A case of tumefactive multiple sclerosis resembling malignant glioma

Abstract

Tumefactive multiple sclerosis(MS)shows imaging features that are not typical of MS. Because extensive edema and mass effects are seen, differentiation from brain tumor is difficult. We present a case of tumefactive MS diagnosed preoperatively as malignant glioma. Case: A 66-year-old man presented with convulsions of the right half of the body. Magnetic resonance imaging (MRI)of the brain showed an annular enhancing mass measuring 4 cm×5 cm×6 cm with substantial edema in the left frontal lobe. Computed tomography(CT)showed hemorrhagic changes, and arterial spin labeling (ASL) MRI showed no increased blood flow in the lesion. We suspected malignant glioma and resected the mass lesion. Histopathological examination was consistent with demyelinating disease, and tumefactive MS was diagnosed. The patient was treated with corticosteroid therapy and plasma exchange therapy postoperatively. Although few imaging findings are specific for tumefactive MS, a lack of increased blood flow in the lesion may be a point of differentiation from malignant glioma.