Calcifying pseudoneoplasm of the neuraxis in direct continuity with a low‐grade glioma: A case report and review of the literature

Abstract

Calcifying pseudoneoplasms of the neuraxis (CAPNON) are presumed to be a non-neoplastic reactive pathology, based on the frequent finding of granulomatous inflammation. To our knowledge, there are few reports of CAPNON in association with a neoplasm. Here, we report the case of a 62-year-old man presenting with headache, which was caused by CAPNON in the left cingulate gyrus. CT scan revealed a calcified mass exhibiting gradual growth and increasing peritumoral edema. MRI showed an intra-axial hypointense mass on T1- and T2-weighted images. Development of a peri-lesional hyperintense lesion on T2-weighted images suggested local edema or tumoral invasion. Gadolinium-enhanced T1-weighted images revealed mild peripheral enhancement of the calcified nodule. L-methyl- C methionine-positron emission tomography revealed the uptake of tracer in the calcified nodule. The calcified mass and its enveloping brain tissue were removed using a parietal craniotomy. The calcified tissue was surrounded by spindle-shaped cells positive for GFAP and nestin. The MIB-1 labeling index of spindle cells was around 10% (i.e. a hot spot). Fourteen months after surgery, gadolinium-enhanced MRI evidenced growth of a tiny residual lesion. Therefore, this report illustrates a potential case of CAPNON arising from low-grade glial neoplasm.

Calcifying pseudoneoplasm of the neuraxis: A rare case involving the oculomotor nerve

“…[ 11 ] C-methionine PET uptake has been described in two cases and is thought to reflect the inflammation associated with CAPNON. [ 7 , 9 ] As in our case, Higa et al . also reported no FDG-PET uptake in CAPNON,[ 7 ] possibly reflecting low glucose uptake and metabolism within the lesion, low cellularity, or the size of the lesion.…”

“…[ 7 , 9 ] As in our case, Higa et al . also reported no FDG-PET uptake in CAPNON,[ 7 ] possibly reflecting low glucose uptake and metabolism within the lesion, low cellularity, or the size of the lesion.…”

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

“…A number of patients have been diagnosed with concurrent degenerative disc/joint disease, prior trauma, or infection. Reports of dual pathology or ‘collision’ lesions include pericallosal lipoma, meningioangiomatosis, dysembryoplastic neuroepithelial tumour, ependymoma, low‐grade glioma, and meningioma 10,34‐39 . Rarely, multiple CAPNON lesions have been identified in the same patient with dissemination in space and/or time 39‐42 …”

Surgically treated intracranial supratentorial calcifying pseudoneoplasms of the neuraxis (CAPNON) with drug-resistant left temporal lobe epilepsy: A case report and review of the literature

“…In the literature, there were 54 (60%) intracranial cases [3], [6], [7], [10], [16], [20], [24], [25], [26], [27], [28], [29], [31], [32], [33], [35], [36], [37], [38], [39], [40], [41], [42], [43], [44], [45], [46], [47], [48], [50], [51], [52], [53], [55], [56], [57], [58], [59] and 36 spinal cases (40.0%) [1], [2], [3], [4], [5], [6], [7], [8], [9], [10], [11], [12], [13], [14], [15], [16], [17], [18], [19], [20], [21], [22], [23] of CAPNON. Of the intracranial cases, 36 lesions were supratentorial [3], [6], [7], [10], [16], [20], [24], [25], [28], [29], [31], [32], [33], [35], [38], [40], [41], [42], [43], [44], [47], [50], [51], [52], [55]...…”

“…Calcifying pseudoneoplasms of the neuraxis (CAPNONs) are very rare lesions; only 90 cases including 54 (60%) intracranial cases and 36 (40%) spinal cases have been reported [1], [2], [3], [4], [5], [6], [7], [8], [9], [10], [11], [12], [13], [14], [15], [16], [17], [18], [19], [20], [21], [22], [23], [24], [25], [26], [27], [28], [29], [30], [31], [32], [33], [34], [35], [36], [37], [38], [39], [40], [41], [42], [43], [44], [45], [46], [47], [48], [49], [50], [51], [52], [53], [54], [55], [56], [57], [58], [59]. These lesions are benign and slow growing, and can present anywhere in the central nervous system, both intracranially and involving the spine.…”