Brain Tumor Res Treat.  2022 Jul;10(3):195-199. 10.14791/btrt.2022.0021.

Cerebral Microangiopathy Mimicking a High-Grade Glioma in Old Age: A Case Report

• Kwon YM
• Han SH
• Sung KS
• Song YJ

• KMID: 2532252
• DOI: http://doi.org/10.14791/btrt.2022.0021

Abstract

Cerebral microangiopathy (CM) has become a common disease related to improved neuroimaging modalities and an increased life expectancy. Intracerebral tumor-like mass lesions have rarely been reported in cases of cerebral amyloid angiopathy (CAA) in elderly patients. However, tumor-like mass lesions from CM without amyloid deposits have rarely been reported. These two angiopathies may have different pathogeneses and neuroimaging characteristics. Herein, we present the case of an 83-year-old man with CM mimicking a high-grade glioma. We described the possible pathogenesis and different neuroimaging features of CM compared to CAA.

Keyword

Cerebral amyloid angiopathy; Cerebral small vessel disease; Microangiopathy; cerebral

Figure

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  Fig. 1 Preoperative images. A: Brain non-contrast enhanced CT shows a diffuse low-density cortical mass lesion on the left posterior temporo-parietal area and a partially high-density lesion, indicating an intralesional hemorrhage. B: The hemorrhagic mass with a different phase present in the diffusion-weighted MRI. C: The fluid-attenuated inversion recovery image shows severe peri-lesional edema and intra-axial cortical mass lesion along the abovementioned area. D and E: The T1-weighted contrast-enhanced MRI shows a large nodular cortical mass lesion with parenchymal enhancement. F: The gradient echo images show a partially low-signal on the intra-lesional hemorrhagic mass.

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  Fig. 2 Intraoperative view. A: The arachnoid membrane is focally thickened with whitish discoloration, and a cortical mass with a small region of cortical bleeding is observed. B: The mass has high vascularity, and the intralesional hematoma is exposed.

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  Fig. 3 Pathological results (hematoxylin and eosin [H&E] staining of subcortical white matter). A: On frozen section evaluation, this lesion was hypocellularity and made up of small-sized vessels and reactive gliosis without nuclear pleomorphism (H&E stain, ×200). B: Contoured vessels are diffusely embedded in white matter in the background of multifocal microhemorrhages (H&E stain, ×200). C: These small vessels are mainly characterized by thickening of the vessel wall, deposits of fibro-hyaline material, and narrowing of the lumen (H&E stain, ×200).

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  Fig. 4 Postoperative images. A: T1-weighted contrast-enhanced MRI shows the removal state of the parenchymal enhanced mass. B: The fluid-attenuated inversion recovery image shows a slightly improved peri-lesional edema.

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