Double extremes of brain tumors - Dilemma of decision-making and pitfalls of image: A case report and literature review

Abstract

Coexistence of multiple primary intracranial tumors has been reported previously. However, most of simultaneous tumors occurred after intracranial radiotherapy or in high association with heredity. Both primary intracranial tumors arising simultaneously at synchronous discrete sites were introduced without prior radiation or genetic disorders. These tumors showed the same characteristic according to preoperative images. Two distinct tumors, meningioma and anaplastic oligoastrocytoma were revealed by postoperative histopathological findings. We present this unusual case to exhibit the rare possibility that two distinct primary brain tumors can occur in the same patient. Although magnetic resonance image were used to define the tumor patterns in almost cases, some diagnostic pitfalls may occur with coexistent primary brain tumors. Hence, a discrepancy between clinical impressions and radiological findings should raise a further survey for potential different natures. Reviewing the literature, we should remove the symptomatic tumors based on mass effect and presenting symptoms first, whether it is a benign-looking meningioma or a malignant astrocytoma. Surgical priority for two distinct synchronous tumors from each other needs individual evaluation carefully.