1
|
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.
Collapse
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.
| |
Collapse
|
2
|
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.
Collapse
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
| | | |
Collapse
|
3
|
Kapoor A, Manje Gowda A, Kaur S, Estifan E, Maroules M. A Rare Case of Cerebral Amyloidoma Mimicking a Hemorrhagic Malignant Central Nervous System Neoplasm. Cureus 2020; 12:e7245. [PMID: 32284920 PMCID: PMC7147526 DOI: 10.7759/cureus.7245] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Cerebral amyloidoma is a rare form of amyloidosis with a localized tumor like an amyloid deposition in the brain composed of insoluble fibrillary protein with cross beta-sheet conformation. Its usual presentation includes vision loss, seizures, behavioral changes, cognitive decline, and recurrent headaches. It has a benign course with a slow progression, and it is not associated with dissemination. We report a case of a 65-year-old Caucasian woman who presented with symptoms of progressively worsening cognitive dysfunction of six months' duration. From CT of the brain, it was found that she had a right frontal and left parietal hemorrhagic mass with a large amount of vasogenic edema and a midline shift. MRI showed heterogeneously enhancing hemorrhagic mass of 5.2 cm x 2.6 cm x 3.6 cm in size, with a satellite lesion. Initially, this was suspected to be a high-grade glioma vs. metastatic hemorrhagic lesions. She underwent stereotactic biopsy of the mass, and histopathology was consistent with cerebral amyloidoma with marked IgA lambda plasma cell differentiation. She did not have any evidence of systemic amyloidosis, and therefore, she is being clinically observed with a regular follow-up and annual CT surveillance. She has remained stable over the past two years, although she has residual cognitive dysfunction. Cerebral amyloidoma can mimic malignant central nervous system (CNS) neoplasms and should be considered as a differential of any single or multiple mass lesions occurring in the white matter region of the brain with a characteristic appearance of "hyperdense lesions" on CT. It is a benign disease with no metastatic potential that usually resolves entirely after resection.
Collapse
Affiliation(s)
- Ashima Kapoor
- Internal Medicine, St. Joseph's University Medical Center, Paterson, USA
| | - Anusha Manje Gowda
- Hematology/Oncology, St. Joseph's University Medical Center, Paterson, USA.,Hematology/Oncology, St. Joseph's Regional Medical Center, Paterson, USA
| | - Supreet Kaur
- Hematology/Oncology, St. Joseph's University Medical Center, Paterson, USA
| | - Elias Estifan
- Internal Medicine, St. Joseph's University Medical Center, Paterson, USA
| | - Michael Maroules
- Hematology/Oncology, St. Joseph's University Medical Center, Paterson, USA
| |
Collapse
|
4
|
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.
Collapse
|
5
|
Cerebral amyloidoma: A mimicker of granulomatous disease on brain MRI. J Neuroradiol 2019; 46:336-339. [PMID: 30853542 DOI: 10.1016/j.neurad.2019.02.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2017] [Revised: 02/19/2018] [Accepted: 02/06/2019] [Indexed: 11/20/2022]
|
6
|
Abstract
Amyloid is an abnormal insoluble protein that can deposit in extracellular space. It can involve nearly any organ system and may manifest as a systemic process or focal lesion (amyloidoma). We present a rare case of localized amyloidosis with trigeminal nerve being the only site of involvement and no evidence of systemic disease. We also review literature relevant to trigeminal amyloidoma and make recommendations for diagnosis and treatment.
Collapse
Affiliation(s)
- Hamza Hashmi
- Oncology, University of Louisville School of Medicine, Louisville, USA
| | - Jugraj Dhanoa
- Internal Medicine, University of Louisville School of Medicine, Louisville, USA
| | - Suresh Manapuram
- Internal Medicine, Saint Francis Hospital and Medical Center, Grand Island, USA
| |
Collapse
|
7
|
Pace A, Lownes S, Shivane A, Hilton D, Weatherby S. A tale of the unexpected: Amyloidoma associated with intracerebral lymphoplasmacytic lymphoma. J Neurol Sci 2015; 359:404-8. [DOI: 10.1016/j.jns.2015.09.372] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2015] [Revised: 08/26/2015] [Accepted: 09/27/2015] [Indexed: 11/26/2022]
|
8
|
Abstract
Although AL amyloidosis usually is a systemic disease, strictly localized AL deposits are not exceptionally rare. Such case reports form a considerable body of published articles. Although both AL amyloidosis types are formed from an N-terminal segment of a monoclonal immunoglobulin light chain, a typical localized AL amyloid differs from the systemic counterpart by the morphological appearance of the amyloid, and presence of clonal plasma cells and of giant cells. In this article it is pointed out that localized AL amyloidosis ('amyloidoma') represents a true plasma cell neoplasm and not a pseudotumor. The pathogenesis of localized AL amyloidosis may differ from that of the systemic type, a suggestion underlined by the fact that localized AL amyloidosis of kappa type is as common as that of lambda origin, in contrast to the systemic form where lambda chains constitute the overwhelming majority of cases. It is suggested that oligomeric assemblies of the produced immunoglobulin light chain are toxic to plasma cells, which in this way commit suicide.
Collapse
Affiliation(s)
- Per Westermark
- Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden.
| |
Collapse
|
9
|
Parmar H, Rath T, Castillo M, Gandhi D. Imaging of focal amyloid depositions in the head, neck, and spine: amyloidoma. AJNR Am J Neuroradiol 2010; 31:1165-70. [PMID: 20075086 DOI: 10.3174/ajnr.a1977] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Amyloidomas are benign tumorlike lesions consisting of localized deposits of amyloid and are the rarest form in the group of amyloidosis-related lesions. Diagnosis requires special stains; therefore, a high degree of suspicion for this disease is required. In this review, we describe the imaging features of amyloidomas involving the intracranial compartment, head and neck, and spine. We also discuss the differential diagnosis and briefly review the pertinent literature.
Collapse
Affiliation(s)
- Hemant Parmar
- Department of Radiology, University of Michigan Health System, Ann Arbor, Michigan 48109-0302, USA.
| | | | | | | |
Collapse
|
10
|
Bookland MJ, Bagley CA, Schwarz J, Burger PC, Brem H. INTRACAVERNOUS TRIGEMINAL GANGLION AMYLOIDOMA. Neurosurgery 2007; 60:E574; discussion E574. [PMID: 17327767 DOI: 10.1227/01.neu.0000255361.32689.b3] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Abstract
OBJECTIVE
Isolated amyloidomas rarely manifest in nervous system tissues. To the authors' knowledge, there have been 52 documented cases of primary amyloid tumors of the central nervous system and closely associated structures. The authors present a case of a woman with a history of presumptive trigeminal neuralgia who was found to have an amyloidoma of the trigeminal ganglion.
CLINICAL PRESENTATION
A 32-year-old Caucasian patient presented with a chief complaint of severe numbness and pain throughout the right side of her face. Her symptoms had been progressive over the previous 3 years. Medical management of her presumptive diseases with Zoloft (Pfizer Inc., New York, NY) and Neurontin (Pfizer Inc.) failed to improve or halt her right facial numbness and pain. Brain magnetic resonance imaging was acquired, demonstrating abnormal contrast enhancement and enlargement of the right trigeminal ganglion. The lesion abutted and indented the right internal carotid artery and extended from Meckel's cave into the inferior cavernous sinus and distally to the foramen ovale.
INTERVENTION
The patient underwent a right frontotemporal craniotomy for resection of the gasserian ganglion lesion. A delicate incision was made in the wall of the cavernous sinus, allowing confirmatory biopsy of the lesion. With the site of the tumor within the cavernous sinus verified by pathology, the remainder of the tumor was removed. A final pathological review of the resected tumor confirmed a diagnosis of amyloidoma of the trigeminal ganglion.
CONCLUSION
We present the case of a patient with a rare trigeminal ganglion amyloidoma that closely mimicked idiopathic trigeminal neuralgia. Even in the absence of systemic signs of amyloidosis, this benign protein deposition disease should be considered in the differential for atypical dysesthesias of the trigeminal dermatomes. Furthermore, central and peripheral nervous system amyloidomas respond well to surgical resection and rarely recur.
Collapse
Affiliation(s)
- Markus J Bookland
- Department of Neurosurgery, The Johns Hopkins School of Medicine, Baltimore, Maryland 21287, USA
| | | | | | | | | |
Collapse
|
11
|
Matsumoto T, Tani E, Fukami M, Kaba K, Yokota M, Hoshii Y. Amyloidoma in the gasserian ganglion: case report. SURGICAL NEUROLOGY 1999; 52:600-3. [PMID: 10660026 DOI: 10.1016/s0090-3019(99)00128-7] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Amyloidoma in the central nervous system is extremely rare. We describe a rare case of amyloidoma in the gasserian ganglion manifesting as trigeminal neuropathy. METHODS A 41-year-old woman was admitted to our hospital with progressive numbness and hypalgesia in the distribution of the second and third divisions of the left trigeminal nerve. There was no evidence of chronic inflammatory disorder or immunological abnormalities. Magnetic resonance images showed a mass in the left Meckel's cave that was brightly enhanced with gadolinium. RESULTS A reddish, firm mass was successfully removed via a left temporal craniotomy. Histologically, the tumor was composed of larger acellular deposits of eosinophilic material. The acellular deposits were positive for potassium permanganate-resistant Congo red staining, showing apple-green birefringence under polarized light and expression of immunoglobulin lambda light chain-derived proteins (A lambda) immunohistochemically. CONCLUSION The present case revealed an A lambda amyloidoma in the left gasserian ganglion. Although the incidence is rare, amyloidoma should be suspected in patients who complain of progressive trigeminal neuropathies and show an enhanced lesion in the gasserian ganglion on MR images.
Collapse
Affiliation(s)
- T Matsumoto
- Department of Neurosurgery, Hyogo College of Medicine, Nishinomiya, Japan
| | | | | | | | | | | |
Collapse
|
12
|
Pasternak S, White VA, Gascoyne RD, Perry SR, Johnson RL, Rootman J. Monoclonal origin of localised orbital amyloidosis detected by molecular analysis. Br J Ophthalmol 1996; 80:1013-7. [PMID: 8976732 PMCID: PMC505682 DOI: 10.1136/bjo.80.11.1013] [Citation(s) in RCA: 26] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
AIMS Primary localised orbital amyloidosis is a rare disease. The purpose of this study was to describe two cases of primary orbital amyloidosis and emphasise the value of molecular analysis of immunoglobulin gene rearrangement in identifying a monoclonal population of cells responsible for the amyloid production. METHODS Charts and biopsy specimens of each case were reviewed. Conventional light microscopy, immunohistochemistry, and polymerase chain reaction (PCR) analysis for immunoglobulin gene rearrangement were performed in both cases. RESULTS An unusual presentation of localised primary amyloidosis with bilateral and extensive enlargement of multiple extraocular muscles was seen in case 1. The presence of amyloid deposits was confirmed by biopsy in both cases. Evidence of a monoclonal population of plasma cells was shown by immunohistochemical analysis in case 2 only. The monoclonal origin of the cells responsible for the amyloid deposition was determined by PCR analysis demonstrating immunoglobulin heavy chain gene rearrangement in both cases. CONCLUSIONS A monoclonal population of plasma cells responsible for the amyloid deposition was present in these two cases. PCR analysis is extremely helpful in determining monoclonality, a finding that may have important therapeutic and prognostic implications.
Collapse
Affiliation(s)
- S Pasternak
- Department of Pathology, Vancouver Hospital and Health Sciences Centre, University of British Columbia, Canada
| | | | | | | | | | | |
Collapse
|
13
|
Silbert PL, Bartleson JD, Miller GM, Parisi JE, Goldman MS, Meyer FB. Cortical petechial hemorrhage, leukoencephalopathy, and subacute dementia associated with seizures due to cerebral amyloid angiopathy. Mayo Clin Proc 1995; 70:477-80. [PMID: 7731259 DOI: 10.4065/70.5.477] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Although cerebral amyloid angiopathy is a well-known cause of cerebral lobar hemorrhage, subacute dementia, seizures, and acute encephalopathy without lobar hemorrhage are infrequently recognized as manifestations of this disease. In this report, we describe a case of cerebral amyloid angiopathy in a 74-year-old woman who had subacute progressive dementia and a superimposed rapid acute neurologic deterioration associated with seizures and the presence of cerebral edema on computed tomographic scans and leukoencephalopathy and cortical petechial hemorrhages on magnetic resonance imaging. A diagnosis of cerebral amyloid angiopathy in conjunction with small cortical infarcts and petechial hemorrhages was confirmed by antemortem biopsy. This clinical and radiologic picture is being increasingly recognized as characteristic of cerebral amyloid angiopathy.
Collapse
Affiliation(s)
- P L Silbert
- Department of Neurology, Mayo Clinic Rochester, Minnesota 55905, USA
| | | | | | | | | | | |
Collapse
|
14
|
Vigushin DM, Hawkins PN, Hsuan JJ, Totty NF, Pepys MB. AL kappa amyloid in a solitary extradural lymphoma. J Neurol Neurosurg Psychiatry 1994; 57:751-4. [PMID: 8006662 PMCID: PMC1072986 DOI: 10.1136/jnnp.57.6.751] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
A 68 year old man with a 10 year history of apparently benign IgM kappa paraproteinaemia presented with dysarthria, left hemiparesis, and a sensory peripheral neuropathy. A calcified right temporoparietal extradural mass was shown by scintigraphy with 123I-serum amyloid P component to contain amyloid. There were no extracranial amyloid deposits. Clinical improvement followed craniotomy and partial resection of tissue which consisted of amyloid and a mixed mononuclear cell infiltrate. The amyloid fibrils consisted of the framework 1 region of the variable domain of monoclonal kappa IV immunoglobulin light chains. There was a prominent B-cell clonal immunoglobulin gene rearrangement in the tumour tissue, supporting a diagnosis of lymphoplasmacytic lymphoma, but no sign of systemic lymphoma. Neurological state, tumour volume, and quantity of amyloid have remained static for two years after treatment with chlorambucil.
Collapse
Affiliation(s)
- D M Vigushin
- Immunological Medicine Unit, Royal Postgraduate Medical School, Hammersmith Hospital, London, UK
| | | | | | | | | |
Collapse
|