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Unusual association of diseases/symptoms
CASE REPORT
A case of oligodendroglioma and multiple sclerosis: Occam’s razor or Hickam’s dictum?
  1. Afsaneh Shirani1,
  2. Gregory F. Wu1,
  3. Caterina Giannini2,
  4. Anne H. Cross1
  1. 1Department of Neurology, Washington University in Saint Louis School of Medicine, St Louis, Missouri, USA
  2. 2Department of Laboratory Medicine and Pathology, Mayo Clinic College of Medicine, Rochester, USA
  1. Correspondence to Dr Afsaneh Shirani, ashirani{at}wustl.edu

Summary

Tumefactive appearing lesions on brain imaging can cause a diagnostic dilemma. We report a middle-aged man who presented with right-sided optic neuritis. A brain MRI showed enhancement of the right optic nerve, and non-enhancing white matter lesions including a 3 cm right frontal lesion with adjacent gyral expansion. Cerebrospinal fluid analysis showed five oligoclonal bands not present in serum. Glatiramer acetate was started for suspected tumefactive multiple sclerosis (MS). A follow-up brain MRI 6 months later showed persistence of the frontal gyral expansion. A brain biopsy led to the diagnosis of an oligodendroglioma, isocitrate dehydrogenase-mutant and 1 p/19q co-deleted (WHO grade II), managed with surgical resection and radiotherapy. Postoperative brain MRI showed a new enhancing periventricular lesion, making the choice of optimal disease-modifying therapy for MS challenging. This case highlights the possibility of coexistence of MS and oligodendroglioma, and emphasises the importance of a tissue diagnosis when atypical MS imaging features are present.

  • multiple sclerosis
  • neurooncology
  • neuroimaging

https://doi.org/10.1136/bcr-2018-225318

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    Footnotes

    • Contributors AS: study concept and design, acquisition of data, interpretation of data and drafting/revising the manuscript. GFW and AHC: study concept and design, interpretation of data and revising the manuscript. CG: study concept and design, preparation of pathology images, interpretation of data and revising the manuscript.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests AS is funded through a clinician scientist development award from the USA National Multiple Sclerosis Society, and a clinical research training scholarship from the American Academy of Neurology. GFW has been a paid consultant for: EMD-Serono and Genzyme/Sanofi and is on the speaker bureau for EMD-Serono and Genzyme/Sanofi. GFW has received research grant funding from Genetech/Roche, the NIH, and the Doris Duke Foundation. CG reports no conflicts of interest. AHC has been a paid consultant for: Biogen, EMD-Serono, Genzyme/Sanofi, Genentech/Roche, and Novartis. AHC was funded in part by the Manny & Rosalyn Rosenthal – Dr John L Trotter MS Center Chair in Neuroimmunology of Barnes-Jewish Hospital Foundation.

    • Patient consent Obtained.

    • Provenance and peer review Not commissioned; externally peer reviewed.