title: Calcifying pseudoneoplasm of the neuraxis in direct continuity with a low-grade glioma: A case report and review of the literature.
abstract: Calcifying pseudoneoplasms of the neuraxis (CAPNON) are presumed to be a non-neoplastic reactive pathology, based on the frequent finding of granulomatous inflammation. To our knowledge, there are few reports of CAPNON in association with a neoplasm. Here, we report the case of a 62-year-old man presenting with headache, which was caused by CAPNON in the left cingulate gyrus. CT scan revealed a calcified mass exhibiting gradual growth and increasing peritumoral edema. MRI showed an intra-axial hypointense mass on T1- and T2-weighted images. Development of a peri-lesional hyperintense lesion on T2-weighted images suggested local edema or tumoral invasion. Gadolinium-enhanced T1-weighted images revealed mild peripheral enhancement of the calcified nodule. L-methyl-11C methionine-positron emission tomography revealed the uptake of tracer in the calcified nodule. The calcified mass and its enveloping brain tissue were removed using a parietal craniotomy. The calcified tissue was surrounded by spindle-shaped cells positive for GFAP and nestin. The MIB-1 labeling index of spindle cells was around 10% (i.e. a hot spot). Fourteen months after surgery, gadolinium-enhanced MRI evidenced growth of a tiny residual lesion. Therefore, this report illustrates a potential case of CAPNON arising from low-grade glial neoplasm.
authors.affiliation: Department of Neurosurgery, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan.
authors.forename: Nayuta
authors.identifier: http://orcid.org/0000-0001-8853-8769
authors.initials: N
authors.lastname: Higa
authors.affiliation: Department of Human Pathology, Gunma University Graduate School of Medicine, Maebashi, Japan.
authors.forename: Hideaki
authors.initials: H
authors.lastname: Yokoo
authors.affiliation: Department of Neurosurgery, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan.
authors.forename: Hirofumi
authors.initials: H
authors.lastname: Hirano
authors.affiliation: Department of Neurosurgery, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan.
authors.forename: Hajime
authors.initials: H
authors.lastname: Yonezawa
authors.affiliation: Department of Neurosurgery, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan.
authors.forename: Tatsuki
authors.initials: T
authors.lastname: Oyoshi
authors.affiliation: Department of Human Pathology, Field of Oncology, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan.
authors.forename: Yuko
authors.initials: Y
authors.lastname: Goto
authors.affiliation: Department of Neurosurgery, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan.
authors.forename: Kazunori
authors.initials: K
authors.lastname: Arita
mesh_terms: D001927:Brain Diseases / Q000150:complications / Q000473:pathology; D001932:Brain Neoplasms / Q000473:pathology*; D002114:Calcinosis / Q000150:complications* / Q000473:pathology*; D005910:Glioma / Q000150:complications / Q000473:pathology*; D006179:Gyrus Cinguli / Q000473:pathology*; D006801:Humans; D008297:Male; D008875:Middle Aged
keywords: GFAP; low-grade glioma; neoplasm; nestin