Abstract
Among 19 patients with Tuberous Sclerosis Complex (TSC), who underwent resection of tubers at our institution, five had diffuse glioma‐like infiltrates. All patients presented with refractory seizures Histologically, 4 resection specimens had the pathognomonic features of neuroglial hamartomas (tubers) and one resection specimen revealed severe cortical microdysgenesis but lacked cells typical of TSC. All lesions were associated with an infiltrate of atypical, mostly elongate, glioma‐like small cells, some of which resembled microglial cells. None of the infiltrating cells resembled reactive astrocytes, and only some of them were labelled with a GFAP immunostain. Likewise, many of the atypical cells did not label with lymphocytic or histiocytic markers. MIB‐1 (Ki67) immunostains marked a variable proportion of both microglial and glioma‐like atypical nuclei. Postoperatively (follow‐up period ranging from one to 28 months) none of the patients have any evidence of a glioma. We report here for the first time that tubers resected for treatment of seizures are sometimes associated with glioma‐like lesions, consisting of foci of hypercellularity which cannot be identified as just lympho‐histiocytic reactions nor reactive gliosis. These foci are indistinguishable from infiltrating gliomas by morphology and immunohistochemistry, and may represent a difficult diagnostic problem.
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