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Central Nervous System Infectious Diseases Mimicking Malignancies Clinoradiologically

Year 2023, Volume: 49 Issue: 3, 325 - 329, 31.12.2023

Mine Özşen Sahsine Tolunay Havva Merve Dinç Şeref Doğan Hasan Kocaeli

https://doi.org/10.32708/uutfd.1368973

Abstract

Central nervous system (CNS) infections are still an important cause of morbidity and mortality despite improved diagnostic and therapeutic methods. The nonspecificity of the observed complaints causes various CNS infectious diseases, especially intracranial tuberculoma and brain abscess, to be clinicoradiologically misinterpreted as malignancies. Considering this situation, we aimed to contribute to the scientific literature by sharing the clinicoradiologic and histomorphologic features of CNS infectious diseases that mimic malignancies clinicoradiologically. In this retrospective study, pathology archives were reviewed and 19 cases who were operated with a prediagnosis of malignancy based on clinicoradiologic findings between 2010 and 2023 but were diagnosed as infectious diseases of the central nervous system on histopathologic evaluation were included. Of the 19 patients included in the study, 8 were female and 11 were male. The mean age of the patients was 51+15.68 years and the age distribution ranged between 21 and 72 years. Based on clinicoradiological findings, excision was scheduled with the preliminary diagnosis of glial tumor in 6 cases, tumoral lesion in 3 cases, pathological fracture due to neoplasia in 3 cases, meningioma in 2 cases, metastasis in 2 cases, nerve sheath tumor in 2 cases and pituitary adenoma in 1 case. Histomorphologic evaluation revealed necrotizing granulomatous inflammation in 52.6%, suppurative inflammation in 15.8% and hydatid cyst in 10.5% of the cases. CNS infections are diseases caused by different agents in different predisposing conditions and have high morbidity and mortality rates if not treated properly and effectively. These diseases have overlapping complaints, symptoms and radiologic findings with primary and metastatic malignancies of the central nervous system, which makes it challenging to diagnose correctly. Possibilities should be kept in mind while evaluating the case and it should be evaluated as a whole together with the clinical history.

Keywords

Infectious disease Glial tumor Metastasis Central nervous system

References

  • 1. Balın ŞÖ, Tartar AS, Demirdağ K, Akbulut A. Kliniğimizde Yatan Santral Sinir Sistemi Enfeksiyonu Tanılı Hastaların Analizi: Beş Yıllık Sonuçlar. Mediterr J Infect Microb Antimicrob. 2019;8:13
  • 2. Tunkel AR, Van de beek D, Scheld WM. Acute menengitis. In: Mandell GL, Bennett JE, Dolin R (eds). Mandeli, Douglas, and Bennett’s Principles and Practice of Infections Diseases. 8th ed. Philadelphia, PA:Churcill Livingstone Elsevier; 2015:1097-137.
  • 3. Altunal LN, Aydın M, Özel AS, Kanadalı A. Bir Eğitim Araştırma Hastanesinde Santral Sinir Sistemi Enfeksiyonlarının Yedi Yıllık Değerlendirilmesi. Adnan Menderes Üniversitesi Sağlık Bilimleri Fakültesi Dergisi. 2021:5(2);170-176.
  • 4. Ahn JS, Yang DH, Kim YK, et al. Multiple intracranial tuberculomas mimicking granulocytic sarcomas in acute myeloid leukemia. J Korean Med Sci. 2007 Sep;22 Suppl(Suppl):S171-3.
  • 5. Calleri G, Libanore V, Corcione S, De Rosa FG, Caramello P. A retrospective study of viral central nervous system infections: relationship amongst aetiology, clinical course and outcome. Infection. 2017;45:227-31.
  • 6. Wall EC, Chan JM, Gil E, Heyderman RS. Acute bacterial meningitis. Curr Opin Neurol. 2021 Jun 1;34(3):386-395. Sinir Sistemi Enfeksiyöz Hastalıkları 329
  • 7.Sunwoo JS, Shin HR, Lee HS, et al. A hospital-based study onetiology and prognosis of bacterial meningitis in adults. Sci Rep. 2021 Mar 16;11(1):6028.
  • 8.Altunal LN, Öztürk S, Aydın M, Özel AS, Kanadalı A. Santral Sinir Sistemi İnfeksiyonu Tanılı 98 Olgunun Klinik Özllikleri.ANKEM Derg 2021;35(3):77-84
  • 9.Lundbo LF, Benfield T. Risk factors for community-acquired bacterial meningitis. Infect Dis (Lond). 2017 Jun;49(6):433-444.
  • 10.Suthar R, Sankhyan N. Bacterial Infections of the Central Nervous System. Indian J Pediatr. 2019 Jan;86(1):60-69.
  • 11.Tunkel AR. Approach to the Patient with Central NervousSystem Infection. In: Mandell GL, Bennett JE, Dolin R (eds). Mandell, Douglas, and Bennett’s Principles and Practice of Infectious Diseases. 8th ed. Philadelphia, PA:Churchill Livingstone Elsevier, 2015:1091-6.
  • 12.Shrivastava A, Arora P, Khare A, Goel G, Kapoor N. Central nervous system filariasis masquerading as a glioma: case report. J Neurosurg. 2017 Sep;127(3):691-693.
  • 13.Ying S, Li-Min L. Cerebral syphilis mimicking metastatic tumors: Report and review of the literature. Neurol India. 2018 Jul-Aug;66(4):1170-1172.
  • 14.Kumar D, Nepal P, Singh S, et al. CNS aspergillomamimicking tumors: Review of CNS aspergillus infection imaging characteristics in the immunocompetent population. J Neuroradiol. 2018 May;45(3):169-176.
  • 15.Ansari AA, Korde P, Iratwar SW, Anjankar A. Intradural extramedullary tuberculoma of the spinal cord mimicking meningioma. BMJ Case Rep. 2022 Dec 9;15(12):e253040.
  • 16.Torres YCAlves-Leon SV, Lima MA. Frequency ofPseudotumoral Central Nervous System Lesions in anOncology Center. World Neurosurg. 2019 Oct;130:e333-e337.
  • 17.Arismendi Morillo GJ, Fernandez Abreu MC, Cardozo SosaDP, Cardozo JJ. Non neoplastic space occupying lesions mimicking central nervous system tumors. Rev Neurol. 2004 Mar;38(5):427-30.
  • 18.Aggarwal A, Patra DP, Gupta K, Sodhi HB. Dural Tuberculoma Mimicking Meningioma: A Clinicoradiologic Review of Dural En-Plaque Lesions. World Neurosurg. 2016Apr;88:686.e1-686.e7.
  • 19.Thwaites G, Fisher M, Hemingway C, Scott G, Solomon T,Innes J. British infection society guidelines for the diagnosis and treatment of tuberculosis of the central nervous system inadults and children. J Infect. 2009;59:167–87.
  • 20.Shah KK, Pritt BS, Alexander MP. Histopathologic review ofgranulomatous inflammation. Clin Tuberc Other Mycobact Dis. 2017 Feb 10:7:1-12.
  • 21.Navarro-Flores A, Fernandez-Chinguel JE, Pacheco-Barrios N,Soriano-Moreno DR, Pacheco-Barrios K. Global morbidity and mortality of central nervous system tuberculosis: a systematic review and meta-analysis. J Neurol. 2022 Jul;269(7):3482-3494.
  • 22.Elvan-Tuz A, Karadag-Oncel E, Kara-Aksay A, Sarioglu FC, Karadag A, Yilmaz-Ciftdogan D. A rare case series of central nervous system cystic echinococcosis. J Trop Pediatr. 2021 Jul 2;67(3):fmab056.
  • 23.Bhatt AS, Mhatre R, Nadeesh BN, Mahadevan A, Yasha TC, Santosh V. Nonneoplastic Cystic Lesions of the Central Nervous System-Histomorphological Spectrum: A Study of 538 Cases. J Neurosci Rural Pract. 2019 Jul;10(3):494-501.
  • 24.Padayachy LC, Ozek MM. Hydatid disease of the brain and spine. Childs Nerv Syst. 2023 Mar;39(3):751-758.
  • 25.Din ND, Raza M, Rahim S, Memon W, Ahmad Z. Hydatid disease of central nervous system, a clinicopathological study of 33 cases. J Neurosci Rural Pract. 2023 Apr-Jun;14(2):293-297.
  • 26.Gün Seda, Ö Terzi, F Karagöz. Patoloji Uzmanı Gözüyle KistHidatik. Kocatepe Tıp dergisi. 2019;20(4):260-263.
  • 27.Geramizadeh B, Kohandel-Shirazi M, Soltani A. A Simple Panel of IDH1 and P53 in Differential Diagnosis BetweenLow-Grade Astrocytoma and Reactive Gliosis. Clin Pathol. 2021 Feb 11:14:2632010X20986168.

Klinikoradyolojik Olarak Maligniteleri Taklit Eden Santral Sinir Sistemi Enfeksiyöz Hastalıkları

Year 2023, Volume: 49 Issue: 3, 325 - 329, 31.12.2023

Mine Özşen Sahsine Tolunay Havva Merve Dinç Şeref Doğan Hasan Kocaeli

https://doi.org/10.32708/uutfd.1368973

Abstract

Santral sinir sistemi (SSS) enfeksiyonları gelişen tanı ve tedavi yöntemlerine rağmen hala önemli bir morbidite ve mortalite nedenidir. Gözlenen şikayetlerin nonspesifik olması özellikle intrakranial tüberküloma ve beyin absesi başta olmak üzere çeşitli SSS enfeksiyon hastalığının klinikoradyolojik olarak malignitelerle karışabilmesine neden olmaktadır. Bu durum göz önünde bulundurularak çalışmamızda klinikoradyolojik olarak maligniteleri taklit eden SSS enfeksiyöz hastalıklarının klinikoradyolojik ve histomorfolojik özelliklerini olgularımız üzerinden paylaşarak bilimsel literatüre katkıda bulunmak amaçlanmıştır. Bu retrospektif çalışmada patoloji arşivi taranarak, 2010-2023 yılları arasında klinikoradyolojik bulgular doğrultusunda malignite ön tanısı ile opere edilen ancak histopatolojik değerlendirme sonucu santral sinir sisteminin enfeksiyon hastalıkları ile uyumlu tanı alan 19 olgu dahil edildi. Çalışmaya dahil edilen 19 olgunun 8’i kadın, 11’i erkekti. Olguların ortalama yaş değeri 51+15,68 iken yaş dağılımı 21 ile 72 arasında değişmekteydi. Klinikoradyolojik bulgular doğrultusunda 6 olguya glial tümör, 3 olguya tümöral lezyon, 3 olguya neoplaziye bağlı patolojik kırık, 2 olguya meningioma, 2 olguya metastaz, 2 olguya sinir kılıfı tümörü ve 1 olguya hipofiz adenomu ön tanısı ile eksizyon planlandı. Histomorfolojik değerlendirmede olguların %52,6’sında nekrotizan granülomatöz iltihap, %15,8’inde süpüratif inflamasyon ve %10,5’inde kist hidatik ile uyumlu bulgular saptandı. SSS enfeksiyonları farklı predispozan durumlarda farklı etkenlerin neden olduğu, doğru ve etkin tedavi edilmediği takdirde morbidite ve mortalite oranları yüksek hastalıklardır. Bu hastalıkların santral sinir sisteminin primer ve metastatik maligniteleri ile örtüşen şikayet, semptom ve radyolojik bulguya sahip olması doğru tanı koymayı zorlaştıran durumlardır. Olguyu değerlendirirken ihtimaller akılda bulundurulmalı ve olgu klinik öyküsü ile birlikte bir bütün halinde değerlendirilmelidir.

Keywords

Enfeksiyöz hastalık Glial tümör Metastaz Santral sinir sistemi

References

  • 1. Balın ŞÖ, Tartar AS, Demirdağ K, Akbulut A. Kliniğimizde Yatan Santral Sinir Sistemi Enfeksiyonu Tanılı Hastaların Analizi: Beş Yıllık Sonuçlar. Mediterr J Infect Microb Antimicrob. 2019;8:13
  • 2. Tunkel AR, Van de beek D, Scheld WM. Acute menengitis. In: Mandell GL, Bennett JE, Dolin R (eds). Mandeli, Douglas, and Bennett’s Principles and Practice of Infections Diseases. 8th ed. Philadelphia, PA:Churcill Livingstone Elsevier; 2015:1097-137.
  • 3. Altunal LN, Aydın M, Özel AS, Kanadalı A. Bir Eğitim Araştırma Hastanesinde Santral Sinir Sistemi Enfeksiyonlarının Yedi Yıllık Değerlendirilmesi. Adnan Menderes Üniversitesi Sağlık Bilimleri Fakültesi Dergisi. 2021:5(2);170-176.
  • 4. Ahn JS, Yang DH, Kim YK, et al. Multiple intracranial tuberculomas mimicking granulocytic sarcomas in acute myeloid leukemia. J Korean Med Sci. 2007 Sep;22 Suppl(Suppl):S171-3.
  • 5. Calleri G, Libanore V, Corcione S, De Rosa FG, Caramello P. A retrospective study of viral central nervous system infections: relationship amongst aetiology, clinical course and outcome. Infection. 2017;45:227-31.
  • 6. Wall EC, Chan JM, Gil E, Heyderman RS. Acute bacterial meningitis. Curr Opin Neurol. 2021 Jun 1;34(3):386-395. Sinir Sistemi Enfeksiyöz Hastalıkları 329
  • 7.Sunwoo JS, Shin HR, Lee HS, et al. A hospital-based study onetiology and prognosis of bacterial meningitis in adults. Sci Rep. 2021 Mar 16;11(1):6028.
  • 8.Altunal LN, Öztürk S, Aydın M, Özel AS, Kanadalı A. Santral Sinir Sistemi İnfeksiyonu Tanılı 98 Olgunun Klinik Özllikleri.ANKEM Derg 2021;35(3):77-84
  • 9.Lundbo LF, Benfield T. Risk factors for community-acquired bacterial meningitis. Infect Dis (Lond). 2017 Jun;49(6):433-444.
  • 10.Suthar R, Sankhyan N. Bacterial Infections of the Central Nervous System. Indian J Pediatr. 2019 Jan;86(1):60-69.
  • 11.Tunkel AR. Approach to the Patient with Central NervousSystem Infection. In: Mandell GL, Bennett JE, Dolin R (eds). Mandell, Douglas, and Bennett’s Principles and Practice of Infectious Diseases. 8th ed. Philadelphia, PA:Churchill Livingstone Elsevier, 2015:1091-6.
  • 12.Shrivastava A, Arora P, Khare A, Goel G, Kapoor N. Central nervous system filariasis masquerading as a glioma: case report. J Neurosurg. 2017 Sep;127(3):691-693.
  • 13.Ying S, Li-Min L. Cerebral syphilis mimicking metastatic tumors: Report and review of the literature. Neurol India. 2018 Jul-Aug;66(4):1170-1172.
  • 14.Kumar D, Nepal P, Singh S, et al. CNS aspergillomamimicking tumors: Review of CNS aspergillus infection imaging characteristics in the immunocompetent population. J Neuroradiol. 2018 May;45(3):169-176.
  • 15.Ansari AA, Korde P, Iratwar SW, Anjankar A. Intradural extramedullary tuberculoma of the spinal cord mimicking meningioma. BMJ Case Rep. 2022 Dec 9;15(12):e253040.
  • 16.Torres YCAlves-Leon SV, Lima MA. Frequency ofPseudotumoral Central Nervous System Lesions in anOncology Center. World Neurosurg. 2019 Oct;130:e333-e337.
  • 17.Arismendi Morillo GJ, Fernandez Abreu MC, Cardozo SosaDP, Cardozo JJ. Non neoplastic space occupying lesions mimicking central nervous system tumors. Rev Neurol. 2004 Mar;38(5):427-30.
  • 18.Aggarwal A, Patra DP, Gupta K, Sodhi HB. Dural Tuberculoma Mimicking Meningioma: A Clinicoradiologic Review of Dural En-Plaque Lesions. World Neurosurg. 2016Apr;88:686.e1-686.e7.
  • 19.Thwaites G, Fisher M, Hemingway C, Scott G, Solomon T,Innes J. British infection society guidelines for the diagnosis and treatment of tuberculosis of the central nervous system inadults and children. J Infect. 2009;59:167–87.
  • 20.Shah KK, Pritt BS, Alexander MP. Histopathologic review ofgranulomatous inflammation. Clin Tuberc Other Mycobact Dis. 2017 Feb 10:7:1-12.
  • 21.Navarro-Flores A, Fernandez-Chinguel JE, Pacheco-Barrios N,Soriano-Moreno DR, Pacheco-Barrios K. Global morbidity and mortality of central nervous system tuberculosis: a systematic review and meta-analysis. J Neurol. 2022 Jul;269(7):3482-3494.
  • 22.Elvan-Tuz A, Karadag-Oncel E, Kara-Aksay A, Sarioglu FC, Karadag A, Yilmaz-Ciftdogan D. A rare case series of central nervous system cystic echinococcosis. J Trop Pediatr. 2021 Jul 2;67(3):fmab056.
  • 23.Bhatt AS, Mhatre R, Nadeesh BN, Mahadevan A, Yasha TC, Santosh V. Nonneoplastic Cystic Lesions of the Central Nervous System-Histomorphological Spectrum: A Study of 538 Cases. J Neurosci Rural Pract. 2019 Jul;10(3):494-501.
  • 24.Padayachy LC, Ozek MM. Hydatid disease of the brain and spine. Childs Nerv Syst. 2023 Mar;39(3):751-758.
  • 25.Din ND, Raza M, Rahim S, Memon W, Ahmad Z. Hydatid disease of central nervous system, a clinicopathological study of 33 cases. J Neurosci Rural Pract. 2023 Apr-Jun;14(2):293-297.
  • 26.Gün Seda, Ö Terzi, F Karagöz. Patoloji Uzmanı Gözüyle KistHidatik. Kocatepe Tıp dergisi. 2019;20(4):260-263.
  • 27.Geramizadeh B, Kohandel-Shirazi M, Soltani A. A Simple Panel of IDH1 and P53 in Differential Diagnosis BetweenLow-Grade Astrocytoma and Reactive Gliosis. Clin Pathol. 2021 Feb 11:14:2632010X20986168.
There are 27 citations in total.

Details

Primary Language Turkish
Subjects Pathology
Journal Section Research Article
Authors

Mine Özşen 0000-0002-5771-7649

Sahsine Tolunay 0000-0002-9038-0515

Havva Merve Dinç 0009-0007-4491-2297

Şeref Doğan 0000-0002-8706-1994

Hasan Kocaeli 0000-0003-4140-5955

Publication Date December 31, 2023
Acceptance Date November 3, 2023
Published in Issue Year 2023 Volume: 49 Issue: 3

Cite

APA Özşen, M., Tolunay, S., Dinç, H. M., Doğan, Ş., et al. (2023). Klinikoradyolojik Olarak Maligniteleri Taklit Eden Santral Sinir Sistemi Enfeksiyöz Hastalıkları. Uludağ Üniversitesi Tıp Fakültesi Dergisi, 49(3), 325-329. https://doi.org/10.32708/uutfd.1368973
AMA Özşen M, Tolunay S, Dinç HM, Doğan Ş, Kocaeli H. Klinikoradyolojik Olarak Maligniteleri Taklit Eden Santral Sinir Sistemi Enfeksiyöz Hastalıkları. Uludağ Tıp Derg. December 2023;49(3):325-329. doi:10.32708/uutfd.1368973
Chicago Özşen, Mine, Sahsine Tolunay, Havva Merve Dinç, Şeref Doğan, and Hasan Kocaeli. “Klinikoradyolojik Olarak Maligniteleri Taklit Eden Santral Sinir Sistemi Enfeksiyöz Hastalıkları”. Uludağ Üniversitesi Tıp Fakültesi Dergisi 49, no. 3 (December 2023): 325-29. https://doi.org/10.32708/uutfd.1368973.
EndNote Özşen M, Tolunay S, Dinç HM, Doğan Ş, Kocaeli H (December 1, 2023) Klinikoradyolojik Olarak Maligniteleri Taklit Eden Santral Sinir Sistemi Enfeksiyöz Hastalıkları. Uludağ Üniversitesi Tıp Fakültesi Dergisi 49 3 325–329.
IEEE M. Özşen, S. Tolunay, H. M. Dinç, Ş. Doğan, and H. Kocaeli, “Klinikoradyolojik Olarak Maligniteleri Taklit Eden Santral Sinir Sistemi Enfeksiyöz Hastalıkları”, Uludağ Tıp Derg, vol. 49, no. 3, pp. 325–329, 2023, doi: 10.32708/uutfd.1368973.
ISNAD Özşen, Mine et al. “Klinikoradyolojik Olarak Maligniteleri Taklit Eden Santral Sinir Sistemi Enfeksiyöz Hastalıkları”. Uludağ Üniversitesi Tıp Fakültesi Dergisi 49/3 (December 2023), 325-329. https://doi.org/10.32708/uutfd.1368973.
JAMA Özşen M, Tolunay S, Dinç HM, Doğan Ş, Kocaeli H. Klinikoradyolojik Olarak Maligniteleri Taklit Eden Santral Sinir Sistemi Enfeksiyöz Hastalıkları. Uludağ Tıp Derg. 2023;49:325–329.
MLA Özşen, Mine et al. “Klinikoradyolojik Olarak Maligniteleri Taklit Eden Santral Sinir Sistemi Enfeksiyöz Hastalıkları”. Uludağ Üniversitesi Tıp Fakültesi Dergisi, vol. 49, no. 3, 2023, pp. 325-9, doi:10.32708/uutfd.1368973.
Vancouver Özşen M, Tolunay S, Dinç HM, Doğan Ş, Kocaeli H. Klinikoradyolojik Olarak Maligniteleri Taklit Eden Santral Sinir Sistemi Enfeksiyöz Hastalıkları. Uludağ Tıp Derg. 2023;49(3):325-9.
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