Distinct supratentorial lesions mimicking cerebral gliomas

Various supratentorial pathological conditions can mimic neoplastic cerebral lesions clinically as well as radiologically. Analysis of the neuroradiological findings, the clinical history, laboratory and other paraclinical data mostly help to narrow down the diagnosis of cerebral pathologies. Sometimes, however, histopathological analysis of the operative specimen after surgery reveals unexpected findings.

In a series of 197 operative procedures performed for glioma surgery between August 2000 and August 2002 we found six distinct cases mimicking supratentorial tumours. Clinicoradiological findings had suggested a neoplastic gliomatous process in all cases. But histopathological examination revealed that in reality one patient had been affected by a stroke, two by hypertensive encephalopathy, and one by radiation necrosis; multiple sclerosis was the underlying pathology in two patients.

Conditions which show features similar to those of neoplastic cerebral lesions require advanced magnetic resonance imaging (MRI). The benefit of such sophisticated imaging in relation to the costs is an important issue in this context. Further research in the field of modern image modalities is necessary to evaluate these noninvasive techniques for specification of intracerebral lesions.