features and patterns to aid in distinguishing IgG4-RD from its mimics through a multimodality approach with emphasis on functional imaging evaluation. ©RSNA, 2023 Quiz questions in the supplemental material and the slide presentation from the RSNA Annual Meeting are available for this article.
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Affiliation(s)
- Kenneth N Huynh
- From the Department of Radiological Sciences, University of California-Irvine, Orange, Calif (K.N.H.); and Department of Radiology, Mayo Clinic Scottsdale, 13400 E Shea Blvd, Scottsdale, AZ 85259 (M.J.K., B.D.N.)
| | - Min J Kong
- From the Department of Radiological Sciences, University of California-Irvine, Orange, Calif (K.N.H.); and Department of Radiology, Mayo Clinic Scottsdale, 13400 E Shea Blvd, Scottsdale, AZ 85259 (M.J.K., B.D.N.)
| | - Ba D Nguyen
- From the Department of Radiological Sciences, University of California-Irvine, Orange, Calif (K.N.H.); and Department of Radiology, Mayo Clinic Scottsdale, 13400 E Shea Blvd, Scottsdale, AZ 85259 (M.J.K., B.D.N.)
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25
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Panyaping T, Punpichet M, Tunlayadechanont P, Tritanon O. Usefulness of a Rim-Enhancing Pattern on the Contrast-Enhanced 3D-FLAIR Sequence and MRI Characteristics for Distinguishing Meningioma and Malignant Dural-Based Tumor. AJNR Am J Neuroradiol 2023; 44:247-253. [PMID: 36732030 PMCID: PMC10187810 DOI: 10.3174/ajnr.a7780] [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: 10/06/2022] [Accepted: 01/03/2023] [Indexed: 02/04/2023]
Abstract
BACKGROUND AND PURPOSE Meningiomas are the most common type of extra-axial dural-based tumors; however, malignant dural-based tumors can mimic meningiomas on imaging. The aim of this study was to determine the efficacy of differentiating meningiomas from malignant dural-based tumors by using rim-enhancement patterns on a contrast-enhanced FLAIR sequence and MR imaging characteristics. MATERIALS AND METHODS This retrospective study included 102 patients with meningiomas and 31 patients with malignant dural-based tumors who underwent pretreatment MR imaging. The rim-enhancement patterns on contrast-enhanced FLAIR and MR imaging characteristics, including the dural tail sign, hyperostosis, bony destruction, leptomeningeal enhancement, peritumoral edema, T2-weighted signal intensity, and tumor enhancement were evaluated. RESULTS Complete rim enhancement of the tumor-brain interface on contrast-enhanced FLAIR (contrast-enhanced-FLAIR rim sign) was present in most meningiomas (91/102, 89.2%) and at significantly greater frequency than in malignant dural-based tumors (2/31, 6.5%) (P < .001). Complete contrast-enhanced FLAIR rim enhancement provided high sensitivity (89.2%), specificity (93.5%), and accuracy (90.2%) for diagnosing meningioma. Additionally, hyperostosis was an MR imaging characteristic that suggested a diagnosis of meningioma. In contrast, bony destruction with cortical breakthrough and leptomeningeal enhancement suggested malignant dural-based tumors. There were limitations of meningiomas of <2.0 cm or at cavernous sinus locations that did not demonstrate contrast-enhanced FLAIR rim enhancement. CONCLUSIONS The rim-enhancement pattern on contrast-enhanced FLAIR could help differentiate meningiomas and malignant dural-based tumors. The presence of complete rim enhancement on contrast-enhanced FLAIR was a robust predictive sign for meningioma.
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Affiliation(s)
- T Panyaping
- From the Department of Diagnostic and Therapeutic Radiology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thialand
| | - M Punpichet
- From the Department of Diagnostic and Therapeutic Radiology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thialand
| | - P Tunlayadechanont
- From the Department of Diagnostic and Therapeutic Radiology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thialand
| | - O Tritanon
- From the Department of Diagnostic and Therapeutic Radiology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thialand
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26
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Patel Z, Wang JZ, Merali Z, Patil V, Nassiri F, Wei Q, Sosa J, Coire C, Zadeh G. DNA methylation profiling of a lipomatous meningioma: illustrative case. JOURNAL OF NEUROSURGERY. CASE LESSONS 2023; 5:CASE22518. [PMID: 36748749 PMCID: PMC10550555 DOI: 10.3171/case22518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/26/2022] [Accepted: 12/05/2022] [Indexed: 02/08/2023]
Abstract
BACKGROUND Lipomatous meningiomas are an extremely rare, benign meningioma subtype subcategorized under metaplastic meningioma in the most recent 2021 update to the World Health Organization classification. They make up less than 0.3% of all meningiomas and, to date, less than 70 cases have been reported in the literature, none of which have undergone molecular profiling. This study aims to promote the utility of molecular profiling to better diagnose these rare tumors. OBSERVATIONS The authors present the first case of a lipomatous meningioma with DNA methylation profiling that both confirmed its benign biology and uncovered unique cytogenetic changes. Molecular characterization of a lipomatous meningioma confirmed its diagnosis as a distinct, benign meningioma subtype and revealed several copy number variations on chromosome 8 and in NF2 and SMARCB1. Here we discuss some of the radiological and histopathological features of lipomatous meningiomas, how they can be used to distinguish from other meningiomas and other similarly presenting tumors, and a brief literature review discussing the pathophysiology and presentation of this rare tumor. LESSONS This study provides evidence supporting the use of molecular profiling to diagnose lipomatous meningiomas and guide their clinical management more accurately.
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Affiliation(s)
- Zeel Patel
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Justin Z. Wang
- MacFeeters Hamilton Neuro-Oncology Program, Princess Margaret Cancer Centre, University Health Network and University of Toronto, Toronto, Ontario, Canada
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada; and
| | - Zamir Merali
- MacFeeters Hamilton Neuro-Oncology Program, Princess Margaret Cancer Centre, University Health Network and University of Toronto, Toronto, Ontario, Canada
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada; and
| | - Vikas Patil
- MacFeeters Hamilton Neuro-Oncology Program, Princess Margaret Cancer Centre, University Health Network and University of Toronto, Toronto, Ontario, Canada
| | - Farshad Nassiri
- MacFeeters Hamilton Neuro-Oncology Program, Princess Margaret Cancer Centre, University Health Network and University of Toronto, Toronto, Ontario, Canada
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada; and
| | - Qingxia Wei
- MacFeeters Hamilton Neuro-Oncology Program, Princess Margaret Cancer Centre, University Health Network and University of Toronto, Toronto, Ontario, Canada
| | - Julio Sosa
- MacFeeters Hamilton Neuro-Oncology Program, Princess Margaret Cancer Centre, University Health Network and University of Toronto, Toronto, Ontario, Canada
| | - Claire Coire
- Division of Neuropathology, Department of Pathology, Trillium Health Partners, Mississauga, Ontario, Canada
| | - Gelareh Zadeh
- MacFeeters Hamilton Neuro-Oncology Program, Princess Margaret Cancer Centre, University Health Network and University of Toronto, Toronto, Ontario, Canada
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada; and
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27
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Kamepalli H, Kalaparti V, Kesavadas C. Imaging Recommendations for the Diagnosis, Staging, and Management of Adult Brain Tumors. Indian J Med Paediatr Oncol 2023. [DOI: 10.1055/s-0042-1759712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/08/2023] Open
Abstract
AbstractNeuroimaging plays a pivotal role in the clinical practice of brain tumors aiding in the diagnosis, genotype prediction, preoperative planning, and prognostication. The brain tumors most commonly seen in adults are extra-axial lesions like meningioma, intra-axial lesions like gliomas and lesions of the pituitary gland. Clinical features may be localizing like partial seizures, weakness, and sensory disturbances or nonspecific like a headache. On clinical suspicion of a brain tumor, the primary investigative workup should focus on imaging. Other investigations like fundoscopy and electroencephalography may be performed depending on the clinical presentation. Obtaining a tissue sample after identifying a brain tumor on imaging is crucial for confirming the diagnosis and planning further treatment. Tissue sample may be obtained by techniques such as stereotactic biopsy or upfront surgery. The magnetic resonance (MR) imaging protocol needs to be standardized and includes conventional sequences like T1-weighted (T1W) imaging with and without contrast, T2w imaging, fluid-attenuated axial inversion recovery, diffusion-weighted imaging (DWI), susceptibility-weighted imaging, and advanced imaging sequences like MR perfusion and MR spectroscopy. Various tumor characteristics in each of these sequences can help us narrow down the differential diagnosis and also predict the grade of the tumor. Multidisciplinary co-ordination is needed for proper management and care of brain tumor patients. Treatment protocols need to be adapted and individualized for each patient depending on the age, general condition of the patient, histopathological characteristics, and genotype of the tumor. Treatment options include surgery, radiotherapy, and chemotherapy. Imaging also plays a vital role in post-treatment follow-up. Sequences like DWI, MR perfusion, and MR spectroscopy are useful to distinguish post-treatment effects like radiation necrosis and pseudoprogression from true recurrence. Radiological reporting of brain tumor images should follow a structured format to include all the elements that could have an impact on the treatment decisions in patients.
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Affiliation(s)
- HariKishore Kamepalli
- Department of Imaging Sciences and Interventional Radiology, Sree Chitra Tirunal Institute of Medical Sciences and Technology, Trivandrum, Kerala, India
| | - Viswanadh Kalaparti
- Department of Imaging Sciences and Interventional Radiology, Sree Chitra Tirunal Institute of Medical Sciences and Technology, Trivandrum, Kerala, India
| | - Chandrasekharan Kesavadas
- Department of Imaging Sciences and Interventional Radiology, Sree Chitra Tirunal Institute of Medical Sciences and Technology, Trivandrum, Kerala, India
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28
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Dev ID, Rangarajan V, Puranik AD, Agrawal A, Shah S, Sahay A, Purandare NC. Sporadic Cerebellar Hemangioblastoma With Strong SSTR Expression on 68 Ga-DOTANOC PET/CT. Clin Nucl Med 2023; 48:e28-e30. [PMID: 36240749 DOI: 10.1097/rlu.0000000000004456] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
ABSTRACT Sporadic cerebellar hemangioblastomas are rare with majority of these tumors presenting as a part of von Hippel-Lindau syndrome. We demonstrate an unusual case of a symptomatic sporadic cerebellar hemangioblastoma mimicking a meningioma on MRI and 68 Ga-DOTANOC PET imaging.
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Affiliation(s)
- Indraja D Dev
- From the Departments of Nuclear Medicine and Molecular Imaging
| | | | - Ameya D Puranik
- From the Departments of Nuclear Medicine and Molecular Imaging
| | - Archi Agrawal
- From the Departments of Nuclear Medicine and Molecular Imaging
| | - Sneha Shah
- From the Departments of Nuclear Medicine and Molecular Imaging
| | - Ayushi Sahay
- Pathology, Tata Memorial Center, Homi Bhabha National Institute, Mumbai, India
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29
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Li Z, Cong Y, Chen X, Qi J, Sun J, Yan T, Yang H, Liu J, Lu E, Wang L, Li J, Hu H, Zhang C, Yang Q, Yao J, Yao P, Jiang Q, Liu W, Song J, Carin L, Chen Y, Zhao S, Gao X. Vision transformer-based weakly supervised histopathological image analysis of primary brain tumors. iScience 2022; 26:105872. [PMID: 36647383 PMCID: PMC9839963 DOI: 10.1016/j.isci.2022.105872] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Revised: 12/03/2022] [Accepted: 12/21/2022] [Indexed: 12/25/2022] Open
Abstract
Diagnosis of primary brain tumors relies heavily on histopathology. Although various computational pathology methods have been developed for automated diagnosis of primary brain tumors, they usually require neuropathologists' annotation of region of interests or selection of image patches on whole-slide images (WSI). We developed an end-to-end Vision Transformer (ViT) - based deep learning architecture for brain tumor WSI analysis, yielding a highly interpretable deep-learning model, ViT-WSI. Based on the principle of weakly supervised machine learning, ViT-WSI accomplishes the task of major primary brain tumor type and subtype classification. Using a systematic gradient-based attribution analysis procedure, ViT-WSI can discover diagnostic histopathological features for primary brain tumors. Furthermore, we demonstrated that ViT-WSI has high predictive power of inferring the status of three diagnostic glioma molecular markers, IDH1 mutation, p53 mutation, and MGMT methylation, directly from H&E-stained histopathological images, with patient level AUC scores of 0.960, 0.874, and 0.845, respectively.
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Affiliation(s)
- Zhongxiao Li
- Computer Science Program, Computer, Electrical and Mathematical Sciences and Engineering (CEMSE) Division, King Abdullah University of Science and Technology (KAUST), Thuwal 23955-6900, Kingdom of Saudi Arabia,KAUST Computational Bioscience Research Center (CBRC), King Abdullah University of Science and Technology (KAUST), Thuwal 23955-6900, Kingdom of Saudi Arabia
| | - Yuwei Cong
- Department of Pathology, The First Affiliated Hospital of Harbin Medical University, 23 Youzheng Street, Nangang District, Harbin 150001, People’s Republic of China
| | - Xin Chen
- Department of Neurosurgery, The First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang Province 150001, China
| | - Jiping Qi
- Department of Pathology, The First Affiliated Hospital of Harbin Medical University, 23 Youzheng Street, Nangang District, Harbin 150001, People’s Republic of China,Corresponding author
| | - Jingxian Sun
- Department of Neurosurgery, The First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang Province 150001, China
| | - Tao Yan
- Department of Neurosurgery, The First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang Province 150001, China
| | - He Yang
- Department of Neurosurgery, The First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang Province 150001, China
| | - Junsi Liu
- Department of Neurosurgery, The First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang Province 150001, China
| | - Enzhou Lu
- Department of Neurosurgery, The First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang Province 150001, China
| | - Lixiang Wang
- Department of Neurosurgery, The First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang Province 150001, China
| | - Jiafeng Li
- Department of Neurosurgery, The First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang Province 150001, China
| | - Hong Hu
- Department of Neurosurgery, The First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang Province 150001, China
| | | | - Quan Yang
- Department of Neurosurgery, The First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang Province 150001, China
| | - Jiawei Yao
- Department of Neurosurgery, The First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang Province 150001, China
| | - Penglei Yao
- Department of Neurosurgery, The First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang Province 150001, China
| | - Qiuyi Jiang
- Department of Neurosurgery, The First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang Province 150001, China
| | - Wenwu Liu
- Department of Neurosurgery, The First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang Province 150001, China
| | - Jiangning Song
- Biomedicine Discovery Institute and Department of Biochemistry and Molecular Biology, Monash University, Melbourne, VIC 3800, Australia,Monash Data Futures Institute, Monash University, Melbourne, VIC 3800, Australia
| | - Lawrence Carin
- Computer Science Program, Computer, Electrical and Mathematical Sciences and Engineering (CEMSE) Division, King Abdullah University of Science and Technology (KAUST), Thuwal 23955-6900, Kingdom of Saudi Arabia,Corresponding author
| | - Yupeng Chen
- School of Microelectronics, Southern University of Science and Technology, Shenzhen 518055, PR China,Corresponding author
| | - Shiguang Zhao
- Department of Neurosurgery, The First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang Province 150001, China,Department of Neurosurgery, Shenzhen University General Hospital, Shenzhen, Guangdong Province 518100, China,Corresponding author
| | - Xin Gao
- Computer Science Program, Computer, Electrical and Mathematical Sciences and Engineering (CEMSE) Division, King Abdullah University of Science and Technology (KAUST), Thuwal 23955-6900, Kingdom of Saudi Arabia,KAUST Computational Bioscience Research Center (CBRC), King Abdullah University of Science and Technology (KAUST), Thuwal 23955-6900, Kingdom of Saudi Arabia,Corresponding author
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30
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Uncommon and atypical meningiomas and imaging variants: A report of 7 cases. MEDICINE INTERNATIONAL 2022; 2:35. [PMID: 36699153 PMCID: PMC9829240 DOI: 10.3892/mi.2022.60] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Accepted: 11/14/2022] [Indexed: 11/16/2022]
Abstract
Meningiomas constitute the most common extra-axial tumor of the central nervous system and can have a wide-ranging manifestation of imaging. There are several types of unusual depictions depicted with the magnetic resonance imaging (MRI) of meningiomas that have been established thus far. It is thus crucial for the reporting radiologist or neurosurgeon to have an in-depth knowledge of their variable manifestations in order to be able to differentiate these neoplasms from the numerous tumors that can mimic their appearance. Meningioma is frequently challenging to diagnose when imaging variants are present. Nevertheless, a number of unusual histological variants have imaging or clinical features which are related to typical meningiomas and, in numerous cases, these require specific surgical management. The present study describes 7 cases of meningiomas, which were either simple atypical, unusual gigantic extracranial intracranial parasagittal, or not visible meningiomas. These uncommon and atypical imaging variants of meningiomas are described herein in an aim to underline their various potential presentations.
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31
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Thibodeau R, Li HK, Babu H, Jafroodifar A, Ramovic M, Hahn SS. Dural lymphoma misdiagnosed as subdural hematoma following head trauma after an episode of syncope. Radiol Case Rep 2022; 17:4774-4779. [PMID: 36238205 PMCID: PMC9550849 DOI: 10.1016/j.radcr.2022.09.044] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 09/08/2022] [Accepted: 09/13/2022] [Indexed: 11/19/2022] Open
Abstract
Primary dural lymphoma is a rare subtype of primary central nervous system lymphoma. Primary dural lymphoma may be radiologically misdiagnosed as it shares similar imaging characteristics with several pathologies, including meningiomas and subdural or epidural hematomas. We present a patient who was originally diagnosed with a subdural hematoma following a syncopal episode on computed tomography. Follow-up magnetic resonance imaging of the brain demonstrated heterogeneously enhancing dural-based mass overlying the left frontoparietal convexity associated with bidirectional dural tails, suggestive of a malignant meningioma. Neurosurgical histopathology revealed marginal zone B-cell lymphoma. This case represents the potential difficulty in diagnosing primary dural lymphoma, especially in the setting of uncertain clinical history and obscured imaging features.
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Key Words
- 18F-FDG PET/CT, 2-deoxy-2-[fluorine-18]fluoro-D-glucose integrated with computed tomography
- ADC, Apparent diffusion coefficient
- CNS, Central nervous system
- CT, Computed tomography
- DWI, Diffusion-weighted imaging
- Dural lymphoma
- ED, Emergency department
- FLAIR, Fluid-attenuated inversion recovery
- MR, Magnetic resonance
- MZBCL, Marginal zone B-cell lymphoma
- Meningioma
- Neuroradiology
- Neurosurgery
- PCNSL, Primary central nervous system tumor
- PCP, Primary care physician
- PDL, Primary dural lymphoma
- Radiation oncology
- SPECT, single-photon emission computed tomography
- Subdural hematoma
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Affiliation(s)
- Ryan Thibodeau
- Department of Radiology, SUNY Upstate Medical University, Syracuse, NY, USA
- Department of Radiology, Albany Medical Center, Albany, NY, USA
| | - Hsin Kwung Li
- Department of Radiation Oncology, SUNY Upstate Medical University, Syracuse, NY, USA
| | - Harish Babu
- Department of Neurosurgery, SUNY Upstate Medical University, Syracuse, NY, USA
| | - Abtin Jafroodifar
- Department of Radiology, SUNY Upstate Medical University, Syracuse, NY, USA
| | - Merima Ramovic
- Department of Medical Oncology, SUNY Upstate Medical University, Syracuse, NY, USA
| | - Seung Shin Hahn
- Department of Radiation Oncology, SUNY Upstate Medical University, Syracuse, NY, USA
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32
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Yadav A, Gupta S, Kaur R. Curious Case of a Vanishing Dural Mass Lesion. Neurol India 2022; 70:2209-2210. [PMID: 36352646 DOI: 10.4103/0028-3886.359177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Arushi Yadav
- Department of Radiodiagnosis, Government Medical College and Hospital, Chandigarh, India
| | - Shreya Gupta
- Department of Radiodiagnosis, Government Medical College and Hospital, Chandigarh, India
| | - Ravinder Kaur
- Department of Radiodiagnosis, Government Medical College and Hospital, Chandigarh, India
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33
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Matias TB, Dal Fabbro M, de Souza Queiroz L, Reis F. Myxofibrosarcoma: Another mimicker of meningioma. NEUROCIRUGIA (ENGLISH EDITION) 2022; 33:242-249. [PMID: 36084960 DOI: 10.1016/j.neucie.2021.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Accepted: 03/17/2021] [Indexed: 06/15/2023]
Abstract
Primary intracranial malignant fibrous histiocytoma (MFH), or myxofibrosarcoma, is an extremely rare condition, with only a few cases reported in the literature. We report a case of a dural-based myxofibrosarcoma in a previously healthy 42-year-old man that was initially presumed to be an atypical meningioma. The findings based on conventional and advanced magnetic resonance sequences, including diffusion-weighted imaging, perfusion weighted imaging and proton magnetic resonance spectroscopy, as well as histopathological aspects, are discussed.
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Affiliation(s)
- Thiago Bezerra Matias
- Department of Radiology, Faculty of Medical Sciences, State University of Campinas (UNICAMP), Campinas, SP, Brazil
| | - Mateus Dal Fabbro
- Department of Neurology and Neurosurgery, Faculty of Medical Sciences, State University of Campinas (UNICAMP), Campinas, SP, Brazil
| | - Luciano de Souza Queiroz
- Department of Pathology, Faculty of Medical Sciences, State University of Campinas (UNICAMP), Campinas, SP, Brazil
| | - Fabiano Reis
- Department of Radiology, Faculty of Medical Sciences, State University of Campinas (UNICAMP), Campinas, SP, Brazil.
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34
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Somatostatin Receptor Targeted PET-Imaging for Diagnosis, Radiotherapy Planning and Theranostics of Meningiomas: A Systematic Review of the Literature. Diagnostics (Basel) 2022; 12:diagnostics12071666. [PMID: 35885570 PMCID: PMC9321668 DOI: 10.3390/diagnostics12071666] [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: 06/14/2022] [Revised: 07/07/2022] [Accepted: 07/08/2022] [Indexed: 11/21/2022] Open
Abstract
The aims of the present systematic review are to: (1) assess the diagnostic performance of somatostatin receptor (SSR)targeted positron emission tomography (PET) with different tracers and devices in patients affected by meningiomas; and (2) to evaluate the theranostic applications of peptide receptor radionuclide therapy (PRRT) in meningiomas. A systematic literature search according to PRISMA criteria was made by using two main databases. Only studies published from 2011 up to March 2022 in the English language with ≥10 enrolled patients were selected. Following our research strategy, 17 studies were included for the assessment. Fourteen studies encompassed 534 patients, harboring 733 meningiomas, submitted to SSR-targeted PET/CT (n = 10) or PET/MRI (n = 4) for de novo diagnosis, recurrence detection, or radiation therapy (RT) planning (endpoint 1), while 3 studies included 69 patients with therapy-refractory meningiomas submitted to PRRT (endpoint 2). A relevant variation in methodology was registered among diagnostic studies, since only a minority of them reported histopathology as a reference standard. PET, especially when performed through PET/MRI, resulted particularly useful for the detection of meningiomas located in the skull base (SB) or next to the falx cerebri, significantly influencing RT planning. As far as it concerns PRRT studies, stable disease was obtained in the 66.6% of the treated patients, being grade 1–2 hematological toxicity the most common side effect. Of note, the wide range of the administered activities, the various utilized radiopharmaceuticals (90Y-DOTATOC and/or 177Lu-DOTATATE), the lack of dosimetric studies hamper a clear definition of PRRT potential on meningiomas’ management.
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35
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Zacharewski N, Movahed-Ezazi M, Song X, Mehta T, Manjila S. De Novo Glioblastoma Masqueraded within a Hemispheric Dural Meningiomatosis: Rare Imaging Findings and Rationale for Two-Staged Resection. J Neurol Surg Rep 2022; 83:e44-e49. [PMID: 35693250 PMCID: PMC9179231 DOI: 10.1055/s-0042-1749215] [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: 08/12/2021] [Accepted: 03/30/2022] [Indexed: 11/04/2022] Open
Abstract
Introduction
Collision tumors present as histologically different juxtaposed neoplasms within the same anatomical region, independent of the adjacent cell population. De novo intracranial collision tumors involving metachronous primary brain neoplasms alongside dural meningiomatosis are not well documented in the literature.
Clinical Presentation
We present staged surgical management of a 72-year-old female with known left hemispheric stable dural-based convexity mass lesions over 10 years and new-onset expressive aphasia and headaches. MRI had revealed left supratentorial dural-based enhanced masses consistent with en plaque meningiomatosis. Embolization angiography showed an unusual tumor blush from an aberrant branch of anterior cerebral artery suggesting a deeper focal intra-axial nature; a stage 1 craniotomy for dural-based tumor resection was completed with diagnosis of a meningioma (WHO grade 1). Intraoperatively, a distinct intra-axial deep discrete lesion was verified stereotactically, concordant with the location of tumor blush. The patient made a complete neurological recovery from a transient postoperative supplemental motor area syndrome in a week. Subsequent postoperative follow-up showed worsening of right hemiparesis and MRI showed an increase in residual lesion size and perilesional edema, which prompted a stage 2 radical resection of a glioblastoma, WHO grade 4. She improved neurologically after surgery with steroids and physical therapy. At 15 months following adjuvant therapy, she remains neurologically intact throughout the postoperative course, with no recurrent tumor on MRI.
Conclusion
A de novo glioblastoma presented as a masquerading lesion within hemispheric convexity meningiomatosis in an elderly patient with no prior radiation/phakomatosis, inciting a non-causal juxtapositional coexistence. The authors highlight rare pathognomonic angiographic findings and the rationale for two-staged resections of these collision lesions that led to excellent clinicoradiological outcome.
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Affiliation(s)
- Nicholas Zacharewski
- Department of Neurosurgery, Hartford Hospital, Hartford, Connecticut, United States
- Department of Trinity College, Hartford, Connecticut, United States
| | - Misha Movahed-Ezazi
- Department of Pathology and Laboratory Medicine, Hartford Hospital, Hartford, Connecticut, United States
| | - Xianyuan Song
- Department of Pathology and Laboratory Medicine, Hartford Hospital, Hartford, Connecticut, United States
| | - Tapan Mehta
- Division of Neuro Intervention, Hartford Hospital, Hartford, Connecticut, United States
| | - Sunil Manjila
- Department of Neurosurgery, Hartford Hospital, Hartford, Connecticut, United States
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36
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Ihwan A, Rafika R, Cangara MH, Sjukur KJ, Faruk M. Correlation between Radiological Images and Histopathological Type of Meningioma: A Cohort Study. Ethiop J Health Sci 2022; 32:597-604. [PMID: 35813670 PMCID: PMC9214728 DOI: 10.4314/ejhs.v32i3.16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2022] [Accepted: 02/01/2022] [Indexed: 11/17/2022] Open
Abstract
Background Histologically affirmed meningiomas represent 37.6% of all essential central nervous system tumors and half of all types of critical central nervous system tumors. This study compares computed tomography (CT) scans of the head with histological findings to establish the characteristics of different types of meningiomas observed in eastern Indonesia. Methods This prospective study evaluated 224 patients by examining the correlation between histological and CT data collected from January to December 2020 at Wahidin Sudirohusodo Hospital, Makassar, Indonesia. We assessed data including the location of pre- and post-contrast CT scans, number of tumors, margin, density, contrast enhancement, bony reaction, calcification, and perifocal edema. Patients underwent biopsies followed by an examination of the anatomical pathology tissue. Results The female-to-male ratio of participants was 4.2 to 1, and the highest incidence was observed in participants of both genders aged 40-60 years. The most common meningioma subtype was meningothelial, while the most commonly observed locations involved the convexity and sphenoid regions. Most meningiomas had well-defined margins on CT imaging: 54.5% of patients exhibited isodense lesions on pre-contrast scans, and 64.7% exhibited high-contrast enhancement. Bone destruction developed in 4.1% of patients, while hyperostosis was observed in 17.4%, and calcification was present in 10.3% of the participants. Edema was identified in 65.2% of cases, of which moderate edema was the most common manifestation. Conclusion Meningioma should be highly suspected in female patients aged 40-60 with isodense lesions on pre-contrast CT scans and high-contrast enhancement on post-contrast CT scans. Meningiomas were primarily classified as convexity meningiomas with well-defined margins. The presence of hyperostosis, calcification, and brain edema supported the meningioma diagnosis.
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Affiliation(s)
- Andi Ihwan
- Department of Neurosurgery, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia, Department of Neurosurgery, Wahidin Sudirohusodo Hospital, Makassar, Indonesia
| | - Rauf Rafika
- Department of Radiology, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia
| | - Muhammad Husni Cangara
- Department of Pathology Anatomy, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia
| | - Kevin Jonathan Sjukur
- Department of Neurosurgery, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia
| | - Muhammad Faruk
- Department of Surgery, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia
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Tumor control and radiobiological fingerprint after Gamma Knife radiosurgery for posterior fossa meningiomas: A series of 46 consecutive cases. J Clin Neurosci 2022; 100:196-203. [PMID: 35489255 DOI: 10.1016/j.jocn.2022.04.031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 03/16/2022] [Accepted: 04/24/2022] [Indexed: 11/20/2022]
Abstract
INTRODUCTION Gamma Knife radiosurgery (GKR) can be a valuable treatment option for posterior cranial fossa meningiomas (PCFM). We retrospectively analyzed outcomes of GKR for PCFM. METHODS Were included forty-six patients with 47 PCFM. Primary endpoint was tumor control. Secondary endpoint was clinical improvement. Biologically effective dose (BED) was evaluated in relationship to primary and secondary outcomes. Mean marginal dose was 12.4 Gy (median 12, 12-14). Mean BED was 63.6 Gy (median 65, 49.1-88.3). Mean target volume (TV) was 2.21 cc (range 0.3-8.9 cc). RESULTS Overall tumor control rate was 93.6% (44/47) after mean follow-up of 47.8 months ± 28.46 months (median 45.5, range 6-108). Radiological progression-free survival at 5 years was 94%. Higher pretherapeutic TVs were predictive for higher likelihood of tumor progression (Odds ratio, OR 1.448, 95% confidence interval - CI 1.001-2.093, p = 0.049). At last clinical follow-up, 28 patients (71.8%) remained stable, 10 (25.6%) improved and 1 patient (2.6%) worsened. Using logistic regression, the relationship between BED and clinical improvement was assessed (OR 0.903, standard error 0.59, coefficient 0.79-1.027, CI -0.10; 0.01; p = 0.14). The highest probability of clinical improvement corresponded to a range of BED values between 56 and 61 Gy. CONCLUSION Primary GKR for PCFM is safe and effective. Higher pretherapeutic TV was predictor of volumetric progression. Highest probability of clinical improvement might correspond to a range of BED values between 56 and 61 Gy, although this was not statistically significant. The importance of BED should be further validated in larger cohorts, other anatomical locations and other pathologies.
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38
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Shimada H, Tago M. Prostate cancer dural metastasis resembling a meningioma. Clin Case Rep 2022; 10:e05601. [PMID: 35414934 PMCID: PMC8979155 DOI: 10.1002/ccr3.5601] [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: 12/03/2021] [Revised: 02/20/2022] [Accepted: 03/07/2022] [Indexed: 11/10/2022] Open
Abstract
CT images of a 56‐year‐old man with headache showed a meningioma‐like mass in the occipital region. The tumor was well‐defined and non‐uniform with bone thickening and no internal calcification. Eventually, he was diagnosed on the basis of histopathology and immunostaining findings as having a dural metastasis from a prostate cancer.
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Affiliation(s)
- Hitomi Shimada
- Department of General Medicine Saga University Hospital Saga Japan
- Shimada Hospital of Medical Corporation Chouseikai Saga Japan
| | - Masaki Tago
- Department of General Medicine Saga University Hospital Saga Japan
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39
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Freddi TDAL, Ottaiano AC, Lucio LL, Corrêa DG, Hygino da Cruz LC. The Trigemius Nerve: Anatomy and Pathology. Semin Ultrasound CT MR 2022; 43:403-413. [DOI: 10.1053/j.sult.2022.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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40
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Abdalla KMS, Tamhankar M, Prabhu AM. Bilateral Optic Neuropathy Mimicking Neuromyelitis Optica in the Setting of Intracranial Germinoma. Neurol Clin Pract 2022; 11:e935-e938. [PMID: 34992988 DOI: 10.1212/cpj.0000000000001101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Bilateral optic neuropathy is uncommon in adults with a prevalence varying from 19% -50% of all optic neuropathies [1]. The most common etiology is Neuromyelitis Optica (NMO) or Devic’s disease. Other less frequent etiologies include myelin-oligodendrocyte-glycoprotein (MOG) antibody, syphilis, meningioma, post-vaccinal, post-infectious (chicken pox, human herpes virus 6), acute disseminated encephalomyelitis and idiopathic. Sequential optic neuropathy is seen in multiple sclerosis, but bilateral simultaneous optic neuropathy is rare [2]. When optic neuropathy involves posterior nerve segments, long segments and the optic chiasm, NMO should be suspected. If there is involvement of the hypothalamus, basal meninges, other cranial neuropathies, sarcoidosis must be considered [3]. Primary intracranial germinoma is a rare condition and should be included in the differential diagnosis, especially if there are atypical features and inadequate response to standard treatment [4].
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Affiliation(s)
- Khaled M S Abdalla
- Department of Neurology (KMSA, AMP), Einstein Medical Center, Philadelphia, PA; and Department of Neurology (MT), Scheie Eye Institute, University of Pennsylvania, Philadelphia
| | - Madhura Tamhankar
- Department of Neurology (KMSA, AMP), Einstein Medical Center, Philadelphia, PA; and Department of Neurology (MT), Scheie Eye Institute, University of Pennsylvania, Philadelphia
| | - Aparna M Prabhu
- Department of Neurology (KMSA, AMP), Einstein Medical Center, Philadelphia, PA; and Department of Neurology (MT), Scheie Eye Institute, University of Pennsylvania, Philadelphia
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41
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Krishnan P, Ghosh N, Sanyal S. En plaque tuberculoma of the dura with extracranial extension in an adolescent mimicking an aggressive en plaque meningioma. J Pediatr Neurosci 2022. [DOI: 10.4103/jpn.jpn_79_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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42
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Garay Buitron F, Pons-Escoda A, Vidal N, Torres A, Camins A. Primary extraosseous dural chondrosarcoma: a case report. BMC Neurol 2021; 21:489. [PMID: 34911493 PMCID: PMC8672547 DOI: 10.1186/s12883-021-02515-y] [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] [Received: 11/04/2021] [Accepted: 12/06/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Dural chondrosarcoma is a very rare intracranial tumor, given that meninges do not normally contain cartilaginous tissue from which it can originate. We present a case of primary extraosseous dural chondrosarcoma. CASE PRESENTATION A 48-year-old woman presented to our tertiary center neurosurgery consultation with progressive headache, vomiting, vertigo, and gait instability of 5 months' duration. An initial brain CT revealed a large parietal mass with gross calcifications and subtle hyperostosis of the inner table. Subsequent brain MRI showed a heterogeneous expansive lesion with a honey-comb enhancement. Discussion of intra- or extra-axial location was warranted, and finally, initial presurgical suspicion of meningioma arose although some atypical imaging features were detected. The differential diagnosis included solitary fibrous tumor-hemangiopericytoma and dural metastasis. Total resection of the lesion was performed, extra-axial origin was confirmed, and pathology resulted in a primary dural chondrosarcoma. CONCLUSION The importance of this case presentation lies in the unusual nature of the final diagnosis, the brief literature review and differential diagnosis with emphasis on imaging pearls, as well as the useful reminder for physicians to consider less frequent diseases when key findings do not unambiguously lead to the usual suspects.
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Affiliation(s)
| | - Albert Pons-Escoda
- Radiology Department, Hospital Universitari de Bellvitge, Barcelona, Spain
| | - Noemí Vidal
- Pathology Department, Hospital Universitari de Bellvitge, Barcelona, Spain
| | - Alberto Torres
- Neurosurgery Department, Hospital Universitari de Bellvitge, Barcelona, Spain
| | - Angels Camins
- Radiology Department, Hospital Universitari de Bellvitge, Barcelona, Spain
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43
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Ong WF, Musa AT, Ooi LW, Karim NKA. Primary osteosarcoma of the sphenoid wing in a middle-aged woman with extensive intracranial extension: A case report. J Taibah Univ Med Sci 2021; 16:943-947. [PMID: 34899138 PMCID: PMC8626810 DOI: 10.1016/j.jtumed.2021.07.007] [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] [Received: 04/05/2021] [Revised: 07/03/2021] [Accepted: 07/15/2021] [Indexed: 12/05/2022] Open
Abstract
Primary osteosarcomas involving the base of the skull in middle-aged patients are rare. We describe the case of a 59-year-old Asian woman presenting with lethargy, epistaxis, left maxillary and mandibular pain, and headache. Computed tomography (CT) and magnetic resonance imaging (MRI) showed a large left greater sphenoid wing tumour with extensive local infiltration and intracranial extension. The tumour was diagnosed as osteosarcoma based on histological examination. In this report, we discuss the clinical presentations, radiological features, and imaging differential diagnoses of this case.
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Affiliation(s)
- Wenn F Ong
- Radiology Department, Hospital Universiti Sains Malaysia, Kota Bharu, Kelantan, Malaysia
| | - Ahmad T Musa
- Radiology Department, Hospital Universiti Sains Malaysia, Kota Bharu, Kelantan, Malaysia
| | - Lin-Wei Ooi
- Neurosurgery Department, Hospital Universiti Sains Malaysia, Kota Bharu, Kelantan, Malaysia
| | - Noor Khairiah A Karim
- Imaging Unit, Advanced Medical and Dental Institute, Universiti Sains Malaysia, Bertam, Kepala Batas, Pulau Pinang, Malaysia
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44
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Sarathy D, Snyder MH, Ampie L, Berry D, Syed HR. Dural Convexity Chondroma Mimicking Meningioma in a Young Female. Cureus 2021; 13:e20715. [PMID: 35106249 PMCID: PMC8788917 DOI: 10.7759/cureus.20715] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/26/2021] [Indexed: 11/11/2022] Open
Abstract
Intracranial meningeal convexity chondroma is a rare benign lesion hypothesized to stem from remnant chondrocyte precursors of embryonic origin. This lesion often masquerades as meningioma given the similar dural-based attachment and pattern of calcification. We describe the case of a 26-year-old female with incidentally discovered convexity meningeal chondroma, originally presumed to be a meningioma. In this case, we share our diagnostic and operative intervention and outcome and discuss the unique pathologic findings in this lesion that differentiate it from similar appearing lesions. To the authors’ knowledge, there are fewer than 20 cases of convexity meningeal chondroma in the literature; thus, we also provide a brief review of the literature regarding this rare pathology.
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Affiliation(s)
- Danyas Sarathy
- Department of Neurological Surgery, University of Virginia, Charlottesville, USA
| | - Matthew H Snyder
- Department of Neurological Surgery, Tufts Medical Center, Boston, USA
| | - Leonel Ampie
- Department of Neurological Surgery, University of Virginia, Charlottesville, USA
| | - Debra Berry
- Department of Pathology, University of Virginia, Charlottesville, USA
| | - Hasan R Syed
- Department of Neurological Surgery, Children's National Hospital, Washington DC, USA
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45
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Chugh A, Punia P, Gotecha S, Kiyawat D, Gore C. Meningoids: Lesions mimicking meningiomas. INTERDISCIPLINARY NEUROSURGERY 2021. [DOI: 10.1016/j.inat.2021.101302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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46
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Orbital Rosai–Dorfman Disease Presenting as Optic Neuritis. J Neuroophthalmol 2021; 42:e293-e296. [DOI: 10.1097/wno.0000000000001405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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47
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Extramedullary Hematopoiesis in the Dura Mater During Treatment of a CNS Embryonal Tumor. J Pediatr Hematol Oncol 2021; 43:e1217-e1219. [PMID: 33031159 DOI: 10.1097/mph.0000000000001962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Accepted: 09/07/2020] [Indexed: 11/25/2022]
Abstract
Extramedullary hematopoiesis (EMH) is hematopoiesis occurring outside of the bone marrow. It has been reported to develop in abdominal organs or lymph nodes after chemotherapy. Here, the authors describe a patient with a localized central nervous system embryonal tumor who, during intensive chemotherapy, developed dural nodules. Biopsy revealed these nodules to be EMH. Without a pathologic diagnosis, this may have been considered disease progression, altering the patient's treatment plan. This report intends to serve as a reminder that EMH should be included in the differential diagnosis of suspicious lesions and highlights the importance of their biopsy because of potential management implications.
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48
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Myeong HS, Koh EJ, Cheon JE, Park SH, Kim SK. Intracranial juvenile xanthogranuloma in an infant. Childs Nerv Syst 2021; 37:3265-3269. [PMID: 33660104 DOI: 10.1007/s00381-021-05088-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2020] [Accepted: 02/09/2021] [Indexed: 11/30/2022]
Abstract
Juvenile xanthogranuloma (JXG) is a type of non-Langerhans cell histiocytosis that most commonly manifests as a solitary cutaneous lesion of the head and neck in children. Intracranial JXG is extremely rare. Although it is widely known that JXG skin lesions gradually disappear over time without treatment, treatment guidelines for intracranial JXG have not been established. It is very difficult to predict whether an intracranial lesion is JXG with only a pre-operative imaging work-up without pathologic confirmation. We report a case of the youngest, a 3-month-old male infant with an intracranial extra-axial mass with rapid growth for 2 months. Additionally, we suggest characteristic MRI findings for intracranial extra-axial JXG of a low T2 signal and a kidney bean shape.
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Affiliation(s)
- Ho-Sung Myeong
- Division of Pediatric Neurosurgery, Seoul National University Children's Hospital, Seoul, Korea
| | - Eun Jung Koh
- Division of Pediatric Neurosurgery, Seoul National University Children's Hospital, Seoul, Korea.,Department of Neurosurgery, Seoul National University College of Medicine, Seoul National University Hospital, 101 Daehak-Ro, Jongro-Gu, Seoul, Seoul, 03080, Korea
| | - Jung-Eun Cheon
- Division of Pediatric Radiology, Seoul National University College of Medicine, Seoul National University Children's Hospital, Seoul, Korea
| | - Sung-Hye Park
- Department of Pathology, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Korea
| | - Seung-Ki Kim
- Division of Pediatric Neurosurgery, Seoul National University Children's Hospital, Seoul, Korea. .,Department of Neurosurgery, Seoul National University College of Medicine, Seoul National University Hospital, 101 Daehak-Ro, Jongro-Gu, Seoul, Seoul, 03080, Korea.
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49
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The Value of SSTR2 Receptor-Targeted PET/CT in Proton Irradiation of Grade I Meningioma. Cancers (Basel) 2021; 13:cancers13184707. [PMID: 34572933 PMCID: PMC8469658 DOI: 10.3390/cancers13184707] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Revised: 09/04/2021] [Accepted: 09/14/2021] [Indexed: 11/17/2022] Open
Abstract
Grade I meningioma is the most common intracranial tumor in adults. The standard imaging for its radiation treatment planning is MRI, and [68Ga]1,4,7,10-tetraazacyclododecane-1,4,7,10-tetraacetic acid (DOTA)-conjugated PET/CT can further improve delineation. We investigated the impact of PET/CT on interobserver variability in identifying the tumor in 30 anonymized patients. Four radiation oncologists independently contoured residual tumor volume, first using only MRI and subsequently with the addition of PET/CT. Conformity indices (CIs) were calculated between common volumes, observer pairs and compared to the volumes previously used. Overall, 29/30 tumors (96.6%) showed [68Ga]Ga-DOTA avidity. With help of PET/CT, the participants identified six cases with new lesions not recognized in MRI, including two where new findings would critically alter the target volume used for radiation. The PET/CT-aided series demonstrated superior conformity, as compared to MRI-only between observer pairs (median CI = 0.58 vs. 0.49; p = 0.002), common volumes (CI = 0.34; vs. 0.29; p = 0.002) and matched better the reference volumes actually used for patient treatment (CI = 0.55 vs. 0.39; p = 0.008). Cis in the PET/CT-aided series were lower for meningiomas outside of the skull base (0.2 vs. 0.44; p = 0.03). We conclude that SSTR2 receptor-targeted PET/CT is a valuable tool for planning particle therapy of incompletely resected meningioma. It serves both as a workup procedure and an aid for delineation process that reduces the likelihood of marginal misses.
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50
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Hirano Y, Miyawaki S, Tanaka S, Taoka K, Hongo H, Teranishi Y, Takami H, Takayanagi S, Kurokawa M, Saito N. Clinical Features and Prognostic Factors for Primary Anaplastic Large Cell Lymphoma of the Central Nervous System: A Systematic Review. Cancers (Basel) 2021; 13:cancers13174358. [PMID: 34503168 PMCID: PMC8431692 DOI: 10.3390/cancers13174358] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Revised: 08/21/2021] [Accepted: 08/23/2021] [Indexed: 12/14/2022] Open
Abstract
Simple Summary Primary anaplastic large cell lymphoma (ALCL) of the central nervous system (CNS) is a subtype of primary central nervous system lymphoma (PCNSL). ALCL is divided into anaplastic lymphoma kinase (ALK)-positive ALCL and ALK-negative ALCL, according to ALK expression. ALK-positive cancers tend to develop at a younger age and tend to have a better prognosis. Almost all past articles on primary ALCL of the CNS have been case reports and there have been no randomized trials or cohort studies on this subject. We thus performed a systematic review of primary ALCL of the CNS. According to the author’s survey, 36 case reports have been published in English-language journals. In this paper, we have summarized the clinical features and prognostic factors for primary ALCL of the CNS based on previous studies. Abstract Primary anaplastic large cell lymphoma (ALCL) of the central nervous system (CNS) is a subtype of primary CNS lymphoma (PCNSL). There are very few comprehensive reports on this extremely rare tumor. Therefore, it is necessary to investigate the clinical features and prognostic factors for primary ALCL of the CNS. We performed a systematic review of the published literature. Past cases were comprehensively searched using PubMed, Cochrane Library, and Web of Science. Clinical information, such as age, sex, anaplastic lymphoma kinase (ALK) status, lesion sites, treatment methods, and survivorship were extracted. Thirty-nine cases with information on ALK status and treatment course were identified. The average observation period was 13 months, and the overall 2-year survival rate was 58%. Univariate analyses showed a statistically significantly better prognosis among patients < 40 years of age (p = 0.039, HR 0.32 (0.11–0.95)) and in relation to ALK positivity (p = 0.010, HR 0.24 (0.08–0.71) and methotrexate treatment (p = 0.003, HR 0.17 (0.05–0.56)). Because of the sparsity of cases, it is necessary to accumulate cases in order to perform more detailed analyses.
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Affiliation(s)
- Yudai Hirano
- Department of Neurosurgery, The University of Tokyo, Bunkyo-ku, Tokyo 113-8655, Japan; (Y.H.); (S.T.); (H.H.); (Y.T.); (H.T.); (S.T.); (N.S.)
| | - Satoru Miyawaki
- Department of Neurosurgery, The University of Tokyo, Bunkyo-ku, Tokyo 113-8655, Japan; (Y.H.); (S.T.); (H.H.); (Y.T.); (H.T.); (S.T.); (N.S.)
- Correspondence: ; Tel.: +81-35-800-8853
| | - Shota Tanaka
- Department of Neurosurgery, The University of Tokyo, Bunkyo-ku, Tokyo 113-8655, Japan; (Y.H.); (S.T.); (H.H.); (Y.T.); (H.T.); (S.T.); (N.S.)
| | - Kazuki Taoka
- Department of Hematology and Oncology, The University of Tokyo, Bunkyo-ku, Tokyo 113-8655, Japan; (K.T.); (M.K.)
| | - Hiroki Hongo
- Department of Neurosurgery, The University of Tokyo, Bunkyo-ku, Tokyo 113-8655, Japan; (Y.H.); (S.T.); (H.H.); (Y.T.); (H.T.); (S.T.); (N.S.)
| | - Yu Teranishi
- Department of Neurosurgery, The University of Tokyo, Bunkyo-ku, Tokyo 113-8655, Japan; (Y.H.); (S.T.); (H.H.); (Y.T.); (H.T.); (S.T.); (N.S.)
| | - Hirokazu Takami
- Department of Neurosurgery, The University of Tokyo, Bunkyo-ku, Tokyo 113-8655, Japan; (Y.H.); (S.T.); (H.H.); (Y.T.); (H.T.); (S.T.); (N.S.)
| | - Shunsaku Takayanagi
- Department of Neurosurgery, The University of Tokyo, Bunkyo-ku, Tokyo 113-8655, Japan; (Y.H.); (S.T.); (H.H.); (Y.T.); (H.T.); (S.T.); (N.S.)
| | - Mineo Kurokawa
- Department of Hematology and Oncology, The University of Tokyo, Bunkyo-ku, Tokyo 113-8655, Japan; (K.T.); (M.K.)
| | - Nobuhito Saito
- Department of Neurosurgery, The University of Tokyo, Bunkyo-ku, Tokyo 113-8655, Japan; (Y.H.); (S.T.); (H.H.); (Y.T.); (H.T.); (S.T.); (N.S.)
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