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Rincón-Arias N, Romo JA, Galvis KA, Sierra MA, Pulido PA, Espinosa S, Castro E, Zorro-Guio OF, Ordoñez-Rubiano EG. Long-Term Progression of a Residual Cerebral Amyloidoma: An Illustrative Case and Systematic Review. World Neurosurg 2024:S1878-8750(24)01451-7. [PMID: 39179025 DOI: 10.1016/j.wneu.2024.08.081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2024] [Revised: 08/11/2024] [Accepted: 08/12/2024] [Indexed: 08/26/2024]
Abstract
OBJECTIVE Cerebral amyloidomas (CA) are exceptionally rare tumor-like lesions composed of cerebral amyloid-beta, which is derived from the cleavage of the amyloid precursor protein. METHODS We presented a case of recurrent CA and performed a systematic review, comparing their initial presentation, imaging features, neurosurgical treatment, and natural history of the disease. ILLUSTRATIVE CASE A 65-year-old male with a history of right homonymous hemianopsia, who underwent subtotal resection of a CA 19 years before, presents to the emergency department with right hemiparesis, dysarthria, and a new onset of clonic seizures. Imaging revealed a left parieto-occipital lesion with calcifications and vasogenic edema. A gross-total resection was performed. Histopathology revealed a hypocellular eosinophilic lesion consistent with CA. Postoperatively, the patient recovered without new neurological deficits. One-year follow-up magnetic resonance imaging showed no residual or recurrence lesion. SEARCH RESULTS Eighty-seven cases, including ours, revealed that 65.5% (n = 57) were females with a median age of 54 years (IQR: 46-62). Most lesions were solitary (82.7%; 72 of 87 lesions). Frontal and parietal lobes were most commonly affected with 32.9% (n = 28) and 30.5% (n = 26), respectively. Seizures were the most common symptom followed by visual compromise. Calcifications were present in 19.5% (n = 17) of the lesions. CONCLUSIONS This systematic review provides insights into the epidemiological, clinical, and neurosurgical characteristics, as well as the long-term prognosis of CA. This marks the first case in the reviewed literature with a 19-year period of follow-up where the patient had reoperation due to disease progression.
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Affiliation(s)
- Nicolás Rincón-Arias
- Department of Neurosurgery, Fundación Universitaria de Ciencias de la Salud, Hospital de San José - Sociedad de Cirugía de Bogotá, Bogotá, Colombia; Department of Neurosurgery, Fundación Universitaria de Ciencias de la Salud, Hospital Infantil Universitario de San José, Bogotá, Colombia.
| | - Jorge Alberto Romo
- Department of Neurosurgery, Fundación Universitaria de Ciencias de la Salud, Hospital de San José - Sociedad de Cirugía de Bogotá, Bogotá, Colombia; Department of Neurosurgery, Fundación Universitaria de Ciencias de la Salud, Hospital Infantil Universitario de San José, Bogotá, Colombia
| | - Katty Andrea Galvis
- Department of Neurosurgery, Fundación Universitaria de Ciencias de la Salud, Hospital de San José - Sociedad de Cirugía de Bogotá, Bogotá, Colombia; Department of Neurosurgery, Fundación Universitaria de Ciencias de la Salud, Hospital Infantil Universitario de San José, Bogotá, Colombia
| | | | - Paula Andrea Pulido
- Department of Neurosurgery, Fundación Universitaria de Ciencias de la Salud, Hospital de San José - Sociedad de Cirugía de Bogotá, Bogotá, Colombia; Department of Neurosurgery, Fundación Universitaria de Ciencias de la Salud, Hospital Infantil Universitario de San José, Bogotá, Colombia
| | - Sebastián Espinosa
- Department of Neurosurgery, Fundación Universitaria de Ciencias de la Salud, Hospital de San José - Sociedad de Cirugía de Bogotá, Bogotá, Colombia; Department of Neurosurgery, Fundación Universitaria de Ciencias de la Salud, Hospital Infantil Universitario de San José, Bogotá, Colombia
| | - Esteban Castro
- Department of Pathology, Fundación Universitaria de Ciencias de la Salud, Hospital de San José - Sociedad de Cirugía de Bogotá, Bogotá, Colombia
| | - Oscar F Zorro-Guio
- Department of Neurosurgery, Fundación Universitaria de Ciencias de la Salud, Hospital de San José - Sociedad de Cirugía de Bogotá, Bogotá, Colombia; Department of Neurosurgery, Fundación Universitaria de Ciencias de la Salud, Hospital Infantil Universitario de San José, Bogotá, Colombia
| | - Edgar G Ordoñez-Rubiano
- Department of Neurosurgery, Fundación Universitaria de Ciencias de la Salud, Hospital de San José - Sociedad de Cirugía de Bogotá, Bogotá, Colombia; Department of Neurosurgery, Hospital Universitario Fundación Santa Fe de Bogotá, Bogotá, Colombia
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2
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Traets MJM, Chuwonpad K, Leguit RJ, Frequin STFM, Minnema MC. Primary cerebral immunoglobulin light chain amyloidoma in a patient with multiple sclerosis. BMJ Case Rep 2024; 17:e256537. [PMID: 38272520 PMCID: PMC10826495 DOI: 10.1136/bcr-2023-256537] [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] [Indexed: 01/27/2024] Open
Abstract
A man in his 60s, known with multiple sclerosis, presented with seizures and paresis of the left arm and leg. Brain imaging showed a white matter lesion, right parietal, which was progressive over the last 6 years and not typical for multiple sclerosis. Brain biopsy showed a B-cell infiltrate with IgA lambda monotypic plasma cell differentiation and amyloid deposits, typed as lambda immunoglobulin light chain (AL). Bone marrow biopsy and PET/CT ruled out a systemic lymphoma. Extended history taking, blood and urine testing (including cardiac biomarkers) identified no evidence of systemic amyloidosis-induced organ dysfunction.Primary cerebral AL amyloidoma is a very rare entity where optimal treatment is difficult to assess. The patient was treated with locally applied volumetric modulated arc radiotherapy, 24 Gy, divided in 12 fractions. Afterwards, the paresis of the left arm partially resolved, and the function of the left leg improved. Seizures did not occur anymore.
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Affiliation(s)
- Marissa J M Traets
- Department of Internal Medicine, Sint Antonius Hospital, Nieuwegein, Netherlands
| | - Krisna Chuwonpad
- Department of Internal Medicine, Sint Antonius Hospital, Nieuwegein, Netherlands
| | - Roos J Leguit
- Department of Pathology, University Medical Center Utrecht, Utrecht, The Netherlands
| | | | - Monique C Minnema
- Department of Hematology, University Medical Centre, Utrecht, Netherlands
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3
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Trikannad AK, Shrestha A, Vellanki S, Cheema HI, Patel TH, Bachu R, Sharma S, Jeffus SK, Thanendrarajan S. Amyloid Light-Chain (AL) Amyloidosis of the Trachea Associated With an Indolent B-cell Neoplasm. Cureus 2024; 16:e53074. [PMID: 38414681 PMCID: PMC10896678 DOI: 10.7759/cureus.53074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/27/2024] [Indexed: 02/29/2024] Open
Abstract
We report the case of a 66-year-old woman who was diagnosed with localized tracheal amyloid light-chain (AL) amyloidosis caused by an underlying B-cell neoplasm. The diagnosis was confirmed through subsequent bronchoscopy and biopsies; however, she experienced a challenging episode of hypoxic respiratory failure that required intervention. Repeat bronchoscopies showed persistent subglottic stenosis and tracheobronchomalacia, which led to tracheal debulking surgery and additional interventions. The patient's treatment began with rituximab, zanubrutinib, and dexamethasone with outpatient follow-up. The rarity of tracheobronchial amyloidosis and its connection to B-cell malignancies are highlighted, emphasizing the challenges in diagnosis and the importance of tailored treatment strategies. The patient's clinical course, characterized by atypical respiratory symptoms, delayed diagnosis, and an evolving treatment approach, underscores the complexities of managing such a rare and intricate case.
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Affiliation(s)
- Anup Kumar Trikannad
- Internal Medicine, University of Arkansas for Medical Sciences, Little Rock, USA
| | - Asis Shrestha
- Internal Medicine, University of Arkansas for Medical Sciences, Little Rock, USA
| | - Sruthi Vellanki
- Internal Medicine, University of Arkansas for Medical Sciences, Little Rock, USA
| | - Hira I Cheema
- Internal Medicine, University of Arkansas for Medical Sciences, Little Rock, USA
| | - Tanvi H Patel
- Internal Medicine, University of Arkansas for Medical Sciences, Little Rock, USA
| | - Ramya Bachu
- Internal Medicine, University of Arkansas for Medical Sciences, Little Rock, USA
| | - Shobhit Sharma
- Radiology, University of Arkansas for Medical Sciences, Little Rock, USA
| | - Susanne K Jeffus
- Pathology, University of Arkansas for Medical Sciences, Little Rock, USA
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4
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Ogilvie J, Zhao R, Camelo-Piragua S, Ibrahim M, Lobo R, Kim J. Magnetic resonance imaging of a temporal lobe cerebral amyloidoma. Radiol Case Rep 2022; 17:2820-2823. [PMID: 35694634 PMCID: PMC9184293 DOI: 10.1016/j.radcr.2022.05.038] [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: 04/19/2022] [Revised: 05/11/2022] [Accepted: 05/13/2022] [Indexed: 11/30/2022] Open
Abstract
Amyloidomas are focal solitary amyloid masses without systemic involvement that have been observed to occur in various body locations. When presenting intracranially, they pose a challenging diagnostic and therapeutic course given their location and rarity. We report a case of a 62-year-old man with a 4-year history of seizure and headaches. Magnetic resonance imaging was initially inconclusive but revealed an ill-defined right temporal lobe lesion. Biopsy later confirmed a cerebral amyloidoma. We also review the current literature on the pathogenesis, imaging findings, prognosis, and treatment of cerebral amyloidomas.
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Affiliation(s)
- Jack Ogilvie
- Department of Radiology, Henry Ford Hospital, 2799 E Grand Blvd, Detroit, MI 48202, USA
| | - Raymond Zhao
- Division of Neuroradiology, Department of Radiology, University of Michigan, 1500 E. Medical Center Dr., Ann Arbor, MI, 48109, USA
| | - Sandra Camelo-Piragua
- Deptartment of Pathology, University of Michigan, 1500 E. Medical Center Dr., Ann Arbor, MI 48109, USA
| | - Mohannad Ibrahim
- Division of Neuroradiology, Department of Radiology, University of Michigan, 1500 E. Medical Center Dr., Ann Arbor, MI, 48109, USA
| | - Remy Lobo
- Division of Neuroradiology, Department of Radiology, University of Michigan, 1500 E. Medical Center Dr., Ann Arbor, MI, 48109, USA
| | - John Kim
- Division of Neuroradiology, Department of Radiology, University of Michigan, 1500 E. Medical Center Dr., Ann Arbor, MI, 48109, USA
- Corresponding author.
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5
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Yamashita H, Fujimoto M, Yokogawa R, Taguchi T, Ohara J, Ogata H, Akiyama Y. Cerebral Amyloidoma Accompanied by Sjögren's Syndrome: A Case Report and Literature Review. NMC Case Rep J 2022; 8:781-786. [PMID: 35079548 PMCID: PMC8769455 DOI: 10.2176/nmccrj.cr.2021-0088] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Accepted: 09/23/2021] [Indexed: 11/20/2022] Open
Abstract
We present a 69-year-old woman with colorectal cancer and a left frontal lobe tumor that was diagnosed as a cerebral amyloidoma after surgical resection. Further postoperative systemic evaluation revealed another amyloidoma in her hip as well as Sjögren's syndrome. Systemic amyloidosis was not present. To the best of our knowledge, this is the first case of cerebral amyloidoma presenting as one of the multiple localized amyloidomas accompanied by Sjögren's syndrome. We also present a systematic review of 65 cerebral amyloidoma cases reported in the literature over the past 40 years and discuss patient characteristics and pathological and imaging findings associated with prognosis.
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Affiliation(s)
| | | | - Ryuta Yokogawa
- Department of Neurosurgery, Tenri Hospital, Tenri, Nara, Japan
| | - Tomoaki Taguchi
- Department of Neurosurgery, Tenri Hospital, Tenri, Nara, Japan
| | - Jiro Ohara
- Department of Neurosurgery, Tenri Hospital, Tenri, Nara, Japan
| | - Hideki Ogata
- Department of Neurosurgery, Tenri Hospital, Tenri, Nara, Japan
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Authier D, Hegenbart U, Pohl F, Rosenwald A, Kircher S, Menhart K, Perl M, Cerny J, Mayer S, Herr W, Grube M. Low dose stereotactic irradiation and dexamethasone in primary cerebral light chain deposition disease (LCDD). Leuk Lymphoma 2021; 62:2267-2271. [PMID: 33787427 DOI: 10.1080/10428194.2021.1907380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Daniel Authier
- Department of Internal Medicine III, Hematology and Oncology, University Hospital Regensburg, Regensburg, Germany
| | - Ute Hegenbart
- Amyloidosis Center, University Hospital Heidelberg, Heidelberg, Germany
| | - Fabian Pohl
- Department of Radiotherapy, University Hospital Regensburg, Regensburg, Germany
| | | | - Stefan Kircher
- Institute of Pathology, University Würzburg, Würzburg, Germany
| | - Karin Menhart
- Department of Nuclear Medicine, University Hospital Regensburg, Regensburg, Germany
| | - Markus Perl
- Department of Internal Medicine III, Hematology and Oncology, University Hospital Regensburg, Regensburg, Germany
| | - Jindrich Cerny
- Department of Internal Medicine III, Hematology and Oncology, University Hospital Regensburg, Regensburg, Germany
| | - Stephanie Mayer
- Department of Internal Medicine III, Hematology and Oncology, University Hospital Regensburg, Regensburg, Germany
| | - Wolfgang Herr
- Department of Internal Medicine III, Hematology and Oncology, University Hospital Regensburg, Regensburg, Germany
| | - Matthias Grube
- Department of Internal Medicine III, Hematology and Oncology, University Hospital Regensburg, Regensburg, Germany
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7
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Abstract
Amyloid deposition can lead to Alzheimer disease and cerebral amyloid angiopathy. Rarely, it presents as a solitary focal deposition, primary cerebral amyloidoma, which can be misinterpreted as a neoplasm because of the "tumor-like" appearances. We present the case of a 54-year-old woman where MRI revealed a T2-hyperintense mass periventricular in the white matter with moderate contrast enhancement. Pathological investigation revealed AL (lambda) amyloidoma. F-florbetapir PET/CT was used to support the diagnosis and in follow-up. This case highlights that F-florbetapir PET/CT might play a role in the diagnostic workup of patients suggestive of cerebral amyloidoma, especially in cases where biopsy is not feasible.
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8
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Gokden M. Amyloid Deposition in the Brain. Arch Pathol Lab Med 2020; 144:1162-1163. [PMID: 33002155 DOI: 10.5858/arpa.2020-0136-le] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/18/2020] [Indexed: 11/06/2022]
Affiliation(s)
- Murat Gokden
- Department of Pathology, University of Arkansas for Medical Sciences, Little Rock, Arkansas
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9
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Basset M, Hummedah K, Kimmich C, Veelken K, Dittrich T, Brandelik S, Kreuter M, Hassel J, Bosch N, Stuhlmann-Laeisz C, Blank N, Müller-Tidow C, Röcken C, Hegenbart U, Schönland S. Localized immunoglobulin light chain amyloidosis: Novel insights including prognostic factors for local progression. Am J Hematol 2020; 95:1158-1169. [PMID: 32602121 DOI: 10.1002/ajh.25915] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 06/22/2020] [Accepted: 06/23/2020] [Indexed: 12/11/2022]
Abstract
In localized light chain amyloidosis (locAL), amyloidogenic light chains (aLC) are produced and deposited locally by a B-cell clone. We present 293 patients with immunohistochemically confirmed locAL. Lung (nodular pulmonary) with 63 patients was the most involved organ. The aLC was λ in 217 cases (κ:λ ratio 1:3). A local B-cell clone was identified in 30% of cases. Sixty-one (21%) had a concomitant autoimmune disorder (cAD). A monoclonal component (MC) were present in 101 (34%) patients and were more frequent in subjects with cAD (51% vs 34%; P = .03). Cigarette smoking was more prevalent in lung locAL (54% vs 37%; P = .018). After a median follow-up of 44 months, 16 patients died and 5- and 10-years locAL progression-free survival (PFS) were 62% and 44%. Interestingly, locAL-PFS was shorter among patients with an identified clonal infiltrate at amyloid deposition site (40 vs 109 months; P = .02) and multinuclear giant cells and/or an inflammatory infiltrate resulted in longer locAL-PFS in lung involvement (65 vs 42 months; P = .01). However, no differences in locAL PFS were observed in patients with cAD, a MC and involved organ site. Treatment was administered in 163 (54%) patients and was surgical in 135 (46%). Median locAL-PFS after first treatment was 56 months. Responders had longer locAL-PFS (78 vs 17 months; P < .001). Three patients with lung locAL and a MC were diagnosed as systemic AL amyloidosis at follow-up. In summary, locAL pathogenesis seems to be heterogeneous and the clonal infiltrate leads local progression.
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Affiliation(s)
- Marco Basset
- Medical Department V, Hematology, Oncology and Rheumatology, University Hospital Heidelberg, Heidelberg, Germany
- Amyloidosis Center Heidelberg, University Hospital Heidelberg, Heidelberg, Germany
- Amyloidosis Research and Treatment Center, IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy
- Department of Molecular Medicine, University of Pavia, Pavia, Italy
| | - Kamal Hummedah
- Medical Department V, Hematology, Oncology and Rheumatology, University Hospital Heidelberg, Heidelberg, Germany
- Amyloidosis Center Heidelberg, University Hospital Heidelberg, Heidelberg, Germany
| | - Christoph Kimmich
- Medical Department V, Hematology, Oncology and Rheumatology, University Hospital Heidelberg, Heidelberg, Germany
- Amyloidosis Center Heidelberg, University Hospital Heidelberg, Heidelberg, Germany
| | - Kaya Veelken
- Medical Department V, Hematology, Oncology and Rheumatology, University Hospital Heidelberg, Heidelberg, Germany
- Amyloidosis Center Heidelberg, University Hospital Heidelberg, Heidelberg, Germany
| | - Tobias Dittrich
- Medical Department V, Hematology, Oncology and Rheumatology, University Hospital Heidelberg, Heidelberg, Germany
- Amyloidosis Center Heidelberg, University Hospital Heidelberg, Heidelberg, Germany
| | - Simone Brandelik
- Amyloidosis Center Heidelberg, University Hospital Heidelberg, Heidelberg, Germany
- Department of Diagnostic and Interventional Radiology, University Hospital Heidelberg, Heidelberg, Germany
| | - Michael Kreuter
- Amyloidosis Center Heidelberg, University Hospital Heidelberg, Heidelberg, Germany
- Center for interstitial and rare lung diseases, Thoraxklinik, University Hospital Heidelberg and German Center for Lung Research, Heidelberg, Germany
| | - Jessica Hassel
- Amyloidosis Center Heidelberg, University Hospital Heidelberg, Heidelberg, Germany
- Skin Cancer Center, Department of Dermatology and National Center for Tumor Diseases (NCT), University Hospital Heidelberg, Heidelberg, Germany
| | - Nikolaus Bosch
- Amyloidosis Center Heidelberg, University Hospital Heidelberg, Heidelberg, Germany
- Heidelberger StimmZentrum, Universitäts HNO Klinik Heidelberg, Heidelberg, Germany
| | | | - Norbert Blank
- Medical Department V, Hematology, Oncology and Rheumatology, University Hospital Heidelberg, Heidelberg, Germany
- Amyloidosis Center Heidelberg, University Hospital Heidelberg, Heidelberg, Germany
| | - Carsten Müller-Tidow
- Medical Department V, Hematology, Oncology and Rheumatology, University Hospital Heidelberg, Heidelberg, Germany
- Amyloidosis Center Heidelberg, University Hospital Heidelberg, Heidelberg, Germany
| | - Christoph Röcken
- Department of Pathology, Christian-Albrechts-University Kiel, Kiel, Germany
| | - Ute Hegenbart
- Medical Department V, Hematology, Oncology and Rheumatology, University Hospital Heidelberg, Heidelberg, Germany
- Amyloidosis Center Heidelberg, University Hospital Heidelberg, Heidelberg, Germany
| | - Stefan Schönland
- Medical Department V, Hematology, Oncology and Rheumatology, University Hospital Heidelberg, Heidelberg, Germany
- Amyloidosis Center Heidelberg, University Hospital Heidelberg, Heidelberg, Germany
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Minimally Invasive Resection of Intracerebral Amyloidoma: Case Report and Systematic Review of the Literature. World Neurosurg 2020; 138:205-213. [PMID: 32084617 DOI: 10.1016/j.wneu.2020.02.072] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Accepted: 02/11/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND Management of cerebral amyloidomas has lacked consensus owing to their rarity. We present a case and review 39 reported cases of amyloidomas in the literature, comparing their initial presentation, imaging characteristics, treatment, and progression. CASE DESCRIPTION A 56-year-old woman presented with a history of intractable headaches and progressive speech difficulty. Imaging demonstrated a 1.7 × 2.6 cm left frontal subcortical hemorrhagic mass with an associated developmental venous anomaly, characteristics initially suggestive of a cavernous malformation. Diffusion tractography imaging was employed to avoid interference with the intact arcuate fasciculus and corticospinal tracts to minimize neurologic deficits. CONCLUSIONS To our knowledge, this is the first documented case of the use of diffusion tractography in preoperative planning for cerebral amyloidoma resection. Our systematic review of 39 reported cases of amyloidomas in the literature provided insight regarding how these rare lesions have manifested and progressed and further understanding of current theories regarding their etiology and pathophysiology. Cerebral amyloidomas are rare, localized, proteinaceous aggregates with variable presentation and prognosis and no apparent relationship to systemic amyloidosis. Biopsy may be useful in determination of progression. Diffusion tractography is a valuable tool for minimizing complications associated with resection.
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11
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Swanson A, Giannini C, Link M, Van Gompel J, Wald J, McPhail E, Theis J, Vaubel R. Trigeminal Amyloidoma: A Report of Two Cases and Review of the Literature. J Neurol Surg B Skull Base 2019; 81:620-626. [PMID: 33381365 DOI: 10.1055/s-0039-1693111] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Accepted: 05/28/2019] [Indexed: 10/26/2022] Open
Abstract
Cerebral amyloidomas, characterized by localized amyloid deposits in the nervous system in the absence of systemic disease, are rare. These typically consist of immunoglobulin light chain (AL)-type, predominantly lambda. Trigeminal nerve involvement is exceptionally rare with only 21 previously reported cases, three with bilateral disease. We report two additional cases of amyloid localized to Meckel's cave with secondary involvement of the trigeminal nerves bilaterally, with protein characterization by mass spectrometry. The patients, both females, 39 and 49-years-old, respectively, presented with the insidious onset of progressive trigeminal neuropathy, including pain and numbness with sensory loss, refractory to medical therapy. One patient experienced bilateral symptoms. Magnetic resonance imaging demonstrated abnormal thickening and contrast enhancement along Meckel's cave bilaterally in both cases. The clinical differential diagnosis included benign neoplasms and inflammatory disorders. At the time of biopsy, the trigeminal nerve was noted to be enlarged and multinodular in one case and associated with abnormal soft tan tissue in the other case. Microscopically, the nerve biopsies showed extensive Congo red-positive amyloid deposits. Liquid chromatography tandem mass spectrometry demonstrated that the amyloid was of (AL)-type in both cases (AL [kappa] in one case and AL [lambda] in the other). After extensive evaluation, there was no evidence of systemic involvement. Both patients received localized radiotherapy for their refractory symptoms. One patient has stable symptomatology and imaging. No follow-up is available for the other patient.
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Affiliation(s)
- Amy Swanson
- Division of Anatomic Pathology, Mayo Clinic, Rochester, Minnesota
| | | | - Michael Link
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Jamie Van Gompel
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota
| | - John Wald
- Department of Diagnostic Radiology, Mayo Clinic, Rochester, Minnesota
| | - Ellen McPhail
- Division of Hematopathology, Mayo Clinic, Rochester, Minnesota
| | - Jason Theis
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota
| | - Rachael Vaubel
- Division of Anatomic Pathology, Mayo Clinic, Rochester, Minnesota
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12
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Löhr M, Kessler AF, Monoranu CM, Grosche J, Linsenmann T, Ernestus RI, Härtig W. Primary brain amyloidoma, both a neoplastic and a neurodegenerative disease: a case report. BMC Neurol 2019; 19:59. [PMID: 30971206 PMCID: PMC6458836 DOI: 10.1186/s12883-019-1274-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Accepted: 03/18/2019] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Scattered extracellular deposits of amyloid within the brain parenchyma can be found in a heterogeneous group of diseases. Its condensed accumulation in the white matter without evidence for systemic amyloidosis is known as primary brain amyloidoma (PBA). Although originally considered as a tumor-like lesion by its space-occupying effect, this condition displays also common hallmarks of a neurodegenerative disorder. CASE PRESENTATION A 50-year-old woman presented with a mild cognitive decline and seizures with a right temporal, irregular and contrast-enhancing mass on magnetic resonance imaging. Suspecting a high-grade glioma, the firm tumor was subtotally resected. Neuropathological examination showed no glioma, but distinct features of a neurodegenerative disorder. The lesion was composed of amyloid AL λ aggregating within the brain parenchyma as well as the adjacent vessels, partially obstructing the vascular lumina. Immunostaining confirmed a distinct perivascular inflammatory reaction. After removal of the PBA, mnestic impairments improved considerably, the clinical course and MRI-results are stable in the 8-year follow-up. CONCLUSION Based on our histopathological findings, we propose to regard the clinicopathological entity of PBA as an overlap between a neoplastic and neurodegenerative disorder. Since the lesions are locally restricted, they might be amenable to surgery with the prospect of a definite cure.
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Affiliation(s)
- Mario Löhr
- Department of Neurosurgery, University Hospital of Wuerzburg, Josef-Schneider-Str. 11, 97080, Würzburg, Germany.
| | - Almuth F Kessler
- Department of Neurosurgery, University Hospital of Wuerzburg, Josef-Schneider-Str. 11, 97080, Würzburg, Germany
| | - Camelia-Maria Monoranu
- Department of Neuropathology, Institute of Pathology, University of Wuerzburg, Josef-Schneider-Str. 2, 97080, Würzburg, Germany
| | - Jens Grosche
- Paul Flechsig Institute for Brain Research, University of Leipzig, Liebigstr. 19, 04103, Leipzig, Germany
| | - Thomas Linsenmann
- Department of Neurosurgery, University Hospital of Wuerzburg, Josef-Schneider-Str. 11, 97080, Würzburg, Germany
| | - Ralf-Ingo Ernestus
- Department of Neurosurgery, University Hospital of Wuerzburg, Josef-Schneider-Str. 11, 97080, Würzburg, Germany
| | - Wolfgang Härtig
- Paul Flechsig Institute for Brain Research, University of Leipzig, Liebigstr. 19, 04103, Leipzig, Germany
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13
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AL amyloidosis with a localized B cell neoplasia. Virchows Arch 2019; 474:353-363. [DOI: 10.1007/s00428-019-02527-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Revised: 01/11/2019] [Accepted: 01/15/2019] [Indexed: 02/06/2023]
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14
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Cerebral Amyloidoma Resulting from Central Nervous System Lymphoplasmacytic Lymphoma: A Case Report and Literature Review. Case Rep Pathol 2018; 2018:5083234. [PMID: 30046502 PMCID: PMC6038588 DOI: 10.1155/2018/5083234] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Accepted: 06/04/2018] [Indexed: 12/16/2022] Open
Abstract
Cerebral amyloidomas are rare cerebral mass lesions often associated with significant morbidity. Cerebral amyloid accumulation can be the result of a number of disease states and it is crucial for proper patient care to identify the pathogenic process leading to amyloidoma formation. Low grade clonal B-cell processes are one cause of cerebral amyloidomas. We report a case of an 87-year-old woman who presented with a lymphoplasmacytic lymphoma associated cerebral amyloidoma complicated by cerebral hemorrhage, discuss the proper workup of this disease entity, and present a review of the literature on this topic.
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Schneider JR, Kwan K, Kulason KO, Faltings LJ, Colantonio S, Safir S, Loven T, Li JY, Black KS, Schaeffer BT, Eisenberg MB. Primary solitary retro-clival amyloidoma. Surg Neurol Int 2018; 9:100. [PMID: 29900030 PMCID: PMC5981182 DOI: 10.4103/sni.sni_483_17] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Accepted: 03/27/2018] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Amyloidosis encompasses a group of disorders sharing the common feature of intercellular deposition of amyloid protein by several different pathogenetic mechanisms. Primary solitary amyloidosis, or amyloidoma, is a rare subset of amyloidosis in which amyloid deposition is focal and not secondary to a systemic process or plasma cell dyscrasia. CASE DESCRIPTION This 84-year-old female presented with history of multiple syncopal episodes, dysphagia, and ataxia. Motor strength was 3+/5 in the right upper extremity. Rheumatoid factor, cyclic citrullinated peptide (CCP), and anti-nuclear antibody (ANA) were normal. Serum and urine immune-electrophoresis detected no abnormal bands. Computed tomography (CT) and magnetic resonance imaging (MRI) demonstrated a non-enhancing soft-tissue mass extending from the retro-clivus to C2 posteriorly, eccentric to the right with severe mass effect on the upper cervical medullary junction. Endoscopic trans-nasal debulking of the retro-clival mass was performed with occiput to C5 posterior instrumentation for spinal stabilization. CONCLUSIONS Primary solitary amyloidosis, unlike other forms of amyloidosis, has an excellent prognosis with local resection. Diagnosis requires special stains and a degree of suspicion for the disease. This is the first report to document an endoscopic trans-nasal approach for removal of a primary solitary amyloidosis of the retro-clivus. Management of vertebral amyloidoma involves aggressive local resection of the tumor when feasible and spine stabilization as the degree of tumor involvement mandates. Complete evaluation for the diagnosis of systemic amyloidosis is essential for the management and prognostication. Surgeons encountering such lesions must maintain high suspicion for this rare disease and advise pathologists accordingly to establish the correct diagnosis.
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Affiliation(s)
- Julia R. Schneider
- Department of Neurosurgery, Zucker School of Medicine at Hofstra/Northwell, Manhasset, New York, USA
| | - Kevin Kwan
- Department of Neurosurgery, Zucker School of Medicine at Hofstra/Northwell, Manhasset, New York, USA
| | - Kay O. Kulason
- Department of Neurosurgery, Zucker School of Medicine at Hofstra/Northwell, Manhasset, New York, USA
| | - Lukas J. Faltings
- Department of Neurosurgery, Zucker School of Medicine at Hofstra/Northwell, Manhasset, New York, USA
| | - Stephanie Colantonio
- Department of Neurosurgery, Zucker School of Medicine at Hofstra/Northwell, Manhasset, New York, USA
| | - Scott Safir
- Department of Neurosurgery, Zucker School of Medicine at Hofstra/Northwell, Manhasset, New York, USA
| | - Tina Loven
- Department of Neurosurgery, Zucker School of Medicine at Hofstra/Northwell, Manhasset, New York, USA
| | - Jian Yi Li
- Department of Pathology and Lab Medicine, Zucker School of Medicine at Hofstra/Northwell, Manhasset, New York, USA
| | - Karen S. Black
- Department of Neuroradiology, Zucker School of Medicine at Hofstra/Northwell, Manhasset, New York, USA
| | - B. Todd Schaeffer
- Department of Otolaryngology and Communicative Disorders, Zucker School of Medicine at Hofstra/Northwell, Manhasset, New York, USA
| | - Mark B. Eisenberg
- Department of Neurosurgery, Zucker School of Medicine at Hofstra/Northwell, Manhasset, New York, USA
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