Neuro-Behcet diseases showing pseudotumoral presentation

Park, Woon Gyu; Kim, Seung Hyun; Kim, Ju Han; Kim, Myung Ho

Abstract

BACKGROUND AND SIGNIFICANCE: Because of the diverse clinical and radiologic manifestations of Neuro-Behcet disease, it is sometimes difficult to differentiate with multiple sclerosis or tumorous condition. We report two cases of Neuro-Behcet disease underwent by stereotaxic biopsy showing vasculitis without any evidence of malignancy, initially misdiagnosed as solitary tumor and metastatic tumor, respectively. CASE: A 35-year-old male admitted due to right hemiparesis. Brain CT showed low density mass shadow in left thalamus. Under the impression of low grade astrocytoma, stereotaxic biopsy was performed. Dense perivascular lymphocytic infiltration with petechial microhemorrhage mixed with hemosiderin pigment was noted in thalamic region. The other patient (male, 44yrs old) admitted due to seizure. On MRI, there are multiple inhomogenous signals on right occipital and left frontal lobe and left thalamus. Under the impression of metastatic tumor, work-up about the primary tumor was done without any positive findings. To determine the primary focus, stereotaxic biopsy was performed. Only reactive gliosis and mild perivascular lymphocytic infiltration was noted in pathologic specimen. With the retrospective careful history taking and follow-up image study, two patients were confirmed as having a Behcet's disease.