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Diagnostic problems in multiple sclerosis. Two cases with clinical diagnosis of MS showing only a diffusely growing
Abstract:
Two cases are presented with a long clinical history of multiple sclerosis (MS) before the diagnosis of an intracranial brain tumor. In the subsequent brain autopsy, however, both cases presented a diffusely growing anaplastic astrocytoma, only, and no changes similar to MS were seen. Diffuse tumor growth was noted in periventricular brain tissue and extended down to pons or medulla. Immunohistochemically, a positive staining for glial fibrillar acidic protein was observed in both cases and in the second case, which presented an increased amount of cerebrospinal fluid IgG, also a positive staining for immunoglobulins was seen. These case histories and subsequent neuropathological findings are presented as examples of diagnostic difficulties in MS, especially in cases with diffusely growing gliomas.
Insights
Diagnosing multiple sclerosis (MS) can be challenging, especially when patients present with symptoms mimicking MS but are later found to have diffusely growing anaplastic astrocytomas, as seen in these two autopsy cases.
Area of Science:
- Neuropathology
- Neuro-oncology
- Clinical Neurology
Background:
- Multiple sclerosis (MS) is a chronic inflammatory demyelinating disease of the central nervous system.
- Intracranial brain tumors, particularly gliomas, can present with diverse neurological symptoms.
- Diagnostic challenges arise when clinical presentations overlap between demyelinating diseases and neoplastic processes.
Observation:
- Two cases with a history suggestive of MS were diagnosed with intracranial brain tumors.
- Neuropathological examination revealed diffusely growing anaplastic astrocytomas.
- Tumor infiltration affected periventricular brain tissue, pons, and medulla.
Findings:
- Immunohistochemistry confirmed glial fibrillar acidic protein positivity in both cases.
- Elevated cerebrospinal fluid IgG and immunoglobulin positivity were noted in one case.
- No neuropathological changes consistent with multiple sclerosis were observed post-mortem.
Implications:
- These cases underscore the diagnostic challenges in distinguishing MS from diffusely growing gliomas.
- Anaplastic astrocytomas can mimic clinical presentations of MS.
- Accurate neuropathological assessment is vital for resolving diagnostic ambiguities in complex neurological cases.