A case of oligodendroglioma and multiple sclerosis: Occam's razor or Hickam's dictum?. (28th June 2018)

• Record Type: Journal Article
• Authors: Shirani, Afsaneh; Wu, Gregory F.; Giannini, Caterina; Cross, Anne H.
• Is Part Of: BMJ case reports. Volume 2018
• Publication Date: 2018-06-28
• Subjects: multiple sclerosis -- neurooncology -- neuroimaging; Medicine -- Case studies -- Periodicals; 610.5
• DOI: 10.1136/bcr-2018-225318
• Languages: English
• ISSNs: 1757-790X

Abstract

Abstract : 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.