NEUROCHIRURGIE.CHU FORT DE FRANCE.Dr MANZO NORBERT. NEUROCHIRURGIEN.

A case of late onset multiple sclerosis mimicking glioblastoma and displaying intraoperative 5-aminolevulinic acid fluorescence
NORBERT MANZO1, ULF NESTLER1
Various case reports and case series describe the resemblance of multiple sclerosis lesions to cerebral glioma on MRI. Multiple sclerosis accounts for about 1% of histological diagnosis in biopsies or surgical specimens resected for suspicion of brain tumor. Only few information is available about the interaction between sclerotic plaques and the fluorescence guided resection agent 5-aminolevulinic acid, which is currently used more and more often to allow for complete resection of malignant brain tumors.
Case description:
We report the case of a 57-year-old male patient who underwent neurosurgical intervention for an intracerebral mass lesion with the features of a malignant brain tumor on preoperative MRI. During intervention, the lesion showed strong 5-Ala fluorescence and intraoperative histological diagnosis on frozen material was malignant astrocytoma. After additional examinations on the paraffin embedded specimens definitive diagnosis revealed multiple sclerosis.
Conclusion:
We hypothesize that the inflammatory lymphatic cells engaged in the demyelinating process are susceptible to protoporphyrin IX accumulation induced by 5-aminolevulinic acid. In this way a fluorescence signal, very similar to the signal of malignant tumor cells, becomes detectable.