Artikel
5-ALA fluorescence in a cerebral infarction mimicking high-grade glioma – a case report
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Veröffentlicht: | 8. Juni 2016 |
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Gliederung
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Objective: 5-aminolevulinic acid (5-ALA) has become an integral part of neurosurgical treatment of malignant glioma. Over time, several other tumor entities have been identified to metabolize 5-ALA as well and presented with a similar fluorescence patterns during surgical resection.
Method: We present a case of a woman with a cerebral lesion with typical radiological features of malignant glioma. After 5-ALA fluorescence guided surgery the lesion turned out to be an ischemic infarction.
Results: The intraoperative frozen section was inconclusive. It showed necrosis with accompanying astrocytosis and pigment-laden macrophages. No viable tumor tissue could be identified. The definite histopathological diagnosis revealed stage II of a cerebral infarction. This is the first description of intraoperative fluorescence activity of postischemic cerebral tissue. Follow-up scans were unremarkable.
Conclusions: This unusual case underlines the importance of radiographic differential diagnoses of malignant glioma. Although, transient neurological deficits can be attributed to tumor growth and edema when encountering a ring-enhancing lesion, cerebral ischemia should be considered as a possible cause as well. The intraoperative fluorescence of a cerebral infarction may be due to inflammatory reactions and cannot be fully explained. Thus the role of 5-ALA in postischemic brain tissue needs further investigation.