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Parenchymal Infiltration in Primary Diffuse Leptomeningeal Gliomatosis: Dynamic Changes in Brain MRI
Yun Jiang1, Juan Chen2, Jing He1
1Department of Neurology, Beijing Hospital, National Center of Gerontology, Beijing, China.
Abstract:
Primary diffuse leptomeningeal gliomatosis (PDLG) is a rare and fatal disease with no special clinical manifestations. Here, we report the dynamic brain magnetic resonance imaging (MRI) changes in a 30-year-old female PDLG patient over a 10-month period. MRI showed aggressive dilation of the subarachnoid space and the ventricular system, numerous encapsulated cysts in the subarachnoid space and the dilated cerebral sulci, diffuse reticulated or focal nodular enhancement in the subarachnoid space, as well as overall enhancement in the cystic walls. In addition to the aforementioned PDLG pathological findings, MRI also revealed non-contrasted solid lesions and a contrasted cyst-like lesion in the paraventricular areas. The dynamic and multiform neuroradiological changes help us to understand the pathological process of PDLG. Of particular interest is the discovery that parenchymal infiltration can occur in PDLG.
Insights
Primary diffuse leptomeningeal gliomatosis (PDLG) is a rare brain tumor. This case study highlights dynamic MRI changes over 10 months, revealing aggressive tumor progression and parenchymal infiltration.
Area of Science:
- Neuro-oncology
- Radiology
- Pathology
Background:
- Primary diffuse leptomeningeal gliomatosis (PDLG) is a rare and aggressive central nervous system malignancy.
- PDLG presents with non-specific clinical symptoms, making early diagnosis challenging.
Observation:
- This report details the 10-month dynamic brain MRI evolution in a 30-year-old female PDLG patient.
- MRI revealed subarachnoid space and ventricular dilation, cystic lesions, and diffuse leptomeningeal enhancement.
Findings:
- Dynamic MRI demonstrated aggressive PDLG progression, including encapsulated cysts and nodular enhancement.
- Novel findings include non-contrasted solid lesions and a contrasted cystic lesion in paraventricular areas.
- Crucially, MRI revealed evidence of parenchymal infiltration, a previously under-recognized feature of PDLG.
Implications:
- Dynamic and multiform neuroradiological changes provide insights into PDLG's pathological processes.
- Understanding these imaging features is vital for accurate diagnosis and management of PDLG.
- The discovery of parenchymal infiltration broadens the understanding of PDLG's invasive potential.
