A challenging case of concurrent multiple sclerosis and anaplastic astrocytoma

Abstract

Background: Cases of gliomas coexisting with multiple sclerosis (MS) have been described over the past few decades. However, due to the complex clinical and radiological traits inherent to both entities, this concurrent phenomenon remains difficult to diagnose. Much has been debated about whether this coexistence is incidental or mirrors a poorly understood neoplastic phenomenon engaging glial cells in the regions of demyelination. Case Description: We present the case of a 41-year-old patient diagnosed with a left-sided frontal contrast enhancing lesion initially assessed as a tumefactive MS. Despite systemic treatment, the patient gradually developed signs of mass effect, which led to decompressive surgery. The initial microscopic evaluation demonstrated the presence of MS and oligodendroglioma; the postoperative evolution proved complex due to a series of MS-relapses and tumor recurrence. An ulterior revaluation of the samples for the purpose of this report showed an MS-concurrent anaplastic astrocytoma. We describe all relevant clinical aspects of this case and review the medical literature for possible causal mechanisms. Conclusion: Although cases of concurrent glioma and MS remain rare, we present a case illustrating this phenomenon and explore a number of theories behind a potential causal relationship.

When tumefactive demyelination is truly a tumor: case report of a radiographic misdiagnosis

“…In our patient case, the tumefactive lesion is cortical; based on location, it should not have been identified as a TD lesion. Despite diagnostic differences, lack of MRI specificity remains a challenge, especially in the presence of active MS, edema and inflammatory processes [ 29 ]. CT-PET imaging can be utilized to identify malignancies but a confirmatory brain biopsy may be required for patients with overlapping features such as atypical ring-enhancing lesions and mass effect [ 30 , 31 ].…”

Concurrent gliomas in patients with multiple sclerosis

“…Gliomas have been reported in patients with multiple sclerosis (MS) 1 , 2 . As immune surveillance is critical in cancer development, a possible causal immuno-genetic relationship between neuroinflammatory diseases and malignant brain tumors has been repeatedly discussed 3 .…”

Concurrent CNS tumors and multiple sclerosis: retrospective single-center cohort study and lessons for the clinical management

“…Another large study investigated the occurrence of brain tumors in 33 different autoimmune diseases and found that none of them (including MS) influences the risk of glioma development but that autoimmune diseases negatively affect survival in glioma and meningioma patients, probably due to the added physical burden or therapeutic limitations [3]. Accordingly, some of the challenges the clinical management of concurrent CNS tumors and MS pose have been described in the literature but due to the rare coincidence of these two CNS diseases, current evidence is limited to single case reports and, to our best knowledge, no cohort studies have been reported [4][5][6][7][8][9].…”