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Sreenivasan S, Agarwal N, Bharath Raju, Kandregula S, Narayan V, Chen CC, Sharma M. Management Strategies of Plasma Cell Granuloma Involving the Central Nervous System: A Systematic Review of the Literature. World Neurosurg 2023; 180:194-202.e11. [PMID: 37708970 DOI: 10.1016/j.wneu.2023.09.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 09/05/2023] [Accepted: 09/07/2023] [Indexed: 09/16/2023]
Abstract
BACKGROUND Plasma cell granuloma (PCG) is a rare clinical entity seen in the neurosurgical literature. It has often been referred to as inflammatory myofibroblastic tumor or inflammatory pseudotumor. No well-defined management guidelines exist in the literature. METHODS Using PRISMA guidelines, we systematically reviewed the literature in PubMed and Google Scholar using MeSH terms: intracranial plasma cell granuloma, myofibroblastic tumor, intracranial pseudotumor, spinal plasma cell granuloma. We analyzed the clinical presentation, treatment strategies, clinical outcomes, and follow-up across different studies. RESULTS Eighty-three studies were included presenting 108 cases. Primary extracranial disease was seen in 4 patients and primary central nervous system (CNS) disease in 104. In the combined cohort, multicompartmental disease was seen in 22 (20.8%) patients. Headache (n=40, 42.59%) was the most common clinical symptom. Surgical excision (n=86, 79.6%) was the most common primary treatment used. Radiation therapy, steroids, and chemotherapy (methotrexate/6-mercaptopurine/rituximab) were also used. Disease recurrence was noted in 25 (33.3%) patients and residual disease in 33 (30.5%). Mortality was seen in 4 (3.7%) patients. In the cranial PCG subgroup (n=87), 81 (93.1%) patients had solitary lesions, and 6 (6.8%) had multiple lesions. Recurrence after primary surgery was noted in 27.58% (n=24). In the spinal PCG subgroup (n=17), the thoracic spine was the most common location (n=9, 52.9%) and recurrence was seen in 5.84% (n=1). CONCLUSIONS Combination of multiple treatment modalities is needed when approaching this complex disease. Spinal PCGs respond favorably to gross total excision, with a low recurrence rate. Cranial PCGs warrant intense follow-up with secondary chemotherapy/radiation/steroids in recurrent cases.
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Affiliation(s)
- Sanjeev Sreenivasan
- Department of Neurosurgery, Rutgers- Robert Wood Johnson Medical School & University Hospital, New Brunswick, New Jersey, USA
| | - Neha Agarwal
- Department of Maternal Fetal Medicine, Fetal Centre, University of Texas Health, McGovern Medical School, Houston, Texas, USA
| | - Bharath Raju
- Department of Neurosurgery, University of Texas Health, McGovern Medical School, Houston, Texas, USA
| | - Sandeep Kandregula
- Department of Neurosurgery, Louisiana State University Health Sciences Centre, Shreveport, Louisiana, USA
| | - Vinayak Narayan
- Department of Neurosurgery, Lenox Hill Hospital, New York, New York, USA
| | - Clark C Chen
- Department of Neurosurgery, University of Minnesota, Minneapolis, Minnesota, USA
| | - Mayur Sharma
- Department of Neurosurgery, University of Minnesota, Minneapolis, Minnesota, USA.
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Su ZJ, Guo ZS, Wan HT, Hong XY. Inflammatory myofibroblastic tumor of the central nervous system: A case report. World J Clin Cases 2022; 10:12637-12647. [PMID: 36579095 PMCID: PMC9791513 DOI: 10.12998/wjcc.v10.i34.12637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 09/16/2022] [Accepted: 11/07/2022] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND An inflammatory myofibroblastic tumor (IMT) occurring in the central nervous system is very rare, and thus its pathogenesis is unknown. This case report and literature review aimed to explore the pathogenesis, clinical features, imaging findings, pathological characteristics, immunohistochemical characteristics, diagnoses, treatments, and risks of postoperative recurrence of IMT in the central nervous system.
CASE SUMMARY A 67-year-old woman was admitted to the hospital with an exophthalmic protrusion and double vision in the left eye that had persisted for 3 mo. Magnetic resonance imaging (MRI) showed a 2.4 cm × 1.3 cm heterogeneous large mass in the bottom of the left anterior cranial fossa, which was closely related to the dura mater. Before surgery, we suspected the mass to be meningioma. The entire mass was successfully removed under neuronavigation and electrophysiological monitoring, and postoperative pathology indicated an IMT with extensive infiltration of chronic inflammatory cells and scattered multinucleated giant cells. Head MRI at the 3-mo follow-up showed that the tumor at the bottom of left anterior cranial fossa had been completely resected without recurrence.
CONCLUSION From the histological, immunohistochemical, and genetic analyses, the present case suggests that the pathogenesis of IMT-CNS is related to autoimmunity.
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Affiliation(s)
- Zhen-Jin Su
- Department of Neurosurgical Oncology, The First Hospital of Jilin University, Changchun 130000, Jilin Province, China
| | - Ze-Shang Guo
- Department of Neurosurgical Oncology, The First Hospital of Jilin University, Changchun 130000, Jilin Province, China
| | - Heng-Tong Wan
- Department of Neurosurgical Oncology, The First Hospital of Jilin University, Changchun 130000, Jilin Province, China
| | - Xin-Yu Hong
- Department of Neurosurgical Oncology, The First Hospital of Jilin University, Changchun 130000, Jilin Province, China
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Intracranial Inflammatory Pseudotumor: A Case Report. IRANIAN JOURNAL OF RADIOLOGY 2021. [DOI: 10.5812/iranjradiol.97807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
: Primary inflammatory pseudotumor of the central nervous system is extremely rare. These lesions may be intra-axial, extra-axial, or a mix of them. We report a case of intracranial inflammatory pseudotumor involving both brain parenchyma and dura.
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Phogat D, Datta SGS, Bajpai M, Tara S, Ganti SK. Intracranial Inflammatory Myofibroblastic Tumor: A Review of 49 cases. AUTOPSY AND CASE REPORTS 2021; 11:e2021254. [PMID: 34307218 PMCID: PMC8214901 DOI: 10.4322/acr.2021.254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 01/07/2021] [Indexed: 11/23/2022] Open
Abstract
Inflammatory Myofibroblastic Tumor (IMT) is a rare pathologic entity that was first described in 1973. This lesion is most commonly found in the lungs, but other organs' involvement has also been reported. Intracranial location of Inflammatory Myofibroblastic Tumor is rare, and the first case was reported in 1980. An intriguing fact about the intracranial IMT is its resemblance with meningioma on clinical presentation and neuroimaging. We came across a case of intracranial Inflammatory Myofibroblastic Tumor (IIMT) in a 27-year-old male who presented with recurrent episodes of seizures and was diagnosed as meningioma on neuroimaging. The lesion did not subside with medical management and kept on progressing in size. The patient had to undergo surgery, and diagnosis of Inflammatory Myofibroblastic Tumor was ascertained on histopathology. This 'surprise' diagnosis prompted us to review the literature on all cases of IIMTs reported to date to better understand the entity and its implications. In this review article, we present our observations regarding various studied parameters, including patient profile, clinical presentation, site of involvement, focality of the lesion, special associations, and lines of management of the 49 published cases of IIMTs.
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Affiliation(s)
- Deepika Phogat
- 151 Base Hospital, Department of Pathology, Guwahati, Assam, India
| | - S G S Datta
- 151 Base Hospital, Department of Neurosurgery, Guwahati, Assam, India
| | - Mukul Bajpai
- 151 Base Hospital, Department of Pathology, Guwahati, Assam, India
| | - Swayam Tara
- 151 Base Hospital, Department of Anesthesia, Guwahati, Assam, India
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5
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A Rare Case of Plasma Cell Granuloma. Case Rep Dent 2020; 2020:8861918. [PMID: 33425399 PMCID: PMC7781719 DOI: 10.1155/2020/8861918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 12/07/2020] [Accepted: 12/17/2020] [Indexed: 11/18/2022] Open
Abstract
Plasma cell granulomas (PCGs) or inflammatory pseudotumors are nonneoplastic lesions that consist of predominantly antibody-secreting plasma cells and innate immune cells such as neutrophils, macrophages, and eosinophils. Unlike in multiple myeloma, the plasma cells are polyclonal and present in a spindly fibroblast-rich stromal background. These lesions mainly occur in the lungs; however, they can arise in other organs. PCGs from the gingiva are extremely rare, and a proper diagnosis is crucial to treat these patients further. These tumors have an increased number of plasma cells that are immunoreactive with CD138 and are polyclonal for kappa and lambda light chains, confirming these proliferations' nonneoplastic nature. Surgical resection with clear margins, when possible, is the primary choice of treatment. Radiation and anti-inflammatory steroid therapy are other therapeutic approaches. Critical and careful examination by a pathologist is necessary to rule out plasma cell neoplasms. Here, we report a rare occurrence of gingival PCG in an elderly male.
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Tanaka T, Fuga M, Teshigawara A, Hasegawa Y, Nishiwaki K, Murayama Y, Yokoo H. IgG4-Related Disease in the Frontal Convexity Concomitant with Smoldering Multiple Myeloma: A Case Report and Review of the Literature Regarding Therapeutic Implications. World Neurosurg 2020; 143:247-260. [PMID: 32768593 DOI: 10.1016/j.wneu.2020.07.212] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 07/25/2020] [Accepted: 07/28/2020] [Indexed: 01/13/2023]
Abstract
BACKGROUND We have reported an extremely rare case of a frontal convexity tumor diagnosed as IgG4-related disease (IgG4-RD) with unique neuroradiological images. CASE DESCRIPTION A 64-year-old man with a history of monoclonal gammopathy of undetermined significance and conservative treatment had presented with a left facial spasm. Computed tomography showed a high-density round tumor with perifocal edema in the right frontal convexity. Magnetic resonance imaging demonstrated unique findings, including low signal intensity on T1- and T2-weighted, fluid-attenuated inversion recovery, and diffusion-weighted images, with slight gadolinium enhancement. The tumor was totally removed via right frontal craniotomy. It had been located in the subdural space, was not adherent to the dura, and was less vascular than meningiomas. Histological investigation demonstrated plasma cells that were strongly positive for IgG4 and contained κ and λ light chains at a ratio of 1.5:1. The serum IgG4 level was elevated. The tumor met the diagnostic criteria for IgG4-RD. The patient was followed up for 3 years during postoperative adjuvant steroid therapy. The steroid therapy was discontinued, and during the next 4 years, neither tumor recurrence nor symptoms were observed. CONCLUSION Intracranial IgG4-RD with smoldering monoclonal gammopathy of undetermined significance is extremely rare. We reviewed the differential diagnosis of plasma cell granuloma and plasmacytoma, therapeutic implications, and clinical outcomes. Complete resection of a conspicuous and solitary IgG4-RD lesion in the frontal convexity is simple and could provide a cure with less-aggressive adjuvant therapy.
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Affiliation(s)
- Toshihide Tanaka
- Department of Neurosurgery, Jikei University School of Medicine Kashiwa Hospital, Chiba, Japan.
| | - Michiyasu Fuga
- Department of Neurosurgery, Jikei University School of Medicine Kashiwa Hospital, Chiba, Japan
| | - Akihiko Teshigawara
- Department of Neurosurgery, Jikei University School of Medicine Kashiwa Hospital, Chiba, Japan
| | - Yuzuru Hasegawa
- Department of Neurosurgery, Jikei University School of Medicine Kashiwa Hospital, Chiba, Japan
| | - Kaichi Nishiwaki
- Department of Clinical Oncology and Hematology, Jikei University School of Medicine Kashiwa Hospital, Chiba, Japan
| | - Yuichi Murayama
- Department of Neurosurgery, Jikei University School of Medicine, Tokyo, Japan
| | - Hideaki Yokoo
- Department of Pathology, Gumma University Graduate School of Medicine, Maebashi, Japan
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Imaging and pathological findings of intramedullary inflammatory pseudotumour in a miniature dachshund: a case report. BMC Vet Res 2019; 15:459. [PMID: 31856853 PMCID: PMC6921595 DOI: 10.1186/s12917-019-2213-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Accepted: 12/11/2019] [Indexed: 11/25/2022] Open
Abstract
Background Inflammatory pseudotumours (IPTs) are distinctive lesions consisting of myofibroblastic spindle cells and a variety of inflammatory cells. The aetiology of IPTs is unknown. Reports of IPTs in veterinary medicine have been scarse. Moreover, only one case of intradural extramedullary IPT has been previously reported. In this report, we introduce the first known case of canine IPT, which occurred in the parenchyma of the spinal cord. Case presentation A 10-year-old female Miniature Dachshund presented with a 2-month-long history of progressively worsening ataxia and tetraparesis. Neurological examination was consistent with a lesion involving the cervical spinal cord. Magnetic resonance imaging revealed an intradural space-occupying lesion in the region of the fourth cervical vertebra. Dorsal laminectomy and resection of the mass were performed. Histopathological examination revealed the proliferation of immature spindle cells (fibroblasts/myofibroblasts and glial cells) and a highly cellular mixture of neutrophils, macrophages and lymphocytic cells. The mass was located in the parenchyma of the spinal cord and was diagnosed as an IPT occurring in the parenchyma of the spinal cord. No causative pathogen was detected. The dog’s symptoms improved, during the first month after surgery. However, neurological symptoms, such as laboured breathing and dysuria, subsequently worsened and the dog died 42 days after surgery. Conclusions The present study describes a canine case of IPT occurring in the parenchyma of the spinal cord. The diagnosis and determination of the site of the mass was difficult solely based on preoperative imaging in the present case. The outcome of this case was poorer than that observed in cases of canine extramedullary IPT and human intramedullary IPT, in which the patients exhibited recovery. The prognosis after surgical resection cannot be decided from the present case alone. However, patients should be monitored for potential serious complications and recurrence.
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Bhujabal SN, Chandra Nath P, Behera R, Swarnakar PK, Dhir MK, Mishra S. Spinal Epidural Inflammatory Pseudotumor: A Case Report and Review of Literature. World Neurosurg 2018; 117:225-228. [DOI: 10.1016/j.wneu.2018.06.079] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2018] [Revised: 06/10/2018] [Accepted: 06/11/2018] [Indexed: 01/19/2023]
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Yoshimura K, Sasaki M, Kojima M, Tsuruzono K, Matsumoto K, Wakayama A, Yoshimine T. Spontaneous Regression of Inflammatory Pseudotumor in the Cauda Equina: A Case Report. NMC Case Rep J 2016; 3:111-114. [PMID: 28664010 PMCID: PMC5386160 DOI: 10.2176/nmccrj.cr.2015-0314] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2015] [Accepted: 04/28/2016] [Indexed: 11/20/2022] Open
Abstract
Spinal intradural extramedullary inflammatory pseudotumor (IPT) is an extremely rare entity. Spontaneous shrinking of a spinal IPT has never been reported. A case of an IPT of the cauda equina that regressed spontaneously is presented. A 78-year-old woman presented with hypoesthesia of both lower legs in the L4 nerve root distribution and motor weakness of the right leg. Preoperative CT myelography and MRI showed two tumor-like lesions located at T12-L1 and L2-3. The lesion at the T12-L1 level appeared to encase several nerve roots. The preoperative diagnosis was ependymoma, schwannoma, or malignant lymphoma. The tumors were biopsied. In the operation, the lesion turned out to consist of swollen and adherent nerve roots. On histopathological examination of the biopsied nerve roots, they were diagnosed as IPT. The patient's symptoms improved gradually without any treatment after the operation. The IPTs regressed on the postoperative MR images and disappeared at one year. This is the first report of spontaneous regression of an IPT in the spinal region. IPT should be considered in the differential diagnosis of a tumor that appears to involve several nerve roots on preoperative imaging, but surgery is necessary for diagnosis. Complete resection is not absolutely required if an intraoperative pathological diagnosis of the frozen section reveals IPT.
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Affiliation(s)
- Kazuhiro Yoshimura
- Department of Neurosurgery, Osaka Neurological Institute, 2-6-23, Shonai, Takara-machi, Toyonaka, Osaka, 561-0836 Japan
| | - Manabu Sasaki
- Department of Neurosurgery and Spine Surgery, Iseikai Hospital, 6-2-25, Sugawara, Hgashiyodogawa-ku, Osaka, 533-0022, Osaka, Japan
| | - Masaru Kojima
- Department of Diagnostic Pathology, Dokkyou University Graduate School of Medicine, 880 Kitakobayashi, Simotsuka-gun, Mibu-cho, 321-0293, Tochigi, Japan
| | - Kouichirou Tsuruzono
- Department of Neurosurgery and Spine Surgery, Iseikai Hospital, 6-2-25, Sugawara, Hgashiyodogawa-ku, Osaka, 533-0022, Osaka, Japan
| | - Katsumi Matsumoto
- Department of Neurosurgery and Spine Surgery, Iseikai Hospital, 6-2-25, Sugawara, Hgashiyodogawa-ku, Osaka, 533-0022, Osaka, Japan
| | - Akatsuki Wakayama
- Department of Neurosurgery, Osaka Neurological Institute, 2-6-23, Shonai, Takara-machi, Toyonaka, Osaka, 561-0836 Japan
| | - Toshiki Yoshimine
- Department of Neurosurgery, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, 565-0871, Osaka, Japan
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Güdük M, Yener U, Sav A, Pamir MN. Intracranial multifocal plasma cell granuloma: a case with multiple operations without recurrence of surgically removed lesions. Acta Neurochir (Wien) 2016; 158:721-723. [PMID: 26852033 DOI: 10.1007/s00701-016-2724-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2015] [Accepted: 01/27/2016] [Indexed: 01/21/2023]
Affiliation(s)
- Mustafa Güdük
- School of Medicine, Department of Neurosurgery, Acıbadem University, İstanbul, Turkey.
| | - Ulaş Yener
- School of Medicine, Department of Neurosurgery, Acıbadem University, İstanbul, Turkey
| | - Aydın Sav
- School of Medicine, Department of Pathology, Acıbadem University, İstanbul, Turkey
| | - M Necmettin Pamir
- School of Medicine, Department of Neurosurgery, Acıbadem University, İstanbul, Turkey
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Peng XZ, Hua LH, Qiang SZ, Qiang W. A case of tumor-like inflammatory demyelinating disease with progressive brain and spinal cord involvement. SAO PAULO MED J 2015; 133:445-9. [PMID: 26648435 PMCID: PMC10871805 DOI: 10.1590/1516-3180.2014.7832407] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2013] [Revised: 07/11/2014] [Accepted: 07/21/2014] [Indexed: 11/22/2022] Open
Abstract
CONTEXT Tumor-like inflammatory demyelinating disease (TIDD) usually occurs in the brain and rarely occurs in the spinal cord. TIDD appears to be very similar to tumors such as gliomas on imaging, which may lead to incorrect or delayed diagnosis and treatment. CASE REPORT Because of headache and incoherent speech, a 24-year-old Chinese male presented to our hospital with a two-week history of respiratory infections. After dexamethasone treatment, his symptoms still got worse and surgery was performed for diagnostic purposes. Histological examination revealed that the lesion was inflammatory. Further lesions appeared in the spine (T3 and T4 levels) after two months and in the right occipital lobe after three months. After intravenous immunoglobulin (IVIG) and methylprednisolone treatment, his symptoms improved. CONCLUSION Progressive lesions may damage the brain and spinal cord, and long-term prednisolone and IVIG therapy are beneficial in TIDD patients.
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Affiliation(s)
- Xu Zhi Peng
- MD, MSc. Attending Physician, Department of Neurology, Wuhan General Hospital of Guangzhou Command, Wuhan, China
| | - Li Hong Hua
- MD, PhD. Professor, Department of Neurology, Wuhan General Hospital of Guangzhou Command, Wuhan, China
| | - Sun Zhi Qiang
- MD, MSc. Attending Physician, Department of Radiology, Wuhan General Hospital of Guangzhou Command, Wuhan, China
| | - Wu Qiang
- MD, PhD. Professor, Department of Neurology, Wuhan General Hospital of Guangzhou Command, Wuhan, China
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Kim MS, Kim IS, Hong JT, Kim JY, Sung JH, Lee SW. Epidural chronic inflammatory mass of the lumbar spine in a human immunodeficiency virus positive patient with a history of repeated epidural injections. Spine J 2015; 15:368-9. [PMID: 25301023 DOI: 10.1016/j.spinee.2014.09.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2014] [Revised: 09/23/2014] [Accepted: 09/30/2014] [Indexed: 02/03/2023]
Affiliation(s)
- Moon Seok Kim
- Department of Neurosurgery, St. Vincent's Hospital, The Catholic University of Korea, 93, Jungbudaero, Paldal-gu, Suwon, Gyeonggi-do, 442-723, South Korea
| | - Il Sup Kim
- Department of Neurosurgery, St. Vincent's Hospital, The Catholic University of Korea, 93, Jungbudaero, Paldal-gu, Suwon, Gyeonggi-do, 442-723, South Korea
| | - Jae Taek Hong
- Department of Neurosurgery, St. Vincent's Hospital, The Catholic University of Korea, 93, Jungbudaero, Paldal-gu, Suwon, Gyeonggi-do, 442-723, South Korea
| | - Joon Young Kim
- Department of Neurosurgery, St. Vincent's Hospital, The Catholic University of Korea, 93, Jungbudaero, Paldal-gu, Suwon, Gyeonggi-do, 442-723, South Korea
| | - Jae Hoon Sung
- Department of Neurosurgery, St. Vincent's Hospital, The Catholic University of Korea, 93, Jungbudaero, Paldal-gu, Suwon, Gyeonggi-do, 442-723, South Korea
| | - Sang Won Lee
- Department of Neurosurgery, St. Vincent's Hospital, The Catholic University of Korea, 93, Jungbudaero, Paldal-gu, Suwon, Gyeonggi-do, 442-723, South Korea
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Renfrow JJ, Mitchell JW, Goodman M, Mellen LA, Wilson JA, Mott RT, Lesser GJ. Relapsing intracranial plasma cell granuloma: A case report. Oncol Lett 2013; 7:531-533. [PMID: 24396482 PMCID: PMC3881914 DOI: 10.3892/ol.2013.1722] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2013] [Accepted: 10/08/2013] [Indexed: 11/06/2022] Open
Abstract
Plasma cell granuloma is a pathological entity reported in nearly every organ system; however, intracranial cases remain rare. In the current case report, we present a case of intracranial plasma cell granuloma with the longest known follow-up period in the literature. Medical follow-up over 14 years, detailing four recurrences following the patient's initial presentation and management, is presented. The patient's treatment course consisted of three craniotomies, 3,600-cGy fractionated radiation and two courses of glucocorticoid therapy. In addition to disease surveillance using clinical examination and imaging, this case represents the first description of the clinical utility of analyzing changes in an inflammatory blood marker, the erythrocyte sedimentation rate, which coincided with recurrence and response to therapy.
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Affiliation(s)
- Jaclyn J Renfrow
- Wake Forest University School of Medicine, Winston-Salem, NC 27157, USA
| | | | - Michael Goodman
- Department of Internal Medicine, Section on Hematology and Oncology, Comprehensive Cancer Center, Wake Forest University School of Medicine, Winston-Salem, NC 27157, USA
| | - Leigh A Mellen
- Hattiesburg Clinic, Department of Pathology, Hattiesburg, MS 39401, USA
| | - John A Wilson
- Department of Neurosurgery, Wake Forest University School of Medicine, Winston-Salem, NC 27157, USA
| | - Ryan T Mott
- Department of Pathology, Wake Forest University School of Medicine, Winston-Salem, NC 27157, USA
| | - Glenn J Lesser
- Department of Internal Medicine, Section on Hematology and Oncology, Comprehensive Cancer Center, Wake Forest University School of Medicine, Winston-Salem, NC 27157, USA
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Abstract
STUDY DESIGN Case report. OBJECTIVE To describe a patient with nodular fasciitis arising in the lumbar extradural space. SUMMARY OF BACKGROUND DATA Nodular fasciitis is a benign proliferation of fibroblasts and myofibroblasts. It commonly occurs in the subcutaneous tissue of an upper extremity, trunk, head, and neck, but rarely arises in the spinal canal. METHODS A 7-year-old boy experienced gradually increasing intense radiating pain from the bilateral buttocks to the lower extremities after a bruise on his lower back. Computed tomography and magnetic resonance imaging demonstrated a relatively circumscribed mass in the dorsal epidural space from the first lumbar vertebra (L1) to L2. The presumptive diagnosis based on the radiologic findings included aggressive neoplasm such as extraskeletal Ewing sarcoma/primitive neuroectodermal tumor or malignant lymphoma. RESULTS The patient underwent L1-L2 laminectomy and resection of the tumor. Histologically, the tumor was mainly composed of a proliferation of spindle cells without atypia, positive for vimentin and smooth muscle actin, and myxoid areas with a loosely textured feathery pattern. These findings are the typical features of nodular fasciitis. Surgery relieved the patient's pain, with no evidence of recurrence at a recent 4-year follow-up. CONCLUSION This report presents a very rare case of extradural nodular fasciitis arising in the lumbar spinal canal, which could have been misinterpreted as a malignant tumor such as extraskeletal Ewing sarcoma/primitive neuroectodermal tumor because of its rapid growth and absence of distinguishing radiologic features. A detailed histopathologic examination including immunohistochemistry is important for the correct diagnosis.
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Puntambekar P, Santhakumar S, Kupsky WJ, Tselis A, Mittal S. Primary intracranial plasma cell granulomas presenting as malignant neoplasms. J Neurooncol 2011; 106:327-37. [PMID: 21786175 DOI: 10.1007/s11060-011-0667-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2011] [Accepted: 07/07/2011] [Indexed: 12/22/2022]
Abstract
Plasma cell granuloma (PCG) is an uncommon non-neoplastic mass lesion of unknown etiology. It is characterized by a polyclonal proliferation of chronic inflammatory cells, mostly mature plasma and other mononuclear cells. PCGs arising in the central nervous system are particularly rare. We report two additional cases of intracranial PCG exclusively involving the brain parenchyma. A 47 year-old woman, presenting with partial motor seizures and fluent aphasia, underwent complete excision of a well-demarcated, enhancing left parietal mass. The second patient was a 56 year-old man presenting with headaches and right-sided weakness who underwent stereotactic biopsy of an ill-defined, heterogeneously enhancing lesion in the left basal ganglia. Immunohistochemical analysis of surgical specimens showed polyclonal plasma cells and mature lymphocytes but no etiological agent. A histopathologic diagnosis of intracranial PCG was made in both cases. PCG should be part of the differential diagnosis of enhancing mass lesions of the brain. The etiology and natural history of these tumor-like lesions is not fully understood. Complete surgical excision appears to be curative. Lesions where total resection is not possible may benefit from adjuvant treatment including corticosteroids and possibly radiation therapy.
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Affiliation(s)
- Preeti Puntambekar
- Department of Neurology, Wayne State University, Detroit Medical Center, Detroit, MI, USA
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Zemmoura I, Hamlat A, Morandi X. Intradural extramedullary spinal inflammatory myofibroblastic tumor: case report and literature review. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2011; 20 Suppl 2:S330-5. [PMID: 21465290 DOI: 10.1007/s00586-011-1783-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/28/2010] [Revised: 01/31/2011] [Accepted: 03/25/2011] [Indexed: 01/21/2023]
Abstract
The authors present the case of an inflammatory myofibroblastic tumor that involves the cervical spinal cord meninges, presenting in a manner mimicking en plaque meningioma, which has never been previously reported. During the first surgical procedure, which did not involve exploration of the intradural space, inflammatory epidural tissue was found. We performed a second operation to remove the tumor that was finally intradural, dural-based and very tough. Imaging studies, surgical findings, and histopathological examinations were used to support the diagnosis. Intradural extramedullary inflammatory myofibroblastic tumor is a rare entity that has only been described nine times in the literature. Surgery remains the treatment of choice. Although histologically benign, spinal inflammatory myofibroblastic tumor can be aggressive and requires a large resection and long-term follow-up of the entire central nervous system with magnetic resonance imaging.
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Affiliation(s)
- Ilyess Zemmoura
- Department of Neurosurgery, Pontchaillou Hospital, University of Rennes, Rennes, France.
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Yoon SH, Kim KJ, Chung SK, Kim HJ, Choe G, Chung SB, Jin YJ. Inflammatory myofibroblastic tumor in the intradural extramedullary space of the lumbar spine with spondylolisthesis: case report and review of the literature. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2010; 19 Suppl 2:S153-7. [PMID: 19941012 PMCID: PMC2899620 DOI: 10.1007/s00586-009-1212-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/01/2009] [Revised: 07/23/2009] [Accepted: 11/03/2009] [Indexed: 10/20/2022]
Abstract
An inflammatory myofibroblastic tumor (IMT) is a rare disease entity reported to arise in various organs but still thought to be a neoplastic or reactive inflammatory condition controversially. The author reports an extremely rare case of intradural extramedullary IMT of lumbar spine which was presenting radiculopathy and neurogenic intermittent claudication due to concomitant spondylolisthesis.
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Affiliation(s)
- Sang Hoon Yoon
- Department of Neurosurgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, 300 Gumi-dong, Bundang-gu, Seongnam-si, Seoul, Gyeonggi-do 463-707 Korea
| | - Ki-Jeong Kim
- Department of Neurosurgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, 300 Gumi-dong, Bundang-gu, Seongnam-si, Seoul, Gyeonggi-do 463-707 Korea
| | - Sang Ki Chung
- Department of Neurosurgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, 300 Gumi-dong, Bundang-gu, Seongnam-si, Seoul, Gyeonggi-do 463-707 Korea
| | - Hyun-Jib Kim
- Department of Neurosurgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, 300 Gumi-dong, Bundang-gu, Seongnam-si, Seoul, Gyeonggi-do 463-707 Korea
| | - Gheeyoung Choe
- Department of Pathology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seoul, Gyeonggi-do Korea
| | - Sang Bong Chung
- Department of Neurosurgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, 300 Gumi-dong, Bundang-gu, Seongnam-si, Seoul, Gyeonggi-do 463-707 Korea
| | - Yong Jun Jin
- Department of Neurosurgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, 300 Gumi-dong, Bundang-gu, Seongnam-si, Seoul, Gyeonggi-do 463-707 Korea
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ISHIHARA M, IZUMOTO S, IWATSUKI K, YOSHIMINE T. Immunohistochemical Study of Multiple Inflammatory Pseudotumors With Both Brain and Spinal Cord Involvement -Case Report-. Neurol Med Chir (Tokyo) 2010; 50:246-50. [DOI: 10.2176/nmc.50.246] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Masahiro ISHIHARA
- Department of Neurosurgery, Osaka University Graduate School of Medicine
| | | | - Koichi IWATSUKI
- Department of Neurosurgery, Osaka University Graduate School of Medicine
| | - Toshiki YOSHIMINE
- Department of Neurosurgery, Osaka University Graduate School of Medicine
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Jeon YK, Chang KH, Suh YL, Jung HW, Park SH. Inflammatory myofibroblastic tumor of the central nervous system: clinicopathologic analysis of 10 cases. J Neuropathol Exp Neurol 2005; 64:254-9. [PMID: 15804057 DOI: 10.1093/jnen/64.3.254] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
To verify the pathologic features, anaplastic lymphoma kinase (ALK) expression and biologic behavior of inflammatory myofibroblastic tumors (IMTs) of the central nervous system (CNS), we analyzed 10 cases of IMTs-CNS (8 cranial, 1 spinal, and 1 orbital). Our series of IMTs of the CNS showed a male predominance (male:female = 6:4) and a wide age range (10-60 years; mean age, 46.7 years). Lesion location also varied, but they were basically dura-based. Radiologically, they showed two patterns: isolated mass forming (n = 6) and an en plaque-like pattern (n = 4). Histopathologically, plasma cell granuloma (PCG)-like (n = 5) or fibrohistiocytic (FHC) variant (n = 5) was present. No correlation was found between the radiologic and histopathologic patterns. Spindle-shaped mesenchymal cells of IMTs expressed smooth muscle actin (SMA) in all cases. ALK expression was not found in our IMTs of the CNS. Late recurrence was found in 2 cases in different sites (20%). Pathologically, IMT-CNS could be subclassified into PCG-like and FHC. Immunostaining for SMA was found to helpfully discriminate myofibroblastic cells and to make a differential diagnosis. Although our cases did not show ALK immunoreactivity, some IMTs-CNS can recur, which suggests the neoplastic potential of these tumors. The rearrangement of the ALK gene in IMTs-CNS should be verified by an examination of more cases.
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Affiliation(s)
- Yoon Kyung Jeon
- Department of Pathology, Seoul National University College of Medicine, Seoul, Republic of Korea
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Despeyroux-Ewers M, Catalaâ I, Collin L, Cognard C, Loubes-Lacroix F, Manelfe C. Inflammatory myofibroblastic tumour of the spinal cord: case report and review of the literature. Neuroradiology 2003; 45:812-7. [PMID: 14517703 DOI: 10.1007/s00234-003-1069-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2002] [Accepted: 05/21/2003] [Indexed: 12/22/2022]
Abstract
Inflammatory myofibroblastic tumours (IMT), also called inflammatory pseudotumours, nodular lymphoid hyperplasia, plasma-cell granuloma and fibrous xanthoma, are rare soft-tissue lesions characterised by inflammatory cells and a fibrous stroma. Clinically and radiologically, they may look like malignant tumours. They rarely affect the central nervous system and are very rare in the spinal cord. We report an IMT of the spinal cord in a 22-year-old woman presenting with spinal cord compression and a cauda equina syndrome. MRI showed a lesion at T9 with extramedullary and intramedullary components giving low signal on T2-weighted images and enhancing homogeneously. Pial lesions on the lumbar enlargement and thoracic spinal were present 11 months after surgery, when the lesion recurred. We present the radiological, operative and pathological findings and review the literature.
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Affiliation(s)
- M Despeyroux-Ewers
- Department of Diagnostic and Therapeutic Neuroradiology, Hôpital Purpan, Place du Docteur Baylac, 31059 Toulouse, France
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Buccoliero AM, Caldarella A, Santucci M, Ammannati F, Mennonna P, Taddei A, Taddei GL. Plasma cell granuloma--an enigmatic lesion: description of an extensive intracranial case and review of the literature. Arch Pathol Lab Med 2003; 127:e220-3. [PMID: 12683907 DOI: 10.5858/2003-127-e220-pcgel] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
We present an unusual case of intracranial plasma cell granuloma in a 70-year-old man with a 6-month history of progressive visual disturbance. The lesion extensively involved the cranial base, extended into the frontal region, and reached the floor of the third ventricle in the suprasellar area. Microscopic examination of multiple diagnostic transsphenoidal biopsies showed an inflammatory proliferation with a predominance of cells that were immunohistochemically determined to be polyclonal plasma cells. Ultrastructural analysis confirmed the presence of numerous mature plasma cells in a mixed inflammatory proliferation. In situ hybridization for Epstein-Barr viral RNA revealed no evidence of viral expression. The patient was treated with steroid therapy and radiotherapy, without any appreciable reduction of the lesion's size. He is alive with persistent severe visual disturbance 14 months after the diagnosis. We discuss the etiopathogenetic, diagnostic, and therapeutic issues related to this entity, and review the literature.
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Affiliation(s)
- Anna Maria Buccoliero
- Dipartimento di Patologia Umana e Oncologia, Università degli Studi di Firenze, Firenze, Italy
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