Multiple Sclerosis Simulating Brain Tumor on Computed Tomography

Otsuka, Seiji; Nakatsu, Shoji; Matsumoto, Shigeo; Sato, Shinichi; Motozaki, Takahiko; Ban, Sadahiko; Yamamoto, Toyoshiro; Takatsuka, Katsuya; Saiwai, Shigeo

doi:10.1097/00004728-198907000-00023

Cited by 17 publications

(7 citation statements)

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“…Results of the first reading by each rater are listed in table 2, and the first reading for all images is illustrated in figure 3. Sensitivity, specificity, and likelihood ratios for each rater are listed in table 3. When the open-ring sign was present, demyelination was from 5 (rater 2) to 11 (rater 1) times more likely than neoplasm or infection.…”

Section: Resultsmentioning

confidence: 99%

“…Contrastenhanced CT or MRI shows large or multiple contrastenhancing ring lesions that can be mistaken easily for neoplasm or infection (figures 1 and 2). [2][3][4] Acute exacerbations may respond to high-dose methylprednisolone or other forms of immunosuppressive therapy 2,4-7 or may improve spontaneously. 8 The terms "myelinoclastic diffuse sclerosis," "Schilder's" or "Marburg's disease," "transitional sclerosis," and "tumefactive demyelination" have been applied to this unusual presentation of demyelinating disease.…”

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confidence: 99%

“…Current evidence indicates that demyelination in MS, which shares many similarities with ADEM and EAE, is the result of an autoimmune process mediated by autoreactive T lymphocytes with specificity for myelin antigens, such as myelin basic protein (MBP), proteolipid protein (PLP), or myelin oligodendrocyte glycoprotein (MOG). 3 It is not clear how the pathogenic autoreactive T cells are activated in the periphery of patients of demyelinating disorders, because there is no contact with the CNS myelin. One of the potential mechanisms may involve molecular mimicry with viral and bacterial peptides, shown to activate MBP-reactive T-cell clones in vitro.…”

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Open-ring imaging sign

et al. 2000

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Open-ring imaging sign

et al. 2000

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“…Although acute demyelinating disease does not generally form large focal lesions in the brain on either computerized tomography (CT) or magnetic resonance imaging (MRI), investigators have occasionally described cases of acute focal demyelinating disease that simulate brain tumors. [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19] On the other hand, there have been very few reports, particularly in Japan, on the surgical pathology of acute focal demyelinating disease occurring as mass lesions. 5,16,18 One reason for this may be the low prevalence of multiple sclerosis (MS) in Japan compared to Western communities.…”

Section: Introductionmentioning

confidence: 99%

Acute focal demyelinating disease simulating brain tumors: Histopathologic guidelines for an accurate diagnosis

Sugita¹,

Terasaki

Shigemori

et al. 2001

Neuropathology

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The object of the present study was to determine the histopathological guidelines for accurate diagnosis of cases of acute focal demyelinating disease that simulates brain tumors. The surgical pathology of three such cases is assessed. Histopathological keys to the diagnosis of such cases are as follows. First, a pattern of sheets of atypical gemistocytic astrocytes in the white matter that show well-formed processes and that are adequately distanced from each other argues against a diagnosis of neoplasm. Second, uniform distribution of foamy macrophages aligned along axons, with occasional focal collections surrounding blood vessels and in the absence of any associated coagulative necrosis argues against the presence of a tumor. Third, perivascular chronic inflammatory infiltration, especially a mixture of lymphocytes and macrophages, favors the diagnosis of demyelination plaque. In such cases the lymphocytes will be predominantly T cells. Fourth, pleomorphic astrocytic proliferation with a lack of vascular endothelial proliferation should raise the suspicion that the lesion may not be a brain tumor. These diagnostic keys should be followed when diagnosing cases that are suspected to be demyelination processes rather than brain tumors. The presence of demyelination plaque should then be confirmed by imaging modalities such as staining with myelin-and axon-specific stains.

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“…Patients with MS may develop space-occupying lesions that may be mistaken as neoplasia and this form of MS is eventually called pseudo-tumor 2 . On the other hand, neoplasia may simulate MS at its initial presentation [3][4][5] . Moreover, though uncommon, there might be a coincidence of MS and a CNS neoplasm in the same patient 6 .…”

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Glioma and multiple sclerosis: case report

Werneck

Scola

Arruda

et al. 2002

Arq. Neuro-Psiquiatr.

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-We report a case of a 44-years-old woman with relapsing-remitting and secondarily progressive form of multiple sclerosis (MS) since aged 24 years, who developed an anaplastic astrocytoma. The neurological manifestations of the tumor were misinterpreted as resulting from MS. Sequential MRI examination and seizures raised the possibility of another nature of her symptoms, besides MS. Her initial good response to high doses corticosteroids led to the initial assumption her symptoms were only exclusively due to the demyelinating process. She underwent craniotomy with radical excision of the lesion. Pathological examination disclosed anaplastic astrocytoma. Other cases of coincidental MS and primary CNS tumors are reviewed, as well as their possible relation.KEY WORDS: multiple sclerosis, anaplastic astrocytoma, cerebral neoplasm.Glioma e esclerose múltipla: relato de caso Glioma e esclerose múltipla: relato de caso Glioma e esclerose múltipla: relato de caso Glioma e esclerose múltipla: relato de caso Glioma e esclerose múltipla: relato de caso RESUMO -Relatamos o caso de uma paciente de 44 anos, portadora de esclerose múltipla forma surtoremissão e progressiva secundária, que na evolução desenvolveu um astrocitoma anaplásico. Os sintomas do tumor se confundiram com os da esclerose múltipla e com a repetição de ressonâncias magnéticas foi possível suspeitar do diagnóstico. Além dos sinais neurológicos, também apresentava crises convulsivas. A melhora com os cursos de pulsoterapia mascaravam os sintomas do tumor. Submetida a craniotomia e retirado tumor com características histológicas e histoquímicas de astrocitoma anaplásico, ao lado de áreas de desmielinização típicas de esclerose múltipla. São discutidos os aspectos radiológicos, incidência e mecanismos da concomitância das duas doenças. PALAVRAS-CHAVE: esclerose múltipla, astrocitoma anaplásico, tumor cerebral.

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Multiple Sclerosis Simulating Brain Tumor on Computed Tomography

Cited by 17 publications

References 0 publications

Open-ring imaging sign

Open-ring imaging sign

Acute focal demyelinating disease simulating brain tumors: Histopathologic guidelines for an accurate diagnosis

Glioma and multiple sclerosis: case report

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