Indian Journal of Pathology and Microbiology

: 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

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 2021 Oct 23 ];51:569-569
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Full Text


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.


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