Tumefactive primary central nervous system vasculitis mimicking a brain metastasis in a patient with kidney cancer

A 71-year-old male patient with papillary renal cell carcinoma (RCC) presented with confusion, right hemiparesis, and aphasia. Initial imaging showed a hyperdense swollen cortex on the left side, suggestive of a stroke. Follow-up imaging revealed a round lesion with peripheral microbleeds, irregular...

Full description

Saved in:
Bibliographic Details
Published in:Arquivos de neuro-psiquiatria 2024-07, Vol.82 (7), p.1-2
Main Authors: Freitas, Leonardo Furtado, Neto, Osorio Lopes Abath, Maley, Joan E, Shekhrajka, Nitesh, Policeni, Bruno A
Format: Article
Language:English
Subjects:
Aphasia
Brain Neoplasms - diagnostic imaging
Brain Neoplasms - secondary
Carcinoma, Renal Cell - diagnostic imaging
Carcinoma, Renal Cell - pathology
Carcinoma, Renal Cell - secondary
Central nervous system
Diagnosis, Differential
Differential diagnosis
Humans
Images in Neurology
Kidney Neoplasms - diagnostic imaging
Kidney Neoplasms - pathology
Lesions
Magnetic Resonance Imaging
Metastases
Neuroimaging
NEUROSCIENCES
Papillary renal cell carcinoma
Paresis
PSYCHIATRY
Vasculitis
Vasculitis, Central Nervous System - diagnostic imaging
Vasculitis, Central Nervous System - pathology
Citations: Items that this one cites
Online Access:Get full text
Tags: Add Tag
No Tags, Be the first to tag this record!
Description
Summary:A 71-year-old male patient with papillary renal cell carcinoma (RCC) presented with confusion, right hemiparesis, and aphasia. Initial imaging showed a hyperdense swollen cortex on the left side, suggestive of a stroke. Follow-up imaging revealed a round lesion with peripheral microbleeds, irregular enhancement, and laminar cortical necrosis. The differential diagnosis included brain metastasis. However, after surgery, the pathology favored vasculitis. This case highlights the challenge of diagnosing central nervous system (CNS) vasculitis, especially in cancer patients. The presentation of CNS vasculitis as a pseudotumoral lesion is rare and often misdiagnosed. The imaging findings, including abnormal perfusion and low FDG uptake, were consistent with an evolving enhancing necrotic lesion. The presence of a dense inflammatory infiltrate with perivascular distribution further supported the diagnosis of vasculitis. This case emphasizes the importance of considering vasculitis as a differential diagnosis in patients with atypical brain lesions, even in the presence of cancer.
ISSN:0004-282X
1678-4227
1678-4227
DOI:10.1055/s-0044-1786762