Tumefactive demyelinating lesions: a clinicopathological correlative study.

Area of Science:

• Neurology
• Neuro-oncology
• Pathology

Background:

• Tumefactive demyelinating lesions (TDL) are rare central nervous system inflammatory conditions.
• TDL often present with imaging characteristics that overlap with intra-axial neoplasms, particularly gliomas.
• Accurate differentiation is critical for appropriate patient management.

Purpose of the Study:

• To describe the clinical, neuroimaging, and neuropathological features of six TDL cases.
• To evaluate the diagnostic utility of neuronavigation-guided biopsy in TDL.
• To assess treatment responses in TDL patients.

Main Methods:

• Retrospective review of six patients diagnosed with TDL.
• Analysis of clinical presentations, magnetic resonance imaging (MRI) findings, and histopathological results.
• Evaluation of treatment outcomes including corticosteroid therapy and plasma exchange.

Main Results:

• Four out of six patients had initial MRI findings suggestive of glioma, not TDL.
• Neuronavigation/stereotactic biopsy successfully established the diagnosis of TDL in all six cases.
• Two patients refractory to corticosteroids showed improvement with plasma exchange.

Conclusions:

• Neuronavigation biopsy is an invaluable tool for diagnosing TDL, especially when imaging is ambiguous.
• TDL management may require alternative therapies like plasma exchange for non-responders.
• Early and accurate diagnosis of TDL impacts treatment decisions and patient outcomes.