The diagnostic difficulties of meningeal and intracerebral plasma cell granulomas?presentation of three cases

Abstract

Meningeal and intracerebral plasma cell granulomas are uncommon inflammatory lesions of unknown etiology. In this paper the diagnostic difficulties in two patients with meningeal plasma cell granuloma and one patient with intracerebral plasma cell granuloma are described. The first patient had an intracranial extra-axial lesion, which was first diagnosed as a meningioma. One and a half years later she underwent a second resection for recurrent tumor growth and the diagnosis of a meningeal plasma cell granuloma was made. The second patient was treated for a central nervous system B-cell lymphoma but proved to have an intracerebral plasma cell granuloma in retrospect 11 years later. In the third patient tuberculous meningitis was considered to be the most likely diagnosis because infratentorial contrast-enhanced thickened meninges (pachymeningitis) were found together with a high protein level in the cerebrospinal fluid and a positive Mantoux test. However, pathological examination of an extra-axial, cervical lesion that was operated upon revealed a meningeal plasma cell granuloma. These cases show the importance of diagnosing a meningeal or intracerebral plasma cell granuloma correctly, since it has both therapeutical and prognostic implications.

Intracranial cell plasma granuloma

“…Meningeal PCG is a rare intracranial disease with few cases reported 1,2 and has been referred to by several names in the literature [2][3][4][5][6] , including inflammatory myofibroblastic tumor, fibrohistiocytoma, xanthomatous pseudotumor 2 , fibroxanthoma, xanthogranuloma 5 and fibroxanthomatous histiocytoma 4 . It occurs in young males (median age, 28 years) and is usually located in the supraand parasellar regions [1][2][3] , even infiltrating the cavernous sinus 2 .…”

“…Contiguous paranasal sinus and intracranial disease has been reported 3 . It is a benign tumor with chronic fibrosis and inflammation of the dura and the arachnoid, sometimes affecting the underlying brain [3][4][5][6] . The inflammatory infiltrate includes mature plasma cells, polyclonal non-neoplastic T and B lymphocytes admixed with macrophages and mononuclear histiocytes.…”

“…The tumor is usually located in the parasellar region, with several cases involving the cerebellum-pontine angles 2,4,5 . It is also described as a diffuse dural thickening, even extending to the cervical canal 2,5 . The involvement of base structures such as the Meckel's cavum, cavernous sinus and internal auditory canal can cause cranial nerve palsy 7 .…”

“…The treatment depends on the location of the tumor. The follow-up is done with MR imaging, evaluating treatment response and tumor recurrence 2,5 . Our patient was submitted to a biopsy to confirm the diagnosis.…”

Intradural Extramedullary Spinal Inflammatory Myofibroblastic Tumor: Case Report and Literature Review

“…To the best of our knowledge, since the first description by Eimoto et al [5], only nine cases of intradural extramedullary [3][4][5][6][7][8][9][10][11] tumors have been reported in the literature (Table 1). A few other cases of epidural [14][15][16][17] or intramedullary [18][19][20] spinal IMT have been reported.…”