Indian Journal of Pathology and Microbiology

LETTER TO EDITOR
Year
: 2008  |  Volume : 51  |  Issue : 4  |  Page : 569-

Demyelinating disease of the brain simulating a space-occupying lesion


Michelle De Padua1, Subashini Prabhakar2, Rahul Lath3,  
1 Department of Histopathology, Apollo Hospitals, Hyderabad, India
2 Department of Nuerology, Apollo Hospitals, Hyderabad, India
3 Department of Nuerosurgery, Apollo Hospitals, Hyderabad, India

Correspondence Address:
Michelle De Padua
Department of Histopathology, Apollo Hospitals, Hyderabad
India




How to cite this article:
Padua MD, Prabhakar S, Lath R. Demyelinating disease of the brain simulating a space-occupying lesion.Indian J Pathol Microbiol 2008;51:569-569


How to cite this URL:
Padua MD, Prabhakar S, Lath R. Demyelinating disease of the brain simulating a space-occupying lesion. Indian J Pathol Microbiol [serial online] 2008 [cited 2020 Aug 15 ];51:569-569
Available from: http://www.ijpmonline.org/text.asp?2008/51/4/569/43769


Full Text

Sir,

Focal demyelinating lesions of the brain can simulate brain tumors clinically and radiologically. We describe a case of demyelinating disease presenting as a space-occupying lesion.

A 19-year-old male presented with complaints of impaired speech and weakness in the upper and lower limbs on the right side since 10 days, along with a mild headache. On examination, dysarthria was present. There was right upper motor neuron 7 th nerve paresis. He had right pyramidal signs. A computed tomography (CT) scan and magnetic resonance imaging (MRI) showed a paraventricular mass lesion in the left frontal lobe with contrast enhancement and perilesional edema [Figure 1]. Possibilities considered were lymphoma, glioma and tuberculoma. A CT guided stereotactic biopsy was done. Histopathology revealed sheets of foamy macrophages, reactive gemistocytic astrocytes and perivascular lymphocytes [Figure 2]. A stain for myelin revealed a complete absence of myelin in these areas [Figure 2]inset .

A diagnosis of demyelinating disease was made. The patient was treated with corticosteroids. He responded very well with almost total recovery of speech and paresis within a period of 2 weeks.

Focal demyelinating disease can present as a space-occupying lesion and mimic tumors on radiology. It is imperative to correctly diagnose these lesions due to the profound impact on treatment. Response to steroids is very good and prognosis is excellent. Histopathological features of this lesion have been well documented. [1],[2],[3] Cerebral infarct is an important differential diagnosis on histology. A myelin stain helps to differentiate between the two since myelin is completely lost in demyelinating disease and is preserved in infarction. The degree of suspicion should be high to correctly diagnose these lesions.

References

1Jain D, Rajesh LS, Vasishta RK, Radotra BD, Banerjee AK. Demyelinating disease simulating brain tumours: A histopathologic assessment of seven cases. Indian J Med Sci 2006;60:47-52.
2SugitaY, Terasaki M, Shigemori M, Sakata K, Morimatsu M. Acute focal demyelinating disease simulating brain tumours: Histopathologic guidelines for an accurate diagnosis. Nueropathology 2001;21:25-31.
3Jaster JH, Bertorini TE, Dohan FC Jr, O'Brien TF, Wang H, Becske T, et al. Solitary focal demyelination in the brain as a paraneoplastic disorder. Med Pediatr Oncol 1996;26:111-5.