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[Gliomatosis cerebri with multifocal progressive lesions on MRI]
Ken Sakushima1, Moemi Yashima-Yamada, Kanako Kubota
1Department of Neurology, Hokkaido University Graduate School of Medicine.
Abstract:
A 77-year-old woman with cognitive impairment and multifocal progressive lesions on brain MRI was admitted to our hospital. Analysis of blood and cerebrospinal fluid showed no evidence of infection, autoimmune disease, or metabolic abnormalities. Histological examination of biopsied tissue from a lesion in the right frontal lobe revealed an abnormally increased glial cell density with enlarged nuclei and a high MIB-1 index. These pathological findings coupled with her progressive clinical history indicated a diagnosis of gliomatosis cerebri. General characteristics of gliomatosis cerebri include diffuse infiltrative lesions in neuroimaging with or without mass effect. However, the present case showed unusual multifocal manifestations in brain MRI. Therefore, histopathological examination must be taken into account for a proper diagnosis.
Insights
Gliomatosis cerebri, a rare brain disorder, can present with unusual multifocal MRI lesions. Histopathology is crucial for accurate diagnosis when imaging is atypical.
Area of Science:
- Neuroscience
- Neuropathology
- Oncology
Background:
- Gliomatosis cerebri is a rare primary brain tumor characterized by diffuse infiltration of the brain parenchyma by glial cells.
- Typical neuroimaging findings include diffuse leptomeningeal or parenchymal enhancement, often with mass effect.
Observation:
- A 77-year-old woman presented with cognitive decline and multifocal brain lesions on MRI.
- Initial blood and cerebrospinal fluid analyses ruled out infection, autoimmune, and metabolic disorders.
- Histological examination of a right frontal lobe biopsy revealed increased glial cell density, enlarged nuclei, and a high MIB-1 proliferation index.
Findings:
- The case demonstrated gliomatosis cerebri with an atypical presentation of multifocal MRI lesions.
- The pathological findings, including glial cell atypia and high proliferation index, confirmed the diagnosis.
- This contrasts with the more common diffuse infiltrative pattern seen in gliomatosis cerebri.
Implications:
- This case highlights the importance of histopathological examination for diagnosing gliomatosis cerebri, especially in atypical presentations.
- Accurate diagnosis is critical for appropriate patient management and prognosis.
- Further research into the diverse imaging manifestations of gliomatosis cerebri may improve early detection.
