P17.74MONOFOCAL LESION OF DEMYELINATING DISEASE AND DIFFERENTIAL DIAGNOSIS WITH HIGH GRADE GLIOMA - CASE REPORT

INTRODUCTION: Pseudoneoplasms of the nervous system are potential to mislead. Clinical, neuroimaging and histologic features are readily misinterpreted in degenerative disease tumor-like lesion. CASE REPORT: A 33 years-old woman was admitted to our observation with an history of intacranial hypertension syndrome and acute left hemiparesis. CT and MR imaging revealed a right frontal ring enhanced lesion with mass effect, suggestive for high grade glioma. Surgical treatment was performed: craniotomy and extensive resection of the lesion. The post-operative course was uneventful, associated to normal neurological status. Pathological examination was a surprise: “tumefactive demyelinating disease” (mixture of macrophages and reactive astrocytes, perivascular lymphocytes). CONCLUSIONS: Multiple sclerosis disease may show a variety of clinical and radiological presentations. Monofocal demyelinating lesion is atypical appearance simulating brain tumor. The knowledge of this diagnostic pitfall is essential to avoid mismanagement.