Higa Nayuta, Yokoo Hideaki, Hirano Hirofumi, Yonezawa Hajime, Oyoshi Tatsuki, Goto Yuko, Arita Kazunori
Department of Neurosurgery, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan.
Department of Human Pathology, Gunma University Graduate School of Medicine, Maebashi, Japan.
Neuropathology. 2017 Oct;37(5):446-451. doi: 10.1111/neup.12384. Epub 2017 Apr 7.
Calcifying pseudoneoplasms of the neuraxis (CAPNON) are presumed to be a non-neoplastic reactive pathology, based on the frequent finding of granulomatous inflammation. To our knowledge, there are few reports of CAPNON in association with a neoplasm. Here, we report the case of a 62-year-old man presenting with headache, which was caused by CAPNON in the left cingulate gyrus. CT scan revealed a calcified mass exhibiting gradual growth and increasing peritumoral edema. MRI showed an intra-axial hypointense mass on T1- and T2-weighted images. Development of a peri-lesional hyperintense lesion on T2-weighted images suggested local edema or tumoral invasion. Gadolinium-enhanced T1-weighted images revealed mild peripheral enhancement of the calcified nodule. L-methyl- C methionine-positron emission tomography revealed the uptake of tracer in the calcified nodule. The calcified mass and its enveloping brain tissue were removed using a parietal craniotomy. The calcified tissue was surrounded by spindle-shaped cells positive for GFAP and nestin. The MIB-1 labeling index of spindle cells was around 10% (i.e. a hot spot). Fourteen months after surgery, gadolinium-enhanced MRI evidenced growth of a tiny residual lesion. Therefore, this report illustrates a potential case of CAPNON arising from low-grade glial neoplasm.
基于肉芽肿性炎症的常见发现，神经轴钙化性假瘤（CAPNON）被认为是一种非肿瘤性反应性病变。据我们所知，很少有CAPNON与肿瘤相关的报道。在此，我们报告一例62岁男性因左侧扣带回的CAPNON导致头痛的病例。CT扫描显示一个钙化肿块，呈逐渐生长且瘤周水肿加重。MRI在T1加权和T2加权图像上显示轴内低信号肿块。T2加权图像上病变周围出现高信号病变提示局部水肿或肿瘤侵犯。钆增强T1加权图像显示钙化结节轻度周边强化。L-甲基-¹¹C-蛋氨酸正电子发射断层扫描显示钙化结节摄取示踪剂。采用顶叶开颅术切除钙化肿块及其周围脑组织。钙化组织被GFAP和巢蛋白阳性的梭形细胞包围。梭形细胞的MIB-1标记指数约为10%（即一个热点）。术后14个月，钆增强MRI显示一个微小残留病变生长。因此，本报告说明了一例可能由低级别胶质瘤引起的CAPNON病例。
