Department of Pathology, Beth Israel Deaconess Medical Center, Boston, MA, USA; Harvard Medical School, Boston, MA, USA.
Department of Pathology, Beth Israel Deaconess Medical Center, Boston, MA, USA; Harvard Medical School, Boston, MA, USA.
J Neurol Sci. 2021 Sep 15;428:117591. doi: 10.1016/j.jns.2021.117591. Epub 2021 Jul 27.
Demyelinating lesions occasionally present as mass-like lesions on imaging, raising concern for malignancy. The disease course of such tumefactive demyelinating lesions (TDLs) is still being defined.
We retrospectively analyzed 21 patients with new-onset neurologic symptoms and mass-like lesions on brain magnetic resonance imaging (MRI), which resulted in biopsy-proven diagnoses of demyelination. 18 patients had a median follow-up of 52 months. The clinical, radiologic and histologic features were associated with disease course.
An aggressive disease course (ADC) was noted in 33% of the patients and was associated with an initial largest lesion size ≥35 mm (p = 0.0007), mass effect (p = 0.01) and perilesional edema (p = 0.01) on MRI. Age 30 years and older, at presentation (p = 0.05), as well as the absence of a prior tonsillectomy (p = 0.0128) were also associated with an ADC.
We identified several factors, including initial larger lesion size, mass effect and perilesional edema on MRI, presentation after 30 years of age and the absence of a prior tonsillectomy, that predict an ADC in patients presenting with TDLs. These predictors of disease course can help guide patient follow-up and stratification for intervention.
脱髓鞘病变偶尔在影像学上表现为肿块样病变，引起恶性肿瘤的担忧。此类肿块样脱髓鞘病变（TDL）的疾病过程仍在确定中。
我们回顾性分析了 21 例新发病例的神经症状和脑磁共振成像（MRI）上的肿块样病变，这些病变导致经活检证实的脱髓鞘诊断。18 例患者的中位随访时间为 52 个月。临床、影像学和组织学特征与疾病过程相关。
33%的患者出现侵袭性疾病过程（ADC），与初始最大病变大小≥35mm（p=0.0007）、肿块效应（p=0.01）和瘤周水肿（p=0.01）相关。发病时年龄 30 岁及以上（p=0.05），以及无扁桃体切除术史（p=0.0128）也与 ADC 相关。
我们发现了一些因素，包括 MRI 上初始较大的病变大小、肿块效应和瘤周水肿、发病年龄 30 岁及以上以及无扁桃体切除术史，这些因素可预测 TDL 患者的 ADC。这些疾病过程的预测因素可以帮助指导患者的随访和干预分层。
