An instructive false diagnosis: steroid-induced complete remission of a CNS tumor--probably lymphoma.
In recent years the incidence of primary cerebral lymphomas has increased. Diagnosis by imaging techniques (CCT, angiography, MRT) and stereotactic biopsy are considered as reliable diagnostic tools. Therapeutically a combination of radio-, steroid- and chemotherapy is recommended. We report a case of space-occupying CNS lesion in which the radiopaque enhancing process completely disappeared after biopsy and steroid therapy. A year later the tumor recurred on the other side and again regressed after steroid therapy. The first biopsy showed signs of a papillar tumor, so a choroid plexus papilloma was suspected. On examination of the treatment history, however, this diagnosis had to be revised. A primary CNS lymphoma seems most probable. The phenomenon of a tumor remission under steroid administration and the problems related to the differential diagnosis are discussed.
Heckmann
J G
JG
Department of Neurology, University Erlangen-Nürnberg, Fed. Rep. of Germany.
Bockhorn
J
J
Stolte
M
M
Druschky
A
A
Neundörfer
B
B
D000368:Aged; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use*; D001623:Betamethasone / Q000627:therapeutic use*; D001932:Brain Neoplasms / Q000175:diagnosis* / Q000188:drug therapy* / Q000473:pathology; D002533:Cerebral Angiography; D003951:Diagnostic Errors; D017809:Fatal Outcome; D006801:Humans; D008223:Lymphoma / Q000175:diagnosis* / Q000188:drug therapy* / Q000473:pathology; D008279:Magnetic Resonance Imaging; D008297:Male; D012008:Recurrence; D013238:Stereotaxic Techniques
D000893:Anti-Inflammatory Agents; D001623:Betamethasone