Mimicking Brain Tumor Research Articles

Verification of mean dose in a tumor using 3D-printed tumor-model scintillators in anthropomorphic phantoms and a spherical phantom

To enhance treatment outcomes of radiotherapy, accurate verification of dosimetric parameters such as the mean, minimum, and maximum doses is essential. This study aimed to measure the mean absorbed dose in a tumor-shaped target and compare the results with the calculated value of the treatment planning system. Tumor model scintillators (TMSs) mimicking brain tumors were fabricated with a commercial 3D printer based on stereolithography files of tumors. The TMSs were irradiated following treatment plans made with the Leksell Gamma Plan® (Elekta AB, Stockholm, Sweden), and the mean dose in each TMS was measured three times and compared with the calculated value. Eleven TMSs were set at the center of a spherical solid water phantom. Two additional TMSs were fabricated according to images of vestibular schwannomas and were set at the tumor location in head model phantoms following each patient's head shape. The mean relative differences between the measured and calculated mean doses were less than one percent. This method provides an independent parameter for evaluating the accuracy of the treatment planning system.

A Case of Multiple Sclerosis Presenting with Tumefactive Lesions

Inflammatory demyelinating diseases including multiple sclerosis (MS) are usually diagnosed based on characteristic clinical and radiological findings. However, some demyelinating diseases have presented with growing large mass-like lesions, and it is difficult to differentiate those demyelinating lesions from brain tumors. We report a case of biopsy-proven MS mimicking brain tumor. This case suggests that inflammatory demyelinating diseases including MS have a wide spectrum and can present with the same radiological features as brain tumors such as lymphoma or high-grade glioma.

A Case of Multiple Sclerosis Presenting with Tumefactive Lesions

Inflammatory demyelinating diseases including multiple sclerosis (MS) are usually diagnosed based on characteristic clinical and radiological findings. However, some demyelinating diseases have presented with growing large mass-like lesions, and it is difficult to differentiate those demyelinating lesions from brain tumors. We report a case of biopsy-proven MS mimicking brain tumor. This case suggests that inflammatory demyelinating diseases including MS have a wide spectrum and can present with the same radiological features as brain tumors such as lymphoma or high-grade glioma.

Applications of organoid technology to brain tumors.

Lacking appropriate model impedes basic and preclinical researches of brain tumors. Organoids technology applying on brain tumors enables great recapitulation of the original tumors. Here, we compared brain tumor organoids (BTOs) with common models including cell lines, tumor spheroids, and patient-derived xenografts. Different BTOs can be customized to research objectives and particular brain tumor features. We systematically introduce the establishments and strengths of four different BTOs. BTOs derived from patient somatic cells are suitable for mimicking brain tumors caused by germline mutations and abnormal neurodevelopment, such as the tuberous sclerosis complex. BTOs derived from human pluripotent stem cells with genetic manipulations endow for identifying and understanding the roles of oncogenes and processes of oncogenesis. Brain tumoroids are the most clinically applicable BTOs, which could be generated within clinically relevant timescale and applied for drug screening, immunotherapy testing, biobanking, and investigating brain tumor mechanisms, such as cancer stem cells and therapy resistance. Brain organoids co-cultured with brain tumors (BO-BTs) own the greatest recapitulation of brain tumors. Tumor invasion and interactions between tumor cells and brain components could be greatly explored in this model. BO-BTs also offer a humanized platform for testing the therapeutic efficacy and side effects on neurons in preclinical trials. We also introduce the BTOs establishment fused with other advanced techniques, such as 3D bioprinting. So far, over 11 brain tumor types of BTOs have been established, especially for glioblastoma. We conclude BTOs could be a reliable model to understand brain tumors and develop targeted therapies.

Distinctive clinicopathological features and differential gene expression of cerebral venous thrombosis mimicking brain tumors

Cerebral venous thrombosis (CVT), a rare type of cerebrovascular disease, can mimic a brain tumor (CVT mimicking brain tumor [CVTMBT]), due to its space-occupying imaging features. We aimed to describe the clinicopathological features and identify the thrombophilia-related gene expression changes in the brain following CVT. We conducted a retrospective qualitative study of CVT patients who were misdiagnosed with brain tumors before surgery at our hospital from 2016 to 2021. We analyzed the clinicopathological characteristics of the cases from our hospital and previously published cases. Five subjects were retrospectively studied, but one refused to provide biological specimens. We performed messenger ribonucleic acid (mRNA) sequencing from eight specimens (four CVTMBT and four non-CVTMBT samples). Differentially expressed genes (DEGs) were screened using the “edge” package in R 3.6.1 software. Thrombophilia-related genes were obtained from the MalaCards human disease database and were cross-checked with DEGs. The intersection was considered to be the potential genes in the pathogenesis of CVTMBT. The medical histories of the five patients with CVTMBT included oral non-steroidal anti-inflammatory drug use, oral contraceptive use, cesarean section, and anemia. All patients underwent craniotomy and were pathologically diagnosed with CVT. The follow-up results revealed that all patients had favorable outcomes without any recurrence. DEG analysis revealed 813 upregulated and 253 downregulated DEGs between patients with CVTMBT and controls. Nine DEGs were associated with thrombophilia, including SERPINE1, SELP, THBD, ITGB3, TFPI, F13A1, PROS1, PPBP, and PROCR, which were considered potential key genes in CVTMBT. CVTMBT presents with enhancement and mass effect on magnetic resonance imaging, accompanied by various predisposing factors, shorter disease duration, and coagulation dysfunction. The nine key genes identified as potential key genes in the pathogenesis of CVTMBT may be potential biomarkers for accurate screening and appropriate treatment.

Clinical features of space occupying lesion due to fungal infections mimicking brain tumor: Case report

Diagnosis and treatment of masses due to fungal infection of the central nervous system is often difficult. Radiologic features are often non-specific and are often confused with malignant lesions so that a new diagnosis can be made by histological examination after resection. The combination of medical and surgical treatment of fungal infections of the central nervous system is optimal in shortening the duration of antifungal therapy, providing a definitive diagnosis and improving patient outcome. A 57-year-old male patient was conscious with complaints of weakness in the left half of the body, progressive chronic headache for 6 months and seizures, with physical examination results in the form of papilledema dextra, paresis N VI dextra et sinistra, paresis N VII S supranuclear, hemiparesis flaccid of left with grade 2/3, chronic progressive cephalgia and with a history of partial seizures become secondary common. Non-reactive HIV, CT scan of the head supporting a primary brain tumor with suspicion of intratumoral bleeding and cerebral edema. After surgery, histopathological examination results suitable for cerebral abscess, leading to fungal infection that is Cryptococcus neoformans. The patient was treated with 600 milligrams of Fluconazole every 12 hours intraoral for 6 months, the complaints improved and the head MRI was evaluated as normal. Conclusions. Diagnosis of fungal infection is still a challenge. The combination of surgical medical therapy in a mass fungal infection of the central nervous system is optimal in shortening the duration of antifungal treatment, providing a definitive diagnosis, and improving patient outcomes.

Culturing astrocytes on substrates that mimic brain tumors promotes enhanced mechanical forces

Astrocytes are essential to brain homeostasis and their dysfunction can have devastating consequences on human quality of life. Such deleterious effects are generally due in part to changes that occur at the cellular level, which may be biochemical or biomechanical in nature. One biomechanical change that can occur is a change in tissue stiffness. Brain tumors are generally associated with increased brain tissue stiffness, but the impact increased tissue stiffness has on astrocyte biomechanical behavior is poorly understood. Therefore, in this study we cultured human astrocytes on flexible substrates with stiffness that mimicked the healthy human brain (1 kPa), meningioma (4 kPa), and glioma (11 kPa) and investigated astrocyte biomechanical behavior by measuring cell-substrate tractions, strain energies, cell-cell intercellular stresses, and cellular velocities. In general, tractions, intercellular stresses, and strain energy was observed to increase as a function of increased substrate stiffness, while cell velocities were observed to decrease with increased substrate stiffness. We believe this study will be of great importance to the fields of brain pathology and brain physiology.

Intracranial Foreign Body Granuloma Mimicking Brain Tumor Recurrence: A Case Series.

Intracranial foreign body granuloma (FBG) is a rare inflammatory reaction to retained foreign material, manifesting acutely or months to years following neurosurgical procedures. Radiographically, FBG can mimic tumor progression, and tissue biopsy may be required to guide management. In this retrospective case series, we present unique clinico-radiographic and histopathological features of six neuro-oncological patients diagnosed with FBG between 2007 and 2019. All six patients (4 women and 2 men, aged 29-54 [median, 30.5] years) had undergone surgical resection of a low- (n = 4) or high-grade (n = 2) glioma. FBG manifestation postsurgery ranged from 1 day to 4 years and was predominantly asymptomatic (n = 5/6). Magnetic resonance imaging universally demonstrated one or multiple peripherally enhancing lesion(s) adjacent to the resection cavity. Histopathology in all (n = 4/4) resected specimens demonstrated an inflammatory reaction to foreign material, confirming FBG. Intracranial FBG constitutes a rare but challenging treatment-related condition effectively managed by surgery, with important therapeutic implications in neuro-oncology.

Tumefactive demyelinating lesions in multiple sclerosis mimicking brain tumors: a major diagnostic challenge

Tumefactive demyelinating lesions (TDL) are large (usually more than 2 cm) demyelinating lesions, that can present with perilesional edema, mass effect, and different en­han­cement patterns mimicking tumor, infection, or acute vascular diseases of the brain. Magnetic resonance ima­ging (MRI) is the most useful diagnostic tool that can help set the proper course of treatment, follow-up and avoid unnecessary invasive procedures. We present a pictorial review of pseudotumoral demyelinating lesions from a series of cases diagnosed in our clinic and we discuss the most important differential diagnostics. We reviewed the magnetic resonance investigations of the patients with known or suspected multiple sclerosis or other inflammatory demyelinating lesions over a period of three years (2018-2020). Out of the 187 reviewed cases, 11 presented TDL, representing 5.88%. The mean age at the time of diagnosis was 38 years old, with a net female predominance. The main common element of TDL was the incomplete ring enhancement pattern, essential for positive and differential diagnosis.

Atypical Virchow-Robin Spaces Mimicking Cystic Primary Brain Tumor – Clinical Report and Literature Review

AbstractThe Virchow-Robin spaces (VRSs), which are often incidentally observed in modern structural neuroimaging examinations, are small cystic cavities that usually surround the small arteries and arterioles at the level of basal ganglia, the anterior perforated substance and the thalamic-mesencephalic junction. Typically, they have similar physicochemical characteristics to cerebral spinal fluid (CSF) and there is no contrast enhancement on brain CT and MRI images. Its real meaning is unknown, although some contemporary studies have suggested that it might be related to certain traumatic brain injury or several other central nervous system (CNS) disorders, as degenerative diseases. Occasionally, some wide and atypical VRS may be mistaken for primary cystic brain tumors, especially in the context of large and symptomatic lesions, multiple clustered cysts, cortical lesions and if there is adjacent reactive gliosis. The present paper reports four patients who were affected by atypical VRS mimicking brain tumors that required imaging follow-up or even a biopsy to confirm the diagnosis or to indicate the correct approach. Although it is not so unusual, one of them occurred concomitantly and adjacent to a diffuse glioma (co-deleted 1p19q, WHO-GII).

Intraparenchymal pericatheter cyst after cerebrospinal fluid shunt: A rare complication with challenging diagnosis – Case presentation and review of the literature

An intraparenchymal pericatheter cyst is a rare complication of ventriculoperitoneal shunt, which is not well described yet. Due to its rarity, lack of characteristic symptoms and radiological features that often mimic brain tumors or abscesses, especially in head computed tomography without contrast can be easily misdiagnosed. We report the case of a 9-year-old girl who was admitted to a peripheral hospital due to severe headaches and vomiting. The child had a history of craniotomy and ventriculoperitoneal shunt for posterior fossa tumor, performed in our department, 4 years earlier. The patient underwent a brain magnetic resonance imaging (MRI) scan and transmitted to our hospital with the diagnosis of brain tumor. However, a closer look at the MRI established the diagnosis of intraparenchymal pericatheter cerebrospinal fluid cyst; hence, the patient underwent shunt revision and cyst drainage. We researched the literature and described 20 reported cases, discussing the pathophysiological mechanisms, the radiological features, and the optimal treatment of this interesting, yet a challenging complication.

Aggressive osteoblastoma with degeneration to secondary aneurysmal bone cyst

ABSTRACT A 4-year-old male patient presented with headaches that started 18 months ago and were associated with progressive loss of balance and difficulty walking. Magnetic resonance imaging (MRI) demonstrated an expansile extra-axial mass lesion in the posterior aspect of the posterior fossa on the left, compressing the adjacent brain, as well as the cerebellar hemispheres; it also distorts the fourth ventricle with severe obstructive hydrocephalus upstream. Histological evaluation diagnosed aggressive osteoblastoma with a secondary aneurysmal bone cyst of the skull. We report a case of aggressive osteoblastoma in which the lesion in the MRI was mimicking brain tumor or intracranial primary tumor rather than primary bone tumor.

Primary Intracranial Rhabdomyosarcoma in a Child Mimicking Brain Tumor- A Case Report

Primary Intracranial Rhabdomyosarcoma in a Child Mimicking Brain Tumor- A Case Report

Primary central nervous system vasculitis mimicking brain tumor: Comprehensive analysis of 13 cases from a single institutional cohort of 191 cases

ObjectiveTo describe the clinical, laboratory, and imaging features and course of patients with primary central nervous system vasculitis (PCNSV) presenting with an intracranial tumor-like mass (TLM). MethodsWe retrospectively studied a cohort of 191 consecutive patients with PCNSV seen at the Mayo Clinic, Rochester, MN over a 35-year period (1982–2017). 13/191 patients presented with a TLM. We compared the findings in these 13 patients with those from the 178 without this presentation. ResultsIn 13 of 191 (6.8%) patients with TLM the diagnosis of PCNSV was established by cerebral biopsy. Granulomatous vasculitis was found in 11/13 patients, accompanied by vascular deposits of β-amyloid peptide in 7. Compared to the 178 patients without TLM, the patients with TLM were more likely to be male (p = 0.04), and less likely to have a transient ischemic attack (p = 0.023), bilateral cerebral infarcts (p = 0.018), or vasculitic lesions on angiography (p = 0.045). They were more likely to have seizures (p = 0.022), gadolinium-enhanced lesions (p = 0.007), and amyloid angiopathy (p = 0.046). All 13 patients responded to therapy and 8/13 (61.5%) had a Rankin disability score of 0 at last visit. Overall, high disability scores (Rankin scores 4–6) at last follow-up were associated with increasing age (odds ratio, OR, 1.49) and cerebral infarction (OR, 3.47), but were less likely in patients with gadolinium-enhanced lesions (OR, 0.36) and amyloid angiopathy (OR, 0.21). ConclusionIn PCNSV a TLM at presentation represents a definable subgroup of patients with a favourable treatment response.

An interesting case of Nocardial brain abscess mimicking brain tumor in an immunocompetent patient. (P5.134)

An interesting case of Nocardial brain abscess mimicking brain tumor in an immunocompetent patient. (P5.134)

Description of a Tumefactive Demyelinating Lesion Studied with Advanced Magnetic Resonance Techniques: A Clinical Report and Review of Literature

Tumefactive Demyelinating Lesions (TDL) is atypical presentation of various demyelinating diseases like Multiple Sclerosis (MS). They can mimic brain tumors in their clinical and radiological features and usually respond favorably to corticosteroid therapy. We report the case of a 17-years-old girl with a single TDL suddenly enlarging even under steroid therapy. She underwent a very strict follow-up with conventional Magnetic Resonance (MRI) and Diffusion Weighted Imaging (DWI), Perfusion Weighted Imaging (PWI), Proton Magnetic Resonance Spectroscopy (PMRS).

Tumefactive demyelination following in vitro fertilization (IVF)

Tumefactive demyelination (TD) is a solitary cerebral demyelinating lesion clinically and radiologically mimicking brain tumors. It can occur in isolation or may be rarely associated with other demyelinating diseases. The underlying pathogenic mechanisms are unknown. We present the first report of TD following in-vitro fertilization (IVF) in a 36-year-old healthy woman who developed subacute right hemiparesis shortly after a scheduled IVF cycle. Evaluation revealed left hemispheric space-occupying lesion pathologically diagnosed as TD. Treatment with intravenous methylprednisolone promptly resulted in a clinical and radiological improvement maintained thereafter. This report confirms and expands the spectrum of inflammatory demyelinating conditions associated with IVF and suggests possible hormonal influence in the development of TD.

Gadolinium enhancement patterns of tumefactive demyelinating lesions: correlations with brain biopsy findings and pathophysiology.

Tumefactive demyelinating lesions (TDLs) can mimic brain tumors on radiological images. TDLs are often referred to as tumefactive multiple sclerosis (TMS), but the heterogeneous nature and monophasic course of TDLs do not fulfill clinical and magnetic resonance imaging (MRI) criteria for multiple sclerosis. Redefining TDLs, TMS and other inflammatory brain lesions is essential for the accurate clinical diagnosis of extensive demyelinating brain lesions. We retrospectively analyzed MRI from nine TDL cases that underwent brain biopsy. Patterns of gadolinium enhancement on MRI were categorized as homogenous, inhomogeneous, patchy and diffuse, open ring or irregular rim, and were compared with pathological hallmarks including demyelination, central necrosis, macrophage infiltration, angiogenesis and perivascular lymphocytic cuffing. All cases had coexistence of demyelinating features and axonal loss. Open-ring and irregular rim patterns of gadolinium enhancement were associated with macrophage infiltrations and angiogenesis at the inflammatory border. An inhomogeneous pattern of gadolinium enhancement was associated with perivascular lymphocytic cuffing. Central necrosis was seen in cases of severe multiple sclerosis and hemorrhagic leukoencephalopathy. These results suggest that the radiological features of TDLs may be related to different pathological processes, and indicate that MRI may be useful in understanding their pathophysiology. Further investigation is needed to determine the precise disease entity of these inflammatory demyelinating brain lesions.

Hematogenous pasteurella haemolytica brain abscess

ABSTRACT Pasteurella infections are common in domestic animals and very rare in human. We report a hematogenously acquired Pasteurella haemolytica brain abscess, mimicking brain tumor on magnetic resonance imaging, in an 18-year-old female patient known with cardiac interventricular communication, without recent history of animal contact. The outcome was good after abscess complete removal and antimicrobials therapy for 6 weeks. To the best of our knowledge, this is the first reported case of P. haemolytica brain abscess.

CD8 T lymphocytes encephalitis mimicking brain tumor in HIV-1 infection

Combined antiretroviral therapy (cART) has led to considerable improvement in the spectrum of disorders affecting the central nervous system (CNS). The majority of focal brain presentations are due to toxoplasmosis, non-Hodgkin's lymphoma, and progressive multifocal leukoencephalopathy. Other causes are much rarer (Moulignier et al. 1994, 1996; Saravanan and Turnbull 2009). A growing number of severe, acute inflammatory leukoencephalopathies, whose causes remain to be identified, have been recently reported (Tavazzi et al. 2010). These include highly destructive forms of HIVassociated leukoencephalopathy (Langford et al. 2002), “burnt out” forms of HIV encephalitis (Scaravilli et al. 2007), immune reconstitution inflammatory syndrome (IRIS) (Venkataramana et al. 2006), brain tumefactive demyelination (Saravanan and Turnbull 2009; Solomon et al. 2013), and discordant HIV diseases (Canestri et al. 2010). A series of cases of diffuse encephalitis with marked perivascular infiltration by CD8 T lymphocytes with corticosteroid-responsive brain inflammation have been described as CD8 encephalitis (Lescure et al. 2013; Gray et al. 2013). Brain MRI shows characteristic perivascular punctuate or linear gadolinium-enhanced lesions, better seen in T1 spin echo with magnetic transfer, that are poorly delineated in T2weighted images (Lescure et al. 2013). We describe the first biopsy-proven focal CD8 encephalitis (CD8-E) mimicking a brain tumor in a HIV+ patient.