Diagnosis: MS or tumour

Epub: Turatti et al. Benign course of tumour-like multiple sclerosis. Report of five cases and literature review. J Neurol Sci. 2012 Nov 11. doi:pii: S0022-510X(12)00583-7. 10.1016/j.jns.2012.10.026.

BACKGROUND: MS with initial neuroradiological features suggestive of brain tumour (tumour-like MS) may represent a challenging diagnosis.

METHODS: Among the MSers seen at the MS centre of this Institution between 2000 and 2010, they identified cases presenting with a large (diameter>2cm), well-defined lesion, suggestive of brain tumour on initial brain magnetic resonance imaging (MRI). Only MSers with at least 10 years follow-up were included.

RESULTS: Five young women with MS who presented with a tumour-like lesion on initial brain MRI are described. All cases presented with sudden-onset neurological deficits due to a single large brain lesion compatible with neoplasm at MRI. Two cases underwent brain stereotactic biopsy, both misdiagnosed as astrocytoma. However, the subsequent clinical and MRI follow-up was consistent with MS in all cases. Unnecessary surgery and radiotherapy were responsible for disability in two cases. In three cases, the course of the disease remains benign after more than 13–years from symptoms onset.

CONCLUSIONS: The report of clinical, radiological and pathological features of five tumour-like MS cases confirms that it is mandatory to consider a demyelinating process in the differential diagnosis of tumour-like brain lesions. Many tumour-like MS cases may have a favourable long term prognosis.

“This case series is  very pertinent as we have recently had a case at our centre with a lesion that looked, and behaved as a tumour, but had other features to support demyelination. Did we do a biopsy or not? The problem is if this individual had a lymphoma and we had waited to treat the lymphoma a lot would have potentially been lost. In the 4-8 weeks it takes for a lymphoma to declare itself over demyelination a lot can happen. This is why doing a biopsy, in these cases, is sometimes necessary; i.e. to make a definitive diagnosis and to start a definitive treatment ASAP.”

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