Article

Multiple brain tumors of different cell types with an unruptured cerebral aneurysm - Case report

Authors:
To read the full-text of this research, you can request a copy directly from the authors.

Abstract

A rare case of coexistent Burkitt-type lymphoma and meningioma associated with an unruptured cerebral aneurysm is presented. A 49-year-old male complaining of headache and right hemiparesis was admitted to our hospital. Neuroradiological examination revealed a multinodular mass in the left frontal convexity and an unruptured cerebral aneurysm at the M1 portion of the left middle cerebral artery. He underwent an operation for tumor removal and aneurysm clipping. Histological examination revealed the tumor to be a typical meningotheliomatous meningioma without malignancy. However, a second operation was necessary for another tumor invading into the left frontal lobe, which proved to be a Burkitt-type lymphoma. The second tumor may have been resulted from irritative effect of the first tumor, but the aneurysm was considered purely coincidental.

No full-text available

Request Full-text Paper PDF

To read the full-text of this research,
you can request a copy directly from the authors.

... Cerebral aneurysm has been associated with a wide variety of tumor types, including meningioma (29.3-44%), glioma (27.5-38%), pituitary adenoma (11-20.6%), lymphoma, craniopharyngioma, chordoma, epidermoid tumor, dermoid tumor, and choroid plexus adenoma (10,16,22,23,25,30). Initial symptoms were caused by the tumor (54-78%) or by the rupture of the aneurysm (17-45%) (16,22,24). ...
... Coexistent primary central nervous system lymphoma (PCNSL) and cerebral aneurysm without phakomatoses or radiation therapy is very rare but has been described. We have identified 3 reported cases of coexistent PCNSL and cerebral aneurysm in the English literature (23,25,30) (Table I). Shigemori et al. reported lymphoma and meningioma with unruptured MCA aneurysm (25). ...
... The aneurysm and the tumor have been discovered at the same time. The tumor was so near to the aneurysm that the same craniotomy could be employed for the approach to both lesions (16,25). The lesion producing the presenting symptoms should be treated first when a single approach to both is unfeasible (33). ...
Article
The primary brain tumors associated with cerebral aneurysms are rare in neurosurgical practice. The present article constitutes an evaluation of the management of coexistent primary brain tumor and cerebral aneurysm. A retrospective study of three cases of primary brain tumor with cerebral aneurysm was performed. We evaluated the complications and clinic outcomes by assessing the clinical and imaging findings. Case 1 presented with a subarachnoid hemorrhage from an aneurysm of the anterior communicating artery, with an incidental left frontal oligodendroglioma. Case 2 presented with chronic headache due to left frontal convexity meningioma, with proximal internal carotid artery aneurysm which was found incidentally during preoperative magnetic resonance angiography. Case 3 was admitted to our hospital complaining of headache, memory disturbance, and weakness in her left lower extremity. Magnetic resonance imaging revealed right frontal lymphoma and an unruptured aneurysm at the left middle cerebral artery. Preoperative magnetic resonance imaging revealed right frontal lymphoma and unruptured left middle cerebral artery. The frequency of primary brain tumor and cerebral aneurysm coexistence is increasing due to improvements in high-resolution imaging. In these complicated cases, the management will differ according to each pathology present, and this is an important problem for a neurosurgeon.
... The frequencies of tumors associated with aneurysms are as follows: Meningioma (44%), glioma (38%) and pituitary adenoma (20.6%). Such association are also found in tumors, such as lymphomas, craniopharyngiomas, chordomas, epidermoid/dermoid tumors (5, 17,22,26,30). Most tumor-related aneurysms are located on the internal carotid artery (26%), middle cerebral artery (26%), anterior cerebral artery (17.4%), anterior communicating artery (13%) and posterior communicating artery (4.3%)(23). ...
... For example, the mortality rate is 38% for such patients whether the tumor and the aneurysm are treated separately or together (21). Generally, a simultaneous treatment of the aneurysm and glial tumor is preferred because of good outcomes (13,26,28), and prognosis remains unchanged when the tumor or aneurysms present separately or together (17). ...
Article
Full-text available
The medical literature reports an association between cerebral neoplasms and aneurysm formation. Some related aneurysms are detected during preoperative screening, whereas others are detected during or after surgery. We report a case of a patient with a de novo cerebral feeding artery aneurysm that we managed during glioblastoma surgery. We present a brief review of the literature on the co-existence of brain tumours, particularly that related to high-grade glioma and aneurysms. The literature discusses several mechanisms underlying tumour formation accompanied by aneurysm formation. Also some classifications were proposed grouping such aneurysms. We question the necessity for the routine use of vascular imaging for patients with glioblastoma.
... 2,6) Many multiple brain tumors with different cell types have been reported, but most involved coexistent meningioma and glioma. 10) There are several hypotheses to explain the association of two different primary intracranial tumors: embryogenic nests causing different brain tumors at different times, systemic carcinogenic factors or metastasis into primary brain tumors, carcinogenic stimulus of adjacent tissues, and growth hormone stimulation, but none have been proved. 10,13) Tumors of the cerebellopontine angle (CPA) account for 10% of intracranial tumors, and are mainly vestibular schwannoma, with 10-15% meningioma, and 2-3% epidermoid cyst. ...
... 10) There are several hypotheses to explain the association of two different primary intracranial tumors: embryogenic nests causing different brain tumors at different times, systemic carcinogenic factors or metastasis into primary brain tumors, carcinogenic stimulus of adjacent tissues, and growth hormone stimulation, but none have been proved. 10,13) Tumors of the cerebellopontine angle (CPA) account for 10% of intracranial tumors, and are mainly vestibular schwannoma, with 10-15% meningioma, and 2-3% epidermoid cyst. 2,8) Collision tumors in this area are rare, with only 15 reported cases: 7 cases of metastatic tumor and vestibular schwannoma, 2 cases of meningioma and vestibular schwannoma, 2 cases of vestibular schwannoma and epidermoid, 1 case of trigeminal schwannoma and epidermoid cyst, 1 case of trochlear and abducens nerve schwannoma and meningioma, 1 case of choroid plexus papilloma and vestibular schwannoma, 1 case of epidermoid and glioblastoma, and 1 case of vestibular schwannoma and cholesterol granuloma. ...
Article
Full-text available
A 71-year-old man presented with vestibular schwannoma manifesting as hearing disturbance and truncal ataxia 16 years after removal of a cerebellopontine angle (CPA) epidermoid cyst, and located adjacent to the remnant lesion. The patient first presented with a 6-month history of right trigeminal neuralgia. Neuroimaging demonstrated a right CPA lesion, suggestive of an epidermoid cyst. Right lateral suboccipital craniotomy was performed and the histological diagnosis was epidermoid cyst. A small lesion remained, but the symptoms were relieved. Sixteen years later, the patient presented with right auditory disturbance, vertigo, and truncal ataxia. Magnetic resonance imaging revealed a multiple cystic mass adjacent to the remnant epidermoid cyst in the right CPA. The lesion was removed and the histological diagnosis was vestibular schwannoma associated with the epidermoid cyst. The irritative effect of the remnant epidermoid cyst or surgical procedures may have caused the vestibular schwannoma, but no evidence of the evolution of the different types of tumors was found.
Article
Full-text available
BACKGROUND Burkitt lymphoma (BL) is an aggressive subtype of B-cell non-Hodgkin lymphoma (NHL) rarely affecting the central nervous system (CNS) as a primary disease. Over the past years, only a few cases of primary CNS Burkitt lymphoma were reported. There is a challenge in early recognition and diagnosis of this type of brain lymphoma. Furthermore, there is no specific treatment protocols for primary CNS Burkitt lymphoma, which adds to the difficulty in managing those patients. We introduce a case of a 65-year-old who presented with fluctuating memory disturbance diagnosed as cerebral Burkitt lymphoma. CASE REPORT A 65-year-old man developed a gradual decrease in his level of consciousness over a span of 4 days, associated with fluctuating memory disturbances. A CT scan showed a hyperdense mass in the region of the trigon of the left lateral ventricle and marked obstructive hydrocephalus involving the temporal, occipital horns, and the left lateral ventricle, with no evidence of other suspicious lesions. A brain biopsy of the lesion revealed features of encephalitis initially, but the patient presented later with worsening symptoms, and a repeated brain biopsy showed features of Burkett lymphoma, with normal pan-CT scan. CONCLUSIONS Primary CNS Burkitt lymphoma (PCNSBL) is a rare disease with no clear evidence in the literature of how to deal with it. Reporting such cases provides a better understanding of how to approach such unusual presentations. Treatment of PCNSBL is challenging and even with the currently adopted approaches, the disease still has a very poor outcome.
Article
Full-text available
With primary central nervous system lymphoma (PCNSL) being a rare disease, the subtype of Burkitt lymphoma (BL) presenting as a sole CNS lesion is an even more exceptional diagnosis. A case of coexistent primary CNS Burkitt lymphoma (PCNSBL) with cerebral palsy (CP) is presented. A 55-year-old Caucasian male presented with increasing bilateral lower extremity weakness above his baseline in addition to signs of increased intracranial pressure. Four abnormal enhancing masses were detected on MRI with biopsy results consistent with Burkitt lymphoma. Complete staging workup was completed with no evidence of extra-CNS disease noted on PET/CT, bone marrow biopsy, or cerebral spinal fluid analysis. The patient was treated with intravenous as well as intrathecal chemotherapy and found to be in a complete remission at six months. Recurrence in the CNS was observed four months later with treatment consisting of whole brain radiation as well as intrathecal chemotherapy. Thirty months after diagnosis, the patient remains disease-free. To our knowledge, this is the first case of PCNSBL in the setting of CP. A review of literature regarding treatment options in this controversial setting is provided.
Article
Full-text available
Most primary intracranial tumors occur as solitary lesions; multiple locations of one tumor, the occurrence of two different tumors or even collision tumors have been described only in a few patients. Multiple primary brain tumors rarely originate in different tissues. Cases not associated with von Recklinghausen's neurofibromatosis constitute only 0.3% of all primary brain tumors. The association of two primary intracranial tumors of different histogenesis in the same individual is rare, except in cases of phakomatosis or radiation-induced tumors. We present three cases with simultaneous occurrence of meningioma with glioblastoma, pituitary adenoma, and acoustic schwannoma respectively, as shown by MRI on admission. In two cases (meningioma/glioblastoma, and adenoma/meningioma associations) both tumors have been approached in one operation, both tumors being completely removed. In the meningioma/acoustic schwannoma association case only the schwannoma was approached surgically due to poor patient status and meningioma being completely clinically silent. Postoperative recovery was good for all three patients and the 1 year follow up showed no growth for the remnant meningioma. Although the particular tumors diagnosed in all three presented cases represent common primary intracranial tumors, the simultaneous occurrence of each two tumors is rare. Previous reported results failed to consistently show a common genetic mark that could explain the development of two different tumors. However, based on our cases and previous literature, we believe that increased research effort could provide significant insights in the appearance and development of multiple brain tumors.
Chapter
Verschlechterung eines bereits vorhandenen Kopfschmerzes ist bei der entsprechenden Kopfschmerzform zu verschlüsseln. Patienten, bei denen sich eine neue Kopfschmerzform (einschließlich Migräne, Kopfschmerz vom Spannungstyp und Clusterkopfschmerz) in enger zeitlicher Beziehung zu einer vaskulären Störung einstellt, werden in Gruppe 6 kodiert. Eine kausale Beziehung ist damit nicht notwendigerweise impliziert. Der Typ des Kopfschmerzes kann mit der 4. Stelle des Codes spezifiziert werden. Alle Kopfschmerzen erfüllen folgende Kriterien (spezifischere Kriterien sind bei den Unterformen angegeben).
Article
Coexistence of brain tumor and intracranial aneurysm was previously considered as an uncommon phenomenon. Actually it is not rare in neurosurgical procedures, and its incidence rate may be underestimated. Furthermore, there remains a lack of consensus regarding numerous aspects of its clinical management. We performed a retrospective study of 12 cases of coexistent brain tumor and intracranial aneurysm in our database. Then a systematic PubMed search of English-language literature published between 1970 and 2012 was carried out using the keywords: "brain tumor" and "intracranial aneurysm" in combination with "associate" or "coexist." A consensus panel of neurosurgeons, anesthetists, interventional neurologists, and intensivests reviewed this information and proposed a treatment strategy. In the majority of patients, clinical symptoms were caused by tumor growth, whereas aneurysm rupture was seen only in a few cases. Meningioma was the commonest tumor associated with aneurysm. In most patients, both lesions occurred within the adjacent area. Treatment of both pathologies in one session was performed in most patients. All of our patients were alive within the period of follow-up. Coexistence of brain tumor and intracranial aneurysm may be a coincidence. The treatment strategy should be designed according to the conditions of tumor and aneurysm, locations of both lesions, and pathologic nature of tumor.
Article
Coexisting intracerebral aneurysms and meningiomas occur relatively rarely, without a clear relationship, although an aneurysm can be located within a meningioma. The aim of this retrospective study was to identify possible explanations for the coexistence of these conditions and to present a rationale for treatment strategies. Ninety-five patients with coexistent meningioma and aneurysm were found in the National Library of Medicine, and 11 more patients were retrieved from our own database. Co-occurrence of both pathologies, sometimes solitary, sometimes multiple, was mostly found in women (3:1). Clinical symptoms in the majority of patients were caused by tumour growth, whereas aneurysm rupture was seen only in a few cases. Consequently tumour resection was performed first in 58 out of the 95 patients, and aneurysm treatment in 38 patients. From available data, the mortality rate three decades before was approximately 40%, but decreased in the last years, due to microsurgical and endovascular techniques. All of our patients were alive after 1 year of follow-up. In patients with intratumoural aneurysms, only three published and one our own case, were treated for both pathologies. The coexistence of meningioma and aneurysm seems to be a coincidence. Treatment should primary focus on the cause of presenting symptoms, but in cases with intratumoural aneurysm, the aneurysm should be treated first. Due to the development of microsurgical and endovascular techniques peri-procedural mortality and morbidity has decreased.
Article
The authors describe a very rare case of intravascular large B-cell lymphoma in a woman whose ruptured distal middle cerebral artery (MCA) aneurysms were filled with lymphoma cells. A 69-year-old woman who had undergone artificial graft replacement for an aortic aneurysm presented with transient left hemiparesis. Magnetic resonance imaging demonstrated a small fresh cerebral infarction in the right frontal lobe, although major cervical and cerebral arteries were shown to be intact on MR angiography. Antiplatelet and anticoagulation treatments commenced. On the 21st day after onset, the patient suffered a subarachnoid hemorrhage, and a digital subtraction angiogram revealed aneurysmal lesions in the distal MCA. Based on the histological examination of the resected aneurysms, proliferation of large B-cell lymphoma was identified in the dilated arterial lumen. On the 71st day after ischemic onset, intracranial hemorrhage recurred, and she died. Postmortem examination revealed similar lymphoma cells only in the intimal layer that had grown on the artificial graft, and it was decided that the patient had had intravascular large B-cell lymphoma. The preceding cerebral infarction was thought to be due to occlusion of the distal MCA by tumor embolus, which may be the initial pathological stage in aneurysm formation. For patients with incomprehensible ischemic cerebral stroke, neoplasm must be taken in consideration.
Article
This 70-year-old woman suffered a subarachnoid hemorrhage (SAH) from a ruptured anterior communicating artery aneurysm encased in a meningioma in the tuberculum sellae. Although preoperative magnetic resonance imaging disclosed that the aneurysmal complex was completely enclosed in the tumor, angiographic studies did not reveal arterial narrowing. The embedded aneurysm caused diffuse SAH rather than intratumoral hemorrhage. These factors indicated very little adhesion between the tumor and the encased arteries. Surgery was performed on the 20th day post-SAH. Intraoperative findings revealed that the tumor did not adhere to the enclosed vasculature except at the point of rupture of the aneurysm. The authors were able to clip the aneurysm safely after piecemeal removal of the tumor, which was finally extirpated without fear of aneurysm rupture. Careful stepwise procedures were essential to treat the aneurysm and the tumor simultaneously.
Article
Primary central nervous system (CNS) lymphoma is rare and is most often seen in immunodeficient patients. The majority of these tumors are the non-Hodgkin type and are high grade. Primary Burkitt lymphoma of the CNS in immunocompetent individuals has rarely been reported. The authors treated a 49-year-old woman who presented with left-sided weakness that had lasted 1.5 months. Magnetic resonance imaging revealed an oval mass in the left parietal region, with central necrosis and peripheral edema, and no attachment to the leptomeninges or ependyma. Pathological examination yielded a diagnosis of typical Burkitt lymphoma. Six months postoperatively, the patient is ambulatory and has improving neurological signs. This is a typical case of primary Burkitt lymphoma of the brain in an immunocompetent patient, which is a very rare event. The imaging pattern of the lesion is not typical of brain lymphomas and can result in an incorrect preoperative diagnosis of other brain tumors, such as glioblastoma multiforme. The patient's treatment and follow-up review are discussed.
Article
The authors report a rare meningioma-primary cerebral B cell lymphoma association that occurred in an insulin-dependent type-I diabetic woman. The woman was initially operated on because of meningothelial meningioma of the fronto-basal region, and 2 months later showed a primitive-non-Hodgkin B cell lymphoma, localized in the same area as the meningioma. The published literature on the meningioma-primary cerebral lymphoma association is revised.
Article
Except for cases with radiotherapy or phacomatosis, multiple primary brain tumors of different histologic types are rare. The authors report the association of an epidermoid cyst and a primary CNS lymphoma. A 66-year-old man with a 20-year history of gait disturbance was admitted because of recently worsening symptoms. Magnetic resonance imaging showed an abnormal mass in the posterior fossa. The mass lesion had the appearance of a cystic tumor with a large mural nodule. Gross total removal of the tumor was performed. Histologic examination disclosed the cystic portion to be an epidermoid, whereas the nodular portion exhibited the histologic and immunohistochemical features of a malignant lymphoma. The lymphoma cells were shown to harbor EBV by in situ hybridization. To our knowledge, this is the first report of the coexistence of an epidermoid cyst and primary CNS lymphoma. When the lesions are adjacent, a definite preoperative diagnosis can be difficult. Epstein-Barr virus-associated CNS lymphoma is rare among the immunologically normal population. The possible pathogenesis for the coexistence of these 2 tumors is discussed.
ResearchGate has not been able to resolve any references for this publication.