Intracavernous Trigeminal Ganglion Amyloidoma

Bookland, Markus J.; Bagley, Carlos A.; Schwarz, Jacob; Burger, Peter C.; Brem, Henry

doi:10.1227/01.neu.0000255361.32689.b3

Cited by 24 publications

(19 citation statements)

References 46 publications

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“…Their prototype is found in the amyloidoma, a localized accumulation of AL l-light-chain-derived amyloid with a predilection for involvement of white matter, choroid plexus, and peripheral nerve. [1][2][3][4] Amyloidomas are indolent lesions, and the diagnosis can be confirmed with both histochemical stains for amyloid (Congo red (CR) and sulfated Alcian blue) and immunohistochemistry for k-and l-immunoglobulin light chains. Amyloid may also be seen in dural deposits of extranodal marginal zone lymphomas.…”

mentioning

confidence: 99%

Immunoglobulin derived depositions in the nervous system: novel mass spectrometry application for protein characterization in formalin-fixed tissues

Rodríguez

Gamez

Vrana

et al. 2008

Laboratory Investigation

101

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Proteinaceous deposits are occasionally encountered in surgically obtained biopsies of the nervous system. Some of these are amyloidomas, although the precise nature of other cases remains uncertain. We studied 13 cases of proteinaceous aggregates in clinical specimens of the nervous system. Proteins contained within laser microdissected areas of interest were identified from tryptic peptide sequences by liquid chromatography-electrospray tandem mass spectrometry (LC-MS/MS). Immunohistochemical studies for immunoglobulin heavy and light chains and amyloidogenic proteins were performed in all cases. Histologically, the cases were classified into three groups: 'proteinaceous deposit not otherwise specified' (PDNOS) (n ¼ 6), amyloidoma (n ¼ 5), or 'intracellular crystals' (n ¼ 2). LC-MS/MS demonstrated the presence of l, but not k, light chain as well as serum amyloid P in all amyloidomas. l-Light-chain immunostaining was noted in amyloid (n ¼ 5), although demonstrable monotypic lymphoplasmacytic cells were seen in only one case. Conversely, in PDNOS k, but not l, was evident in five cases, both light chains being present in a single case. In three cases of PDNOS, a low-grade B-cell lymphoma consistent with marginal zone lymphoma was present in the brain specimen (n ¼ 2) or spleen (n ¼ 1). Lastly, in the 'intracellular crystals' group, the crystals were present within CD68 þ macrophages in one case wherein k-light chain was found by LC-MS/MS only; the pathology was consistent with crystalstoring histiocytosis. In the second case, the crystals contained immunoglobulin G within CD138 þ plasma cells. Our results show that proteinaceous deposits in the nervous system contain immunoglobulin components and LC-MS/MS accurately identifies the content of these deposits in clinical biopsy specimens. LC-MS/MS represents a novel application for characterization of these deposits and is of diagnostic utility in addition to standard immunohistochemical analyses.

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confidence: 99%

Immunoglobulin derived depositions in the nervous system: novel mass spectrometry application for protein characterization in formalin-fixed tissues

Rodríguez

Gamez

Vrana

et al. 2008

Laboratory Investigation

101

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“…Cerebral amyloidoma usually occurs as a single lesion, but multiple lesions have been reported in about one-third of the cases, and it commonly involves the supratentorial and subcortical white matter of the brain [2]. Few cases have reported amyloidoma formation at the skull base [3] within the trigeminal nerve causing trigeminal neuralgia [2][3]. Spinal and peripheral nerves may also be involved, with Gasserian ganglion being the most common site [4].…”

Section: Discussionmentioning

confidence: 99%

A Rare Case of Cerebral Amyloidoma Mimicking a Hemorrhagic Malignant Central Nervous System Neoplasm

Kapoor

Gowda

Kaur

et al. 2020

Cureus

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Cerebral amyloidoma is a rare form of amyloidosis with a localized tumor like an amyloid deposition in the brain composed of insoluble fibrillary protein with cross beta-sheet conformation. Its usual presentation includes vision loss, seizures, behavioral changes, cognitive decline, and recurrent headaches. It has a benign course with a slow progression, and it is not associated with dissemination. We report a case of a 65-year-old Caucasian woman who presented with symptoms of progressively worsening cognitive dysfunction of six months' duration. From CT of the brain, it was found that she had a right frontal and left parietal hemorrhagic mass with a large amount of vasogenic edema and a midline shift. MRI showed heterogeneously enhancing hemorrhagic mass of 5.2 cm x 2.6 cm x 3.6 cm in size, with a satellite lesion. Initially, this was suspected to be a high-grade glioma vs. metastatic hemorrhagic lesions. She underwent stereotactic biopsy of the mass, and histopathology was consistent with cerebral amyloidoma with marked IgA lambda plasma cell differentiation. She did not have any evidence of systemic amyloidosis, and therefore, she is being clinically observed with a regular follow-up and annual CT surveillance. She has remained stable over the past two years, although she has residual cognitive dysfunction. Cerebral amyloidoma can mimic malignant central nervous system (CNS) neoplasms and should be considered as a differential of any single or multiple mass lesions occurring in the white matter region of the brain with a characteristic appearance of "hyperdense lesions" on CT. It is a benign disease with no metastatic potential that usually resolves entirely after resection.

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“…Augmenting this approach with an orbitozygomatic removal, as well as the dissection of the temporal muscle [31], can decrease retraction of the temporal lobe [62,84]. By opening the sylvian fissure, the view into Meckel's cave and cavernous sinus (CS) can be extended [4,22,85].…”

Section: Anterolateral and Lateral Approachesmentioning

confidence: 99%

“…Neuroendocrine carcinoma [63] Adenoid cystic carcinoma [5] Malignant melanotic schwannoma [23,61,101] Squamous cell carcinoma [63] Adenocarcinoma [63] Inflammatory Sarcoidosis [19,69] Amyloidoma [22,24,28] IgG4 disease [63] Necrotizing granulomatous inflammation [63] Inflammatory pseudotumor [63] Hematologic malignancies Primary malignant lymphoma [26] Multiple myeloma [32] NK/T lymphoma [63] Diffuse B-cell lymphoma* Plasmacytoma [63] Marginal zone lymphoma [63] Chronic eosinophilic leukemia [63] Lymphoplasmocytic lymphoma [63] Non-Hodgkin lymphoma [63] Cystic Arachnoid cyst [5,21,34,61,64] Epidermoid cyst [17,29] Meningoceles [102] *Illustrative case report presented in this article should, however, be seen as complementary and not competitive [73], since each one of them carries its own risks and advantages. Even though newly described endoscopic approaches appear promising, clinical experiences remain to be reported and an advanced anatomical knowledge of the neurovascular array within and surrounding the skull base is of utmost priority to assure safety during and after procedures.…”

Section: ] Metastaticmentioning

confidence: 99%

Access to Meckel’s cave for biopsies of indeterminate lesions: a systematic review

et al. 2020

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Accessing Meckel's cave (MC) is surgically challenging. Open approaches are complex and often correlated with high morbidity. Endoscopic approaches emerged in the last decade as feasible alternatives to open approaches, especially for sampling indeterminate lesions. This article first analyses available routes to approach Meckel's cave and presents furthermore an illustrative case. We conducted a systematic review and reported according to the guidelines for preferred reporting items for systematic reviews and meta-analyses (PRISMA). Various surgical approaches identified through the search are evaluated and discussed in detail. Additionally, we report on a case of woman with a lesion in MC, which was accessed through an endoscopic transpterygoid approach subsequently diagnosed as a diffuse large B cell lymphoma. Our search delivered 75 articles that included case reports (n = 21), cadaveric studies (n = 32), clinical articles (n = 16), review of the literatures (n = 3), as well as technical notes (n = 2) and a radiological manuscript (n = 1). Open routes included lateral approaches with many variations, mainly intra-and extradural pterional approaches and anterior petrosal, as well as a retrosigmoid intradural suprameatal and a lateral transorbital approach. Endoscopically, MC was reached via approaches that included transpterygoid, transorbital or infraorbital fissure routes. Percutaneous approaches, e.g. through the foramen ovale, were also described. Multiple surgical approaches to MC are currently available. Their different characteristics as well as individual patient factors, such as clinical history and the localization of the disease, have to be considered when choosing a surgical corridor. Studies included in this review highlight the endonasal endoscopic transpterygoidal technique as an excellent corridor for biopsies in the ventral MC.

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Intracavernous Trigeminal Ganglion Amyloidoma

Cited by 24 publications

References 46 publications

Immunoglobulin derived depositions in the nervous system: novel mass spectrometry application for protein characterization in formalin-fixed tissues

Immunoglobulin derived depositions in the nervous system: novel mass spectrometry application for protein characterization in formalin-fixed tissues

A Rare Case of Cerebral Amyloidoma Mimicking a Hemorrhagic Malignant Central Nervous System Neoplasm

Access to Meckel’s cave for biopsies of indeterminate lesions: a systematic review

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