Premium
Acute focal demyelinating disease simulating brain tumors: Histopathologic guidelines for an accurate diagnosis
Author(s) -
Sugita Yasuo,
Terasaki Mizuhiko,
Shigemori Minoru,
Sakata Kiyohiko,
Morimatsu Minoru
Publication year - 2001
Publication title -
neuropathology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.701
H-Index - 61
eISSN - 1440-1789
pISSN - 0919-6544
DOI - 10.1111/j.1440-1789.2001.00365.x
Subject(s) - pathology , medicine , coagulative necrosis , myelin , white matter , infiltration (hvac) , demyelinating disease , glial tumor , lesion , glioma , disease , magnetic resonance imaging , radiology , central nervous system , physics , thermodynamics , cancer research , endocrinology
The object of the present study was to determine the histopathological guidelines for accurate diagnosis of cases of acute focal demyelinating disease that simulates brain tumors. The surgical pathology of three such cases is assessed. Histopathological keys to the diagnosis of such cases are as follows. First, a pattern of sheets of atypical gemistocytic astrocytes in the white matter that show well‐formed processes and that are adequately distanced from each other argues against a diagnosis of neoplasm. Second, uniform distribution of foamy macrophages aligned along axons, with occasional focal collections surrounding blood vessels and in the absence of any associated coagulative necrosis argues against the presence of a tumor. Third, perivascular chronic inflammatory infiltration, especially a mixture of lymphocytes and macrophages, favors the diagnosis of demyelination plaque. In such cases the lymphocytes will be predominantly T cells. Fourth, pleomorphic astrocytic proliferation with a lack of vascular endothelial proliferation should raise the suspicion that the lesion may not be a brain tumor. These diagnostic keys should be followed when diagnosing cases that are suspected to be demyelination processes rather than brain tumors. The presence of demyelination plaque should then be confirmed by imaging modalities such as staining with myelin‐and axon‐specific stains.