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Monjarás-Romo G, Zavala-Romero L, Tejada-Pineda MF, Meraz-Soto JM, Ballesteros-Herrera D, Cienfuegos-Meza J, Alcaráz-Félix RJ, Moreno-Jiménez S. Lhermitte-Duclos Disease: A Case Series. Cureus 2023; 15:e44326. [PMID: 37779805 PMCID: PMC10536449 DOI: 10.7759/cureus.44326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/29/2023] [Indexed: 10/03/2023] Open
Abstract
Lhermitte-Duclos disease (LDD), or dysplastic cerebellar gangliocytoma, is a rare benign tumor characterized by unilateral hemispheric cerebellar expansion. It is linked to mutations in the phosphatase and tensin homolog (PTEN) gene, which inhibit the phosphatidylinositol-3'-kinase pathway, leading to increased cell division and defective neuronal migration. This study aims to compare the clinical, radiological, histopathological, surgical resolution, and follow-up characteristics of reported cases of this rare condition. An in-depth search of LDD patients' clinical records at our institute between 2003 and 2023 was conducted, in addition to a systematic literature review on PubMed. Three patients with a diagnosis of LDD were found. Cerebellar abnormalities, varying headaches, and visual impairment were all present clinically. On T2 in the posterior fossa, all three MRI scans displayed the typical hyperintense parallel streak appearance. The histopathological report showed that large ganglion cells had replaced the granular layer, Purkinje cells had degenerated, the molecular layer had become hyper-myelinated, and synaptophysin and chromogranin were positive. Partial tumor resection and avoiding intracranial hypertension were the main goals of treatment. Genetic follow-up was conducted for all three patients. Neurosurgeons must be aware of LDD to provide close genetic monitoring despite the benign nature of the tumor because of its link to Cowden syndrome and elevated risk of cancer in other organs.
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Affiliation(s)
- Gonzalo Monjarás-Romo
- Radiosurgery Department, National Institute of Neurology and Neurosurgery "Manuel Velasco Suárez", Mexico, MEX
| | - Lilian Zavala-Romero
- Radiosurgery Department, National Institute of Neurology and Neurosurgery "Manuel Velasco Suárez", Mexico, MEX
| | | | - Juan Marcos Meraz-Soto
- Radiosurgery Department, National Institute of Neurology and Neurosurgery "Manuel Velasco Suárez", Mexico, MEX
| | - Daniel Ballesteros-Herrera
- Radiosurgery Department, National Institute of Neurology and Neurosurgery "Manuel Velasco Suárez", Mexico, MEX
| | - Jesús Cienfuegos-Meza
- Pathology Department, National Institute of Neurology and Neurosurgery "Manuel Velasco Suárez", Mexico, MEX
| | | | - Sergio Moreno-Jiménez
- Radiosurgery Department, National Institute of Neurology and Neurosurgery "Manuel Velasco Suárez", Mexico, MEX
- Neurosurgery-Radiosurgery Department, American British Cowdray Medical Center, Mexico, MEX
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Wei G, Zhang W, Li Q, Kang X, Zhao H, Liu X, Tang X, Wu Y, Han J, Yin H. Magnetic resonance characteristics of adult-onset Lhermitte-Duclos disease: An indicator for active cancer surveillance? Mol Clin Oncol 2014; 2:415-420. [PMID: 24772310 DOI: 10.3892/mco.2014.258] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2013] [Accepted: 01/14/2014] [Indexed: 11/06/2022] Open
Abstract
Lhermitte-Duclos disease (LDD) is a rare, non-cancerous entity characterized by enlarged, abnormally developed cerebellar folia containing dysplastic cells. Symptomatic LDD is commonly observed in adults (adult-onset LDD, aLDD) as an isolated condition or associated with Cowden's disease (CD). The present study aimed to investigate the magnetic resonance imaging (MRI) characteristics and the underlying pathological findings in 7 cases of aLDD, with emphasis on the association with CD and the need for active cancer surveillance once the diagnosis of LDD is confirmed. The MRI findings along with the clinical and histopathological data collected from 7 patients with aLDD were retrospectively reviewed. The diagnosis of CD was based on a range of clinical characteristics, according to the International Cowden Consortium Criteria. A thorough review of the published data was conducted and our results indicated that all 7 cases shared similar MRI characteristics, whether the aLDD was sporadic (2 cases) or associated with CD (5 cases), including a highly typical non-enhancing striated MRI appearance of thickened folia, consisting of alternating bands on T1- and T2-weighted images. On gross examination, the involved cerebellar folia were distorted and enlarged, whereas the histopathological examination revealed that the molecular layer was widened and occupied by abnormal ganglion cells. Moreover, a reduction in the number or absence of the Purkinje cells and hypertrophy of the granular cell layer were observed. Our findings were consistent with the diagnosis of LDD. Variable levels of vacuolization of the white matter and the molecular layer were observed in all the cases. Notably, CD34 immunohistochemical analysis revealed the presence of angiogenesis within the lesions. aLDD associated with CD exhibited no pathological or immunohistochemical characteristics that were distinct from those of isolated aLDD. Of the 7 cases of aLDD, 5 presented with symptoms suggestive of CD, which is a syndrome associated with a high risk of multiple benign and malignant neoplasms. In conclusion, aLDD exhibits characteristic MRI and histopathological findings and displays a strong association with CD. Therefore, we recommend that the MRI diagnosis of aLDD triggers active cancer surveillance and preventive care.
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Affiliation(s)
- Guangquan Wei
- Molecular Imaging Center, Department of Radiology, Xijing Hospital, The Fourth Military Medical University, Xi'an, Shaanxi 710032
| | - Wei Zhang
- Department of Cardiology, Tangdu Hospital, The Fourth Military Medical University, Xi'an, Shaanxi 710038
| | - Qinlong Li
- Department of Pathology, Xijing Hospital; The Fourth Military Medical University, Xi'an, Shaanxi 710032, P.R. China
| | - Xiaowei Kang
- Molecular Imaging Center, Department of Radiology, Xijing Hospital, The Fourth Military Medical University, Xi'an, Shaanxi 710032
| | - Haitao Zhao
- Molecular Imaging Center, Department of Radiology, Xijing Hospital, The Fourth Military Medical University, Xi'an, Shaanxi 710032
| | - Xianping Liu
- Molecular Imaging Center, Department of Radiology, Xijing Hospital, The Fourth Military Medical University, Xi'an, Shaanxi 710032
| | - Xing Tang
- Molecular Imaging Center, Department of Radiology, Xijing Hospital, The Fourth Military Medical University, Xi'an, Shaanxi 710032
| | - Yuanming Wu
- Center for Gene Typing; The Fourth Military Medical University, Xi'an, Shaanxi 710032, P.R. China
| | - Juntao Han
- Department of Surgery, Xijing Hospital, The Fourth Military Medical University, Xi'an, Shaanxi 710032, P.R. China
| | - Hong Yin
- Molecular Imaging Center, Department of Radiology, Xijing Hospital, The Fourth Military Medical University, Xi'an, Shaanxi 710032
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