Biopsy Proven Tumefactive Multiple Sclerosis with Concomitant Glioma: Case Report and Review of the Literature

Abstract

We report a case of pathologically confirmed tumefactive multiple sclerosis (MS) followed shortly thereafter by the diagnosis of an oligoastrocytoma. The complexity of diagnosis and management of concomitant presence of tumefactive MS and glial cell tumors is discussed.

Keywords: demyelination; glial cell tumors; multiple sclerosis; oligoastrocytoma; tumefactive.

Figure 1

Left image: axial T2 FLAIR showing 2 cm × 2.3 cm left frontal mass with substantial edema. Middle image: sagittal T1 post-contrast image showing contrast enhancement in a “ring-like” pattern. Right image: axial T2 FLAIR showing residual changes consistent with partial resection of the previous ring-enhancing left frontal mass.

Figure 2

Pathological specimen of the left frontal lobe lesion. Left image: H&E section showing white matter with reactive gliosis (reactive astrocytes with abundant eosinophilic cytoplasm). Right image: Luxol fast blue showing absence of myelin.

Figure 3

(A) Sagittal T1 post-contrast showing large area of right occipitoparietal lesion with a ring-like enhancing pattern (left image) and axial T2 FLAIR MRI showing substantial peri-lesional edema (right image). (B) Sagittal T1 post-contrast MRI showing marked increase in the size of the right parietal lobe lesion with surrounding local edema and enhancement.