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[A pediatric case of multiple sclerosis mimicking malignant brain tumor]
Hideyuki Akiyama1, Akira Yanagisawa, Hirotaka Yamamoto
1Department of Neurosurgery, Hyogo Prefectural Kobe Children's Hospital, 1-1-1 Takakuradai, Suma-ku, Kobe City, Hyogo 654-0081, Japan.
Abstract:
We report a pediatric case of multiple sclerosis mimicking malignant brain tumor. A 11-year-old male presented with high fever, vomiting and partial convulsion of left lower extremity followed by left visual impairment. Magnetic resonance imaging (MRI) revealed a mass lesion in the right frontal lobe with significant peripheral edema. Incomplete ring-like enhancement by gadolinium administration was also noted. Open biopsy of the lesion was undertaken that provided pathological confirmation of demyelinating changes. Luxol fast blue stain and Bodian stain demonstrated extensive myelin loss and good preservation of axons. The patient was given intravenous high-dose methyl-prednisolone and sequential oral low-dose prednisone, which improved his neurological status progressively. The lesion was dramatically decreased in size and finally disappeared. Although many tumor-like demyelinating lesions were reported previously, pediatric cases of multiple sclerosis mimicking malignant brain tumor are extremely rare. Pathological examinations including Luxol fast blue stain and Bodian stain are essential for exact diagnosis.
Insights
Pediatric multiple sclerosis can mimic brain tumors in children. Prompt diagnosis and treatment with corticosteroids led to the resolution of a demyelinating lesion in an 11-year-old boy.
Area of Science:
- Neurology
- Pediatric Neurology
- Neuro-oncology
Background:
- Multiple sclerosis (MS) is a rare neurological condition in children.
- MS can present with symptoms and imaging findings that resemble malignant brain tumors.
Observation:
- An 11-year-old male presented with fever, vomiting, seizures, and visual impairment.
- Magnetic resonance imaging (MRI) revealed a right frontal lobe mass with edema and ring enhancement.
- Brain biopsy confirmed demyelinating changes with significant myelin loss but preserved axons.
Findings:
- The patient received high-dose intravenous methylprednisolone and oral prednisone.
- Neurological symptoms improved progressively.
- The brain lesion significantly decreased in size and resolved completely.
Implications:
- This case highlights the importance of considering MS in pediatric patients with suspected brain tumors.
- Pathological examination, including Luxol fast blue and Bodian stains, is crucial for accurate diagnosis.
- Early corticosteroid treatment can effectively manage MS lesions mimicking brain tumors in children.
