Haydarpasa Numune Med J. 2021; 61(3): 245-255 | DOI: 10.14744/hnhj.2021.59862

Tumefactive Demyelinating Lesions: A Case Series of 11 Patients and Review of The Literature

Mustafa Efendioðlu¹, Tuðçe Kýzýlay², Ruziye Erol Yýldýz², Devran Suer², Zerrin Karaaslan³, Cemile Handan Mýsýrlý², Erdem Tuzun³, Recai Türkoðlu^2
1Department of Neurosurgery, University of Health Sciences Hamidiye Faculty of Medicine, Haydarpasa Numune Health Application and Research Center, Istanbul, Turkey
²Department of Neurology, University of Health Sciences Hamidiye Faculty of Medicine, Haydarpasa Numune Health Application and Research Center, Istanbul, Turkey
³Department of Neuroscience, Aziz Sancar Institute of Experimental Medicine, Istanbul University, Istanbul, Turkey

INTRODUCTION: The aim of this study was to present the follow-up data of eleven patients with tumefactive demyelinating lesions (TDL) with pointing the challenges of differential diagnosis and indicate the possible prognostic features.

METHODS: In our study, a retrospective analysis was performed by collecting clinical, laboratory and radiological findings with the prospective follow-up of 11 patients with TDL who presented with at least one cerebral demyelinating lesion (> 2cm) and admitted to Haydarpasa Numune Training and Research Hospital between 2000-2020.
RESULTS: 72.7% of the patients were female (n = 8) and 27.2% were male (n = 3). There was a female predominance (F / M = 2.66) and the mean age of onset was 33.45 years (18-68 years). While TDL was the first neurological event in 9 (81.8%) of 11 patients, 2 patients (18.1%) had developed TDL after the diagnosis of multiple sclerosis (MS). Among 9 patients whose first neurological event was a tumefactive lesion, three of them were diagnosed with Neuromyelitis Optica (NMO), two patients with MS, and two patients with acute demyelinating encephalomyelitis (ADEM). Two patients were followed up as TDL with a monophasic course. The average follow-up period was 62.16 months (1-180 months).
DISCUSSION AND CONCLUSION: It is difficult to diagnose TDL by distinguishing it from other lesions, including brain tumors, with clinical and radiological findings. Detailed anamnesis, physical examination and magnetic resonance imaging (MRI) can eliminate the need for brain biopsy in patients for the diagnosis. Early diagnosis of TDL and aggressive immunomodulatory treatments may delay the progression to a second demyelinating event or clinically definite MS.

Keywords: Tumefactive demyelinating lesion, multiple sclerosis, brain tumors, magnetic resonance imaging

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Tümefaktif Demiyelizan lezyonlar: 11 Olgu Serisi ve Literatür Derlemesi

Mustafa Efendioðlu¹, Tuðçe Kýzýlay², Ruziye Erol Yýldýz², Devran Suer², Zerrin Karaaslan³, Cemile Handan Mýsýrlý², Erdem Tuzun³, Recai Türkoðlu^2
1Saðlýk Bilimleri Üniversitesi Hamidiye Týp Fakültesi, Haydarpaþa Numune Saðlýk Uygulama ve Araþtýrma Merkezi, Beyin Cerrahisi Anabilim Dalý, Ýstanbul, Türkiye
²Saðlýk Bilimleri Üniversitesi Hamidiye Týp Fakültesi, Haydarpaþa Numune Saðlýk Uygulama ve Araþtýrma Merkezi, Nöroloji Anabilim Dalý, Ýstanbul, Türkiye
³Ýstanbul Üniversitesi, Aziz Sancar Deneysel Týp Araþtýrma Enstitüsü,Sinirbilim Anabilim Dalý, Ýstanbul, Türkiye

GÝRÝÞ ve AMAÇ: Bu çalýþmanýn amacý; Tümefaktif demiyelizan lezyonu(TDL) olan onbir hastanýn ayýrýcý tanýdaki zorluklarýný takip verilerinin eþliðinde sunulmasý ve olasý prognostik faktörlerin özelliklerini ortaya koymaktýr.
YÖNTEM ve GEREÇLER: Çalýþmamýz SBÜ Haydarpaþa Numune Eðitim Araþtýrma Hastanesi’nde; 2000-2020 yýllarý arasýnda en az bir serebral demiyelinizan lezyon (> 2cm) ile baþvuran TDL olan 11 hastanýn prospektif takibi ile klinik, laboratuvar ve radyolojik bilgileri toplanarak retrospektif bir analiz gerçekleþtirildi.
BULGULAR: Hastalarýmýzýn %72,7’si kadýn (n=8), %27,2’si erkek (n=3) idi. Kadýn üstünlüðü (K/E= 2,66) görülmekle birlikte ortalama baþlangýç yaþý 33,45 yýl (min: 18 max: 68) idi. 11 hastanýn 9’unda (%81,8) TDL ilk nörolojik olay ile prezente olurken, 2’sinde (%18,1) MS teþhisi konulduktan sonra TDL geliþti.
Ýlk nörolojik olayý tümefaktif lezyon olan 9 hastanýn 3’ünde Nöromiyelitis Optika(NMO), 2’si Multipl Skleroz(MS), 2’si Akut Dissemine Ensefalomiyelit(ADEM) tanýsý konularak izlendi. Ýki hasta ise monofazik seyirli TDL olarak takibe alýndý. Ortalama takip süresi: 62,16 ay (min: 1 ay, max: 180 ay) idi.
TARTIÞMA ve SONUÇ: TDL klinik ve radyolojik bulgular ile beyin tümörü dahil diðer lezyonlardan ayýrt edilerek taný konulmasý zordur. Ayrýntýlý anamnez, fizik muayene ve MR görüntüleme, hastalarýn beyin biyopsisine olan ihtiyacýný ortadan kaldýrabilir. Erken teþhis ve agresif immünomodülatör tedaviler, ikinci bir demiyelinizan olayý veya klinik olarak kesin MS'e ilerlemeyi geciktirebilir.

Anahtar Kelimeler: Tümefaktive demyelizan lezyon, multiple sklerozis, beyin tümörleri, magnetik rezonans görüntüleme

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