Calcifying pseudoneoplasm of the foramen magnum—Case report and review of the literature

Wiśniewski, Karol; Janczar, Karolina; Tybor, Krzysztof; Papierz, W; Jaskólski, Dariusz J.

doi:10.3109/02688697.2015.1039491

Cited by 15 publications

(14 citation statements)

References 3 publications

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“…In contrast, CAPNONs have limited EMA positivity that is often linear in distribution and typically seen at the periphery of the amorphous cores or the tissue edge of CAPNONs, 3 which may be reflective of the meningeal involvement in the stroma rather than the constituent of CAPNONs. In the 24 reviewed cases of skull base CAPNONs, EMA immunostaining was positive with or without specified distribution in 6 cases (including our 2 cases), 14,15,17,24 but negative in 2 cases, 16,20 and not mentioned in the remaining 16 cases. We speculate that EMA is usually negative in CAPNONs without the meningeal involvement or focally positive in CAPNONs with the meningeal involvement, and its positivity is limited to the meningothelial cells entrapped in CAPNON lesions.…”

Section: Discussionmentioning

confidence: 68%

“…After abstract and full-text screening, 18 records were identified including 23 unique cases of skull base CAPNONs ( Figure 5, Table 1). 4,[7][8][9][10][11][13][14][15][16][17][18][19][20][21][22][23][24] All 24 patients (including our previously unpublished case) were symptomatic, with 11 (45.8%) patients presenting with cranial neuropathies (Table 1). [7][8][9]13,16,20 One patient (Case 5) was managed conservatively, 13 and one patient (Case 22) underwent a biopsy of the lesion, 14 while the rest underwent resection of the lesion.…”

Section: Literature Reviewmentioning

confidence: 99%

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Skull Base Calcifying Pseudoneoplasms of the Neuraxis: Two Case Reports and a Systematic Review of the Literature

Yang

Reddy

Ellenbogen

et al. 2019

Can. J. Neurol. Sci.

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ABSTRACT:Background:Calcifying pseudoneoplasm of the neuraxis (CAPNON) is a rare tumefactive lesion. CAPNONs can mimic calcified meningiomas at the skull base.Methods:Here, we report two cases of CAPNON and present a systematic review of the literature on skull base CAPNONs, to compare CAPNONs with calcified meningiomas.Results:Case 1: A 57-year-old man presented with right-sided lower cranial neuropathies and gait ataxia. He underwent a subtotal resection of a right cerebellopontine angle lesion, with significant improvement of his gait ataxia. However, his cranial neuropathies persisted. Pathological examination of the lesion was diagnostic of CAPNON, with the entrapped nerve fibers identified at the periphery of the lesion, correlating with the patient’s cranial neuropathy. Case 2: A 70-year-old man presented with progressive headache, gait difficulty, and cognitive impairment. He underwent a frontotemporal craniotomy for a near-total resection of his right basal frontal CAPNON. He remained neurologically stable 7 years after the initial resection without evidence of disease recurrence. We analyzed 24 reported CAPNONs at the skull base in our systematic review of the literature. Cranial neuropathies were present in 11 (45.8%) patients. Outcomes regarding cranial neuropathies were documented in six patients: two had sacrifice of the nerve function with surgical approaches and four had persistent cranial neuropathies.Conclusion:While CAPNON can radiologically and grossly mimic calcified meningiomas, they are two distinctly different pathologies. CAPNONs located at the skull base are commonly associated with cranial neuropathies, which may be difficult to reverse despite surgical intervention.

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Section: Discussionmentioning

confidence: 68%

Section: Literature Reviewmentioning

confidence: 99%

Skull Base Calcifying Pseudoneoplasms of the Neuraxis: Two Case Reports and a Systematic Review of the Literature

Yang

Reddy

Ellenbogen

et al. 2019

Can. J. Neurol. Sci.

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“…The frequent adjacent granulomatous and inflammatory reaction along with an indolent course and a generally good prognosis support a benign or reactive rather than neoplastic process . Of the 65 cases of CAPNON that we identified in the literature, only one case presented with two separate lesions diagnosed 8 years apart in the same individual . The remaining 64 cases were solitary.…”

Section: Introductionmentioning

confidence: 77%

“…This entity shows male predominance (1.92:1) but does not seem to have a predilection for an age group . Sixty‐five cases have been reported in the literature, 41 of which were intracranial and mostly intradural, 20 in the spinal canal and four at the craniovertebral junction . Of the 65 reported cases, 64 cases consisted of a solitary lesion, while only one case presented with one initial lesion and the second many years later …”

Section: Discussionmentioning

confidence: 99%

Multiple calcifying pseudoneoplasms of the neuraxis (MCAPNON): Distinct entity, CAPNON variant, or old neurocysticercosis?

Abdaljaleel

Mazumder

et al. 2016

Neuropathology

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We report a case of multiple calcifying pseudoneoplasms of the neuraxis (MCAPNON) with associated multifocal perivascular microcalcifications and vascular calcinosis. Calcifying pseudoneoplasm of the neuraxis (CAPNON) is a very rare condition that may arise in extra-axial and occasionally, in intra-axial locations. Moreover, it is nearly always a solitary mass with only one case with two lesions reported. While the etiology and pathogenesis of CAPNON remains unclear, the histopathology findings of this entity have been well described. We report a case of a 62-year-old woman with 18 calcifying radiologic lesions involving bilateral cerebral hemispheres. Histologically, these lesions have features similar to that reported for CAPNON, including nodular calcification with fibro-osseous components and peripheral histiocytic reaction. The patient had a poorly documented diagnosis of neurocyticercosis 32 years prior, although without tissue confirmation. The lack of detectable cysticercus serum antibody titers, and absence of residual larval or cyst wall tissue render multifocal calcific involution of that parasite unprovable although still plausible. We also raise the possibility of a blood-brain barrier derangement and/or a metabolic disorder as an alternative etiology. Whether this case of MCAPNON shares the same pathogenesis as the usual solitary CAPNON is unclear.

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“…In the brain, there may be involvement of the parenchyma, ventricles, corpus callosum, dura, pineal gland, arachnoid cisterns, cerebellum, and foramen magnum 2,7‐11,15‐23 . In the neck (facial bones, skull base, craniovertebral junction), reported locations include the orbits, sella, clivus, temporal bone, cranial nerves, skull base foramina, and craniocervical junction 24‐28 . In the spine, lesions have been reported at the cervical, thoracic, lumbar and sacral levels, with variable involvement of the spinal cord, facet joints, intervertebral disc, dura, and neural foramina 2,7‐11,29‐33 .…”

Section: Discussionmentioning

confidence: 99%

New insights into calcifying pseudoneoplasm of the neuraxis (CAPNON): a 20‐year radiological–pathological study of 37 cases

Eschbacher

Paolini

et al. 2020

Histopathology

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New insights into calcifying pseudoneoplasm of the neuraxis (CAPNON): a 20-year radiological-pathological study of 37 cases Aims: Calcifying pseudoneoplasm of the neuraxis (CAPNON) is a rare entity that can occur anywhere within the central nervous system. Histologically, CAPNON has been characterised as a benign, calcified, fibro-osseous lesion with a characteristic chondromyxoid fibrillary matrix with dense calcification and varying degrees of spindle, epithelioid, fibrous, meningothelial and giant cells. The underlying aetiology of CAPNON is controversial and incompletely understood. The aim of this study was to perform a comprehensive radiological and histological review to further characterise this entity. Methods and results: In this article, we review our institutional 20-year experience including 37 cases of CAPNON with detailed pathological analysis, evaluation of concurrent lesions, correlation with radiological imaging, and critical review of the literature. The classic histological finding of chondromyxoid matrix was present in one-third of cases. Underlying or dual pathologies were frequent, and included diverse underlying conditions. Radiologically, dense calcification and dural attachment were the most common features. Enhancement was often low, but was more prominent in the setting of inflammatory changes, aggressive growth, and dual pathology. Conclusion: Our results suggest that CAPNON represents a spectrum of reactive processes that can arise in association with diverse underlying pathologies, including inflammatory, degenerative, vascular and neoplastic lesions.

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Calcifying pseudoneoplasm of the foramen magnum—Case report and review of the literature

Cited by 15 publications

References 3 publications

Skull Base Calcifying Pseudoneoplasms of the Neuraxis: Two Case Reports and a Systematic Review of the Literature

Skull Base Calcifying Pseudoneoplasms of the Neuraxis: Two Case Reports and a Systematic Review of the Literature

Multiple calcifying pseudoneoplasms of the neuraxis (MCAPNON): Distinct entity, CAPNON variant, or old neurocysticercosis?

New insights into calcifying pseudoneoplasm of the neuraxis (CAPNON): a 20‐year radiological–pathological study of 37 cases

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