Esclerose múltipla simulando tumor cerebral: apresentação de caso com comprovação histopatológica

Tilbery, Charles Peter; Guidugli-neto, João

doi:10.1590/S0004-282X1995000200023

Resumos

Os autores apresentam o caso de uma paciente com 41 anos de idade que iniciou seu quadro clínico com hemiparesia direita progressiva. A RNM revelou massa expansiva na região temporoparietal esquerda e lesão menor na área frontal direita. O exame do LCR foi normal. Devido à possibilidade de se tratar de tumor ou abscesso, a paciente foi submetida a biópsia cerebral. O resultado revelou tratar-se de área de desmielinização, sendo negativos os testes efetuados para vírus.

esclerose múltipla; RNM; desmielinização

A 41 year old woman with subacute onset of moderate and progressive right hemiparesis showed on the MRI a unilateral white matter lesion on the left temporoparietal region and a small lesion on the right frontal region. The CSF was normal. Because possible diagnosis of tumor or abscess, the patient underwent a cerebral biopsy. The histological result was of brain tissue with demyelination and reactive changes. The stains for viral etiology were negative.

multiple sclerosis; MRI; demyelination

Esclerose múltipla simulando tumor cerebral: apresentação de caso com comprovação histopatológica

Multiple sclerosis simulating brain tumor: report of a case with histopathological confirmation

Charles Peter Tilbery^I; João Guidugli-neto^II

^IProfessor Adjunto de Neurologia

^IIPatoIogista Chefe do HIAE

RESUMO

Os autores apresentam o caso de uma paciente com 41 anos de idade que iniciou seu quadro clínico com hemiparesia direita progressiva. A RNM revelou massa expansiva na região temporoparietal esquerda e lesão menor na área frontal direita. O exame do LCR foi normal. Devido à possibilidade de se tratar de tumor ou abscesso, a paciente foi submetida a biópsia cerebral. O resultado revelou tratar-se de área de desmielinização, sendo negativos os testes efetuados para vírus.

Palavras-chave: esclerose múltipla, RNM, desmielinização.

SUMMARY

A 41 year old woman with subacute onset of moderate and progressive right hemiparesis showed on the MRI a unilateral white matter lesion on the left temporoparietal region and a small lesion on the right frontal region. The CSF was normal. Because possible diagnosis of tumor or abscess, the patient underwent a cerebral biopsy. The histological result was of brain tissue with demyelination and reactive changes. The stains for viral etiology were negative.

Key-words: multiple sclerosis, MRI, demyelination.

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Agradecimento

À Dra. Carol K. Petito (Universidade de Miami), pela revisão histopatológica realizada no material.

Aceite: 12-dezembro-1994.

Trabalho do Setor de Investigações Neuroimunológicas da Faculdade de Ciências Médicas da Santa Casa de São Paulo (FCMSP) e do Serviço de Anatomia Patológica do Hospital Albert Einstein (HIAE): Dr. Charles Peter Tilbery - Rua Sampaio Vidal 855 - 01443-001 São Paulo SP - Brasil

1. Bittencourt PRM, Kendall BE. Computerized axial tomography and diagnosis of multiple sclerosis. Arq Neuropsiquiatr 1983, 41: 171-181.
2. Cowan J, Ormerod IEC, Rudge P. Hemiparetic multiple sclerosis. J Neurol Neurosurg Psychiatry 1990, 53: 675-680.
3. Cunnigham ME, Kishome PRS, Renagachary SA. Progressive multifocal leukoencephalopathy presenting as focal mass lesion in the brain. Surg Neurol 1977, 8: 448-450.
4. Giang DW, Produri KR, Eskin TA, Ketonen LM, Fiedman PA, Wang DD, Herndon RM. Multiple sclerosis masquerading as a mass lesion. Neuroradiology 1992, 34: 150-154.
5. Gütling E, Landis T. CT ring sign imitating tumor disclosed as multiple sclerosis by MRI: a case report. J Neurol Neurosurg Psychiatry 1989, 52: 903-906.
6. Hunter SB, Ballinger WE, Rubin JJ. Multiple sclerosis mimicking primary brain tumor. Arch Pathol Lab Med 1987, 111: 464-468.
7. Kepes JJ. Large focal tumor-like demyelinating lesions of the brain: intermediate entity between multiple sclerosis and acute disseminated encephalomyelitis? A study of 31 patients. Ann Neurol 1993, 33: 18-27.
8. Kelly, R. Clinical aspects of multiple sclerosis. In Vinken PJ, Bruyn GW, Klawans HL (eds). Handbook of clinical neurology (Demyelinating diseases) Amsterdam: Elsevier, 1985, p 49-78.
9. Moreno AL, Brown JM, Waller SF, Lundy MM, Brown TJ. The complementary roles of brain scintillography and computed tomography in multiple sclerosis. Clin Nucl Med 1983, 8: 618-622.
10. Morimoto T, Nagao T, Sano N, Habara S. A case of multiple sclerosis with multi-ring-like and butterfly-like enhacement on computerized tomography. Brain Dev 1985, 7: 43-45.
11. Nelson MJ, Miller SL, McLain W, Gold LHA. Multiple sclerosis: large plaques causing mass effect and ring sign. J Comp Tomogr 1981, 5: 892-894.
12. Oppenheimer DR. The cervical cord in multiple sclerosis. Neuropathol Exp Neurobiol 1986, 27: 623-626.
13. Ormerod IEC, Bronstein A, Rudge P. Magnetic resonance imaging in clinically isolated lesions of the brain stem. J Neurol Neurosurg Psychiatry 1986, 49: 737-743.
14. Paty DW, McFarlin DE, McDonald WI. Magnetic resonance imaging and laboratory aids in the diagnosis of multiple sclerosis. Ann Neurol 1991, 29: 3-5.
15. Peterson K, Rosemblum MK, Powers JM, Alvord E, Walfer RW, Posner JB. Effect of brain irradiation on demyelinating lesions. Neurology 1993, 43: 2105-2112.
16. Rieth KG, DiChiro G, Cromwell LD, McKeener DE, Kornblith PL, Kufta CV, Pleet AB. Primary demyelinating disease simulating glioma of the corpus callosum: report of three cases. J Neurosurg 1981, 55: 620-624.
17. Royatta M, Latuala M. Diagnotic problems in multiple sclerosis: two cases with clinical diagnosis of MS showing only a diffusely growing malignant astrocytoma. Eur Neurol 1986, 25: 195-207.
18. Sagar HJ, Warlow CP, Sheldon PWE, Esiri MM. Multiple sclerosis with clinical and radiological features of cerebral tumor. J Neurol Neurosurg Psychiatry 1982, 45: 802-808.
19. Van der Velden M, Bots GTA, Endtz LJ. Cranial CT in multiple sclerosis showing a mass effect. Surg Neurol 1979, 12: 307-310.
20. Vliegenthart WE, Sanders EACM, Bruyn GW, Vielvoye GJ. An unusual CT-scan appearance in sclerosis. J Neurol Sci 1985, 71: 129-134.
21. Youl BD, Kermode AG, Thompson JA. Destructive lesions in demyelinating disease. J Neurol Neurosurg Psychiatry 1991, 54: 288-292.

Datas de Publicação

Publicação nesta coleção
20 Jan 2011
Data do Fascículo
Jun 1995

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

[1] 1. Bittencourt PRM, Kendall BE. Computerized axial tomography and diagnosis of multiple sclerosis. Arq Neuropsiquiatr 1983, 41: 171-181.

[2] 2. Cowan J, Ormerod IEC, Rudge P. Hemiparetic multiple sclerosis. J Neurol Neurosurg Psychiatry 1990, 53: 675-680.

[3] 3. Cunnigham ME, Kishome PRS, Renagachary SA. Progressive multifocal leukoencephalopathy presenting as focal mass lesion in the brain. Surg Neurol 1977, 8: 448-450.

[4] 4. Giang DW, Produri KR, Eskin TA, Ketonen LM, Fiedman PA, Wang DD, Herndon RM. Multiple sclerosis masquerading as a mass lesion. Neuroradiology 1992, 34: 150-154.

[5] 5. Gütling E, Landis T. CT ring sign imitating tumor disclosed as multiple sclerosis by MRI: a case report. J Neurol Neurosurg Psychiatry 1989, 52: 903-906.

[6] 6. Hunter SB, Ballinger WE, Rubin JJ. Multiple sclerosis mimicking primary brain tumor. Arch Pathol Lab Med 1987, 111: 464-468.

[7] 7. Kepes JJ. Large focal tumor-like demyelinating lesions of the brain: intermediate entity between multiple sclerosis and acute disseminated encephalomyelitis? A study of 31 patients. Ann Neurol 1993, 33: 18-27.

[8] 8. Kelly, R. Clinical aspects of multiple sclerosis. In Vinken PJ, Bruyn GW, Klawans HL (eds). Handbook of clinical neurology (Demyelinating diseases) Amsterdam: Elsevier, 1985, p 49-78.

[9] 9. Moreno AL, Brown JM, Waller SF, Lundy MM, Brown TJ. The complementary roles of brain scintillography and computed tomography in multiple sclerosis. Clin Nucl Med 1983, 8: 618-622.

[10] 10. Morimoto T, Nagao T, Sano N, Habara S. A case of multiple sclerosis with multi-ring-like and butterfly-like enhacement on computerized tomography. Brain Dev 1985, 7: 43-45.

[11] 11. Nelson MJ, Miller SL, McLain W, Gold LHA. Multiple sclerosis: large plaques causing mass effect and ring sign. J Comp Tomogr 1981, 5: 892-894.

[12] 12. Oppenheimer DR. The cervical cord in multiple sclerosis. Neuropathol Exp Neurobiol 1986, 27: 623-626.

[13] 13. Ormerod IEC, Bronstein A, Rudge P. Magnetic resonance imaging in clinically isolated lesions of the brain stem. J Neurol Neurosurg Psychiatry 1986, 49: 737-743.

[14] 14. Paty DW, McFarlin DE, McDonald WI. Magnetic resonance imaging and laboratory aids in the diagnosis of multiple sclerosis. Ann Neurol 1991, 29: 3-5.

[15] 15. Peterson K, Rosemblum MK, Powers JM, Alvord E, Walfer RW, Posner JB. Effect of brain irradiation on demyelinating lesions. Neurology 1993, 43: 2105-2112.

[16] 16. Rieth KG, DiChiro G, Cromwell LD, McKeener DE, Kornblith PL, Kufta CV, Pleet AB. Primary demyelinating disease simulating glioma of the corpus callosum: report of three cases. J Neurosurg 1981, 55: 620-624.

[17] 17. Royatta M, Latuala M. Diagnotic problems in multiple sclerosis: two cases with clinical diagnosis of MS showing only a diffusely growing malignant astrocytoma. Eur Neurol 1986, 25: 195-207.

[18] 18. Sagar HJ, Warlow CP, Sheldon PWE, Esiri MM. Multiple sclerosis with clinical and radiological features of cerebral tumor. J Neurol Neurosurg Psychiatry 1982, 45: 802-808.

[19] 19. Van der Velden M, Bots GTA, Endtz LJ. Cranial CT in multiple sclerosis showing a mass effect. Surg Neurol 1979, 12: 307-310.

[20] 20. Vliegenthart WE, Sanders EACM, Bruyn GW, Vielvoye GJ. An unusual CT-scan appearance in sclerosis. J Neurol Sci 1985, 71: 129-134.

[21] 21. Youl BD, Kermode AG, Thompson JA. Destructive lesions in demyelinating disease. J Neurol Neurosurg Psychiatry 1991, 54: 288-292.