CASE REPORTS   

Journal of Neurosurgical Sciences 1999 March;43(1):69-72

Copyright © 1999 EDIZIONI MINERVA MEDICA

lingua: Inglese

Aspecific inflammatory lesion (histiocytosis?) simulating intramedullary astrocytoma. Case report

Palma L. ¹, Rizzo G. ¹, Lio R. ², Mariottini A. ¹, Mazzocchio R. ¹

¹ Department of Ophtalmological and Neurosurgical Sciences, Chair of Neurosurgery; ² Institute of Morbid Anatomy, Siena University Medical School, Siena, Italy

We ­report an excep­tion­al ­case of aspe­cif­ic inflam­ma­to­ry ­lesion of ­the tho­rac­ic spi­nal ­cord sim­u­lat­ing an intra­me­dul­lary ­glial ­tumor. ­Patient his­to­ry ­was char­ac­ter­ized by pro­gres­sive spas­tic par­a­par­e­sis ­with uri­nary incon­ti­nence; MR imag­ing (T4-T5) ­showed an enhanc­ing intrin­sic ­mass ­lesion. Mye­lot­o­my ena­bled par­tial resec­tion of gray­ish astro­cy­to­ma-­like tis­sue. ­Only ­light micro­scope exam­ina­tion ­was pos­sible ­and dis­closed aspe­cif­ic inflam­ma­to­ry tis­sue com­posed of eosin­o­phils, lym­pho­cytes ­and his­tio­cy­tes. ­After ­the oper­a­tion, ­the ­patient ­improved prompt­ly ­and no fur­ther ther­a­py ­was admin­is­tered. Con­trol ­MRI ­after ­four ­months, ­one ­year ­and ­two ­years ­showed com­plete dis­ap­pear­ance of ­the intra­me­dul­lary ­mass ­lesion ­and ­the ­patient ­remained clin­i­cal­ly ­stable ­with no oth­er ­signs of dis­ease. ­Since elec­tron micro­scop­ic as ­well as immu­no­his­to­chem­i­cal stud­ies ­were ­not avail­able, a defin­i­tive his­to­log­i­cal diag­no­sis ­was ­not pos­sible. How­ev­er on ­the ­basis of ­some clin­i­cal sim­i­lar­ities ­with cas­es of iso­lat­ed his­tio­cy­to­sis X of ­the ­CNS report­ed in ­the lit­er­a­ture, we sug­gest ­that a diag­no­sis of iso­lat­ed intra­me­dul­lary eosin­o­phil­ic gra­nu­lo­ma ­could be rea­son­able.