A 30 year old man with headaches, imbalance and aphasia

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Presentation transcript:

A 30 year old man with headaches, imbalance and aphasia Teaching NeuroImages Neurology Resident and Fellow Section © 2013 American Academy of Neurology

Vignette 30 year old man Weeks of progressive headache, imbalance and aphasia Brain imaging revealed enhancing left frontal mass Chest Imaging revealed mediastinal and hilar adenopathy © 2013 American Academy of Neurology Jordan JT, et al

Imaging C D A B Jordan JT, et al Brain and Chest Imaging. Coronal contrasted T1 (A) shows heterogeneously enhancing mass. Axial FLAIR (B) shows vasogenic edema. Chest X-ray (C) and CT (D) demonstrate lymphadenopathy (arrows). Jordan JT, et al © 2013 American Academy of Neurology

Imaging * * A B Jordan JT, et al Pathology. Lymph node biopsy (A) reveals sarcoid, with non-caseating granuloma (asterisk) surrounded by lymphocytes (arrow). Brain biopsy (B) reveals glioblastoma, with vascular proliferation (arrow) and pseudopalisading necrosis (asterisk). * Jordan JT, et al © 2013 American Academy of Neurology

Brain Mass with Hilar Adenopathy: The Importance of Histological Diagnosis This case emphasizes the importance of histologic diagnosis before initiating therapy. One study demonstrated nearly 50% variation in diagnosis following brain biopsy, 27% leading to a change in treatment.1 Sarcoid is associated with increased risk of certain cancers, though this has not been demonstrated for gliomas.2 1.Kim J.E., Kim D.G., Paek S.H., Jung H.W. Stereotactic biopsy for intracranial lesions: reliability and its impact on the planning of treatment. Acta Neurochir 2003;145:547-555 2. Le Jeune I., Gribbin J., West J., Smith C., Cullinan P., et al. The Incidence of Cancer in Patients with Idiopathic Pulmonary Fibrosis and Sarcoidosis in the UK. Resp Med 2007 Dec;101(12):2534-2540 Jordan JT, et al © 2013 American Academy of Neurology