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. 2020 Jul 6;10(1):11065.
doi: 10.1038/s41598-020-68063-6.

Impact of histological diagnosis on the treatment of atypical brainstem lesions

Marcos Dellaretti  1   2 , Breno Bezerra Arruda Câmara  3 , Pedro Henrique Piauilino Benvindo Ferreira  3 , José Batista da Silva Júnior  3 , Rosa Maria Esteves Arantes  4
Affiliations

Impact of histological diagnosis on the treatment of atypical brainstem lesions

Marcos Dellaretti et al. Sci Rep. .

Abstract

For atypical brainstem lesions, histological diagnosis can have an impact on treatment, especially in cases where diffuse glioma is not found. Since radiotherapy is the only therapeutic modality that has shown clinical and radiographic improvement in patients with diffuse glioma, the misdiagnosis of diffuse glioma can have drastic consequences, particularly in patients with nontumorous lesions. Thus, the purpose of this study was to evaluate the impact of histological diagnosis on the treatment of atypical brainstem lesions. This was a retrospective study of 31 patients who underwent biopsy of atypical brainstem lesions. The procedures were performed between January 2008 and December 2018 at the Life Center Hospital and Santa Casa de Belo Horizonte, MG, Brazil. A diagnosis was obtained in 26 (83.9%) cases. Three patients presented complications: one presented bleeding with no clinical repercussions and two showed worsening of neurological deficit, only one of which was definitive. No mortality occurred due to the procedure. The histological diagnosis was diffuse glioma in seven cases (22.6%) and not diffuse glioma in 19 cases (61.3%). Thus, the histological diagnosis had an impact on the treatment of 19 patients (treatment impact rate: 61.3%). The histological diagnosis of intrinsic brainstem lesions is a safe, efficient procedure with a high diagnosis rate, and as such, it should be considered in the management of atypical lesions.

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Conflict of interest statement

The authors declare that they have no conflicts of interest.

Figures

Figure 1
Figure 1
Magnetic resonance imaging appearance of an atypical brainstem tumor. (a) T1-weighted axial image without and (b) with gadolinium demonstrates an enhanced prominent contrast and lesion outside the limits of the pons.
Figure 2
Figure 2
Hematoxylin and eosin (H&E): (a) shows increased cellularity with irregular nuclei, scarce cytoplasm and perivascular accumulation of cells. (b shows scattered binucleated and multinucleated cells.
Figure 3
Figure 3
Immunohistochemistry. The histological field (×400 objective) shows strong positivity for CD20.
See this image and copyright information in PMC

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