Lhermitte-Duclos disease (dysplastic gangliocytoma of the cerebellum). Report of a case and review of the literature

Dysplastic gangliocytoma of the cerebellum (Lhermitte-Duclos disease)

Dysplastic gangliocytoma of the cerebellum is a rare disorder requiring surgical resection. During surgical exploration, the margin with normal cerebellar tissue is often not distinct. We present here a case in which we surgically treated a patient with Lhermitte-Duclos disease, and discuss radical resection of the tumour. The patient was first admitted at the age of 34 years. A MRI scan revealed a large left cerebellar mass typical of dysplastic gangliocytoma. Postoperatively the patient developed severe cerebellar syndrome with only partial recovery after 4 years. MRI revealed no impairment of cerebrospinal fluid circulation; the mass in the left cerebellum had been removed, and no recurrent disease was visible. Clinical problems after gross total or complete removal of Lhermitte-Duclos lesions have not been reported in the literature, but herein we stress the importance of extreme caution in removing these lesions in cerebellar areas that have no distinct border between the tumour and normal tissue.

Lhermitte-Duclos Disease: Case Report

Lhermitte-Duclos disease is a rare disorder with an unknown pathogenesis. A single report of a pathological proven case of Lhermitte-Duclos disease is presented with clinical, imaging, and histopathological findings. A brief review of the condition is provided with an emphasis on imaging description.

From the archives of the AFIP: superficial gliomas: radiologic-pathologic correlation. Armed Forces Institute of Pathology

Glial neoplasms that are peripherally located and involve the cortical gray matter are noteworthy because of their predilection to serve as a seizure locus, their amenability to surgical resection, their generally favorable prognosis, and their characteristic imaging features, which facilitate diagnosis before surgery. The smaller lesions include ganglioglioma and dysembryoplastic neuroepithelial tumor. Gangliogliomas contain both neuronal and glial components and occur most commonly in the temporal lobe. Variant forms of gangliogliomas may occur and are related to the different compositions of the underlying cellular population. Gangliocytomas lack glial cells and are located both in the cerebral hemispheres and the cerebellum. Lhermitte-Duclos disease represents a specific type of cerebellar gangliocytoma with dysplastic features and is characterized by a laminar pattern at imaging. Dysembryoplastic neuroepithelial tumors occur predominantly in children and young adults with partial seizures and most commonly arise in the temporal lobe, frequently in combination with cortical dysplasia. Surrounding vasogenic edema is conspicuously absent in both gangliogliomas and dysembryoplastic neuroepithelial tumors. The larger masses in this group include desmoplastic infantile ganglioglioma and pleomorphic xanthoastrocytoma and tend to involve the leptomeninges and cortical territory. Both invoke an intense desmoplastic reaction, which appears as an enhancing soft-tissue component at imaging.

Lhermitte-Duclos disease: literature review and novel treatment strategy

BACKGROUND

Lhermitte-Duclos disease (LDD) is a rare pathologic entity involving the cerebellum. The fundamental nature of the entity and its pathogenesis remain unknown, and considerable debate has centered on whether it represents a neoplastic, malformative or hamartomatous lesion. The cell or cells of origin remain incompletely defined. Previous reports of cases in the English literature have dealt predominantly with the clinical and pathological aspects yet few address issues of treatment.

METHODS

A case of Lhermitte-Duclos disease (LDD) in a 54-year-old female leading to local compressive symptoms and obstructive hydrocephalus is presented. A craniectomy, in addition to a C1 laminectomy followed by a decompressive duroplasty (using autologous fascia lata graft) was performed.

RESULTS

The patient clinically improved and follow-up MRI 11 months post-operatively revealed improvement in hydrocephalus.

CONCLUSION

The histological and immunohistochemical features of the lesion are described, emphasizing the role of an abnormal dysplastic granule cell layer. The evidence in favor of each of the major theories of pathogenesis, malformative and neoplastic is discussed. Based on these facts a form of surgical intervention involving decompressive duroplasty is proposed.

Dysplastic gangliocytoma of the cerebellum (Lhermitte-Duclos disease)

The case of a 30-year-old male patient is presented who was admitted with a 3-month history of elevated intracranial pressure and reduced-hearing on the right. CT revealed hydrocephalus due to displacement of the 4th ventricle by a large non-enhancing cerebellar mass with calcifications. MRI sequences showed a space-occupying lesion within the right cerebellar hemisphere with unusual septations. At operation, the poorly demarcated lesion was excised from the apparently normal surrounding cerebellar tissue and histologically proven to be a dysplastic gangliocytoma (Lhermitte-Duclos disease). Clinical and neuroradiological appearance of this rare entity, as well as hypotheses on its pathogenesis are discussed.

Dysplastic gangliocytoma of the cerebellum (Lhermitte-Duclos disease) and its relation to the multiple hamartoma syndrome (Cowden disease)

The clinical manifestations, surgical treatment and postoperative results of three patients with gangliocytomas of the cerebellum (Lhermitte-Duclos disease) are presented. Particular attention is placed in one of the cases, that of a young woman with a short clinical history of episodic symptoms of intracranial hypertension, dizziness and ataxia, with a concomitant frontal meningioma and in the general context of a multiple hamartoma syndrome (Cowden disease). The possible relationship between both diseases is contemplated, since they can be the extremes of a wide spectrum of a peculiar form of phakomatosis.

Association of Lhermitte-Duclos and Cowden disease: report of a new case and review of the literature

Lhermitte-Duclos disease is a rare entity, and its pathological features are unique. Pathological findings are characteristic of the disease, with global hypertrophy of the cerebellum, coarse gyri, and the typical "inverted cortex" pattern. Several associated lesions were noted in many patients with Lhermitte-Duclos disease. It is only recently that an association between Lhermitte-Duclos disease and Cowden disease was reported. Cowden disease, or multiple hamartomas syndrome, is a familial disease associating breast cancer, cutaneomucous tricholemmomas, and various other tumoural and dysplasic conditions. A new case of Lhermitte-Duclos disease associated with Cowden disease is reported. A review of the literature found 72 cases of Lhermitte-Duclos disease; 26 had conditions suggesting Cowden disease and seven were definite cases of Cowden disease. The association of Lhermitte-Duclos disease and Cowden disease is probably underestimated. Cowden disease represents a new form of phakomatosis; Lhermitte-Duclos disease may occur as a sporadic disease, or as part of familial Cowden disease. The possibility of preneoplastic states in Cowden syndrome stresses the importance of a thorough screening when Lhermitte-Duclos disease is diagnosed.

Immunohistochemistry and proliferative activity in Lhermitte-Duclos disease

We have evaluated a recurrence of Lhermitte-Duclos disease by immunohistochemistry for Purkinje cell markers and proliferative activity (proliferating cell nuclear antigen), by electron microscopy and for DNA ploidy (image analysis). While most of the abnormal neurons in the lesion appear to be derived from granule cells, several Purkinje cell specific polyclonal and monoclonal antibodies, including L7, PEP 19 and calbindin, labeled a minor subpopulation. Staining with monoclonal antibodies to proliferating cell nuclear antigen and measuring cell DNA index and ploidy with a cell image analyzer revealed no proliferative activity. Electron microscopy findings were similar to those previously reported. In spite of its recurrence, our findings support the notion that Lhermitte-Duclos disease is malformative, not neoplastic, and that the characteristic neurons are derived predominantly but not exclusively from a non-Purkinje cell source, probably the granule cell.

Dysplastic gangliocytoma (Lhermitte-Duclos disease): CT and MR imaging

Dysplastic gangliocytoma (Lhermitte-Duclos disease) is a rare entity. Usually presenting as a posterior fossa mass, dysplastic gangliocytoma is not a true neoplasm but a hard-to-characterize lesion that may represent an abnormality of cell migration or a phacomatosis. Previous reports of CT findings are rare in the radiologic literature, and high-field (1.5 Tesla) MR images have never been described in the pediatric age group. We present a case of dysplastic gangliocytoma in a one-year-old boy with CT and MR findings.