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Reactive gliosis mimicking tumor recurrence - a case series documenting MRI abnormalities and neuropathological
Abstract:
The aim of this study is to identify, in our center, all cases of foreign-body reactions to hemostatic agents or other prostheses resulting in a radiological suspicion of tumor recurrence. We interrogated our internal database to identify all such cases and systematically evaluated the MRI brain scans of patients: (i) at the time of initial tumor diagnosis, (ii) postoperatively, (iii) and at the time of suspected tumor recurrence. In addition, we reviewed each patient's operative notes and reviewed the histology of all cases following a second surgical intervention. In total, we identified 8 patients, 7 of whom had a WHO grade II glioma at initial surgery. We did not identify any distinguishing radiological abnormalities from the initial diagnostic brain scan to the suspected recurrence, and histologically all cases were characterized by extensive gliosis; with both macrophages and reactive astrocytes present throughout. The cause of gliosis was identified as being relating to hemostatic agents in 4 cases; in the other 4 cases, the foreign-body reaction was presumed to be caused be materials used in a craniotomy or cranioplasty. This study highlights the difficulty in radiologically diagnosing a foreign-body reaction and also identifies that such a gliotic reaction may occur as a consequence of exogenous materials used in a craniotomy or cranioplasty. .
Insights
Foreign-body reactions to surgical materials can mimic tumor recurrence on brain MRI scans. This study found gliosis from hemostatic agents or craniotomy materials difficult to distinguish from actual tumor regrowth.
Area of Science:
- Neurosurgery
- Neuroradiology
- Pathology
Background:
- Foreign-body reactions to surgical implants can present as tumor recurrence on imaging.
- Distinguishing these reactions from actual tumor progression is a clinical challenge.
Purpose of the Study:
- To identify and characterize foreign-body reactions mimicking tumor recurrence in patients undergoing neurosurgery.
- To evaluate the radiological and histological features of these reactions.
Main Methods:
- Retrospective review of 8 patients with suspected tumor recurrence due to foreign-body reactions.
- Systematic evaluation of serial MRI brain scans (pre-op, post-op, recurrence suspicion).
- Review of operative notes and histology following repeat surgery.
Main Results:
- 7 out of 8 patients had WHO grade II glioma.
- No distinguishing radiological features between initial scans and suspected recurrence.
- Histology revealed extensive gliosis with macrophages and reactive astrocytes.
- 4 cases linked to hemostatic agents; 4 to craniotomy/cranioplasty materials.
Conclusions:
- Foreign-body reactions to surgical materials pose a diagnostic challenge in neuro-oncology.
- Gliosis from hemostatic agents or craniotomy materials can mimic tumor recurrence radiologically.
- Histological examination is crucial for accurate diagnosis.
