Gangliogliomas (GGs) are rare tumors of the central nervous system occurring in the young population (8.5-25 years). GGs are one of the most common cause of epilepsy associated with CNS tumors and significant proportion of them is refractory to antiepileptic medications. Multifocal gangliogliomas are very rare and only few handful cases are reported. A rare case of multiple spinal ganglioglioma has also been reported in the literature. We present a case of an adolescent girl who presented with multiple episodes of seizures. She was initially evaluated and diagnosed with multiple tuberculomas. She was managed with antiepileptics and antitubercular medications. Her seizure frequency had decreased; but despite prolonged and complete course of anti-tubercular treatment, the lesions were not subsiding in size. Antitubercular medications were restarted and subsequent scan showed progression in the size of the lesions; and hence biopsy was done from the largest lesion. Histopathology was suggestive of GG. Ganglioglioma can be multifocal and can mimic other lesions like tuberculosis, radiologically. Surgical excision of the lesion provides the best treatment option. It is still under consideration whether to remove all of the lesions or only ones with considerable size. She had another episode of seizure and is now planned for surgical excision of the other lesion.
Published in | Clinical Neurology and Neuroscience (Volume 5, Issue 3) |
DOI | 10.11648/j.cnn.20210503.13 |
Page(s) | 50-54 |
Creative Commons |
This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited. |
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Copyright © The Author(s), 2021. Published by Science Publishing Group |
Multifocal Ganglioglioma, Intracranial Ganglioglioma, Tuberculoma
[1] | Dudley RW, Torok MR, Hoffman L, Levy JM, Handler MH, Liu AK, et al. Response to Journal Club: Pediatric Low-Grade Ganglioglioma: Epidemiology, Treatments, and Outcome Analysis of 348 Children From the Surveillance, Epidemiology, and End Results Database. Neurosurgery. 2016; 79 (2): 309. Epub 2016/07/20. doi: 10.1227/NEU.0000000000001275. PubMed PMID: 27428632. |
[2] | Louis DN, Perry A, Reifenberger G, von Deimling A, Figarella-Branger D, Cavenee WK, et al. The 2016 World Health Organization Classification of Tumors of the Central Nervous System: a summary. Acta Neuropathol. 2016; 131 (6): 803-20. Epub 2016/05/10. doi: 10.1007/s00401-016-1545-1. PubMed PMID: 27157931. |
[3] | Paduch T, Baborie A, Krauss JK. Bifocal temporal ganglioglioma. Neurosurg Rev. 1999; 22 (2-3): 112-6. Epub 1999/11/05. doi: 10.1007/s101430050042. PubMed PMID: 10547009. |
[4] | Silver JM, Rawlings CE, 3rd, Rossitch E, Jr., Zeidman SM, Friedman AH. Ganglioglioma: a clinical study with long-term follow-up. Surg Neurol. 1991; 35 (4): 261-6. Epub 1991/04/01. doi: 10.1016/0090-3019(91)90002-q. PubMed PMID: 2008640. |
[5] | Rades D, Zwick L, Leppert J, Bonsanto MM, Tronnier V, Dunst J, et al. The role of postoperative radiotherapy for the treatment of gangliogliomas. Cancer. 2010; 116 (2): 432-42. Epub 2009/11/13. doi: 10.1002/cncr.24716. PubMed PMID: 19908258. |
[6] | Gregory N. Fuller TR, david M. Wildrick. Brain Tumors: An Overview of Current Histopathologic and Genetic Classification. In: Winn HR, editor. Youmans & Winn Neurological Surgery, 7th Edition. 7th ed2017. p. 768-70. |
[7] | Wolf HK, Muller MB, Spanle M, Zentner J, Schramm J, Wiestler OD. Ganglioglioma: a detailed histopathological and immunohistochemical analysis of 61 cases. Acta Neuropathol. 1994; 88 (2): 166-73. Epub 1994/01/01. doi: 10.1007/BF00294510. PubMed PMID: 7985497. |
[8] | Ma SP, Tsui A, Kaye AH. Multicentric hemispheric ganglioglioma in a 20-year-old adult. J Clin Neurosci. 2015; 22 (2): 418-20. Epub 2014/10/12. doi: 10.1016/j.jocn.2014.08.003. PubMed PMID: 25304433. |
[9] | de Abreu PP, Muniz BC, Ventura N, Gasparetto E, Marchiori E. Intraventricular ganglioglioma with dissemination of cerebrospinal fluid. Radiol Bras. 2018; 51 (4): 272-73. Epub 2018/09/12. doi: 10.1590/0100-3984.2016.0222. PubMed PMID: 30202135; PubMed Central PMCID: PMCPMC6124589. |
[10] | Yamamoto T, Komori T, Shibata N, Toyoda C, Kobayashi M. Multifocal neurocytoma/gangliocytoma with extensive leptomeningeal dissemination in the brain and spinal cord. Am J Surg Pathol. 1996; 20 (3): 363-70. Epub 1996/03/01. doi: 10.1097/00000478-199603000-00014. PubMed PMID: 8772791. |
[11] | Lummus SC, Aisner DL, Sams SB, Foreman NK, Lillehei KO, Kleinschmidt-DeMasters BK. Massive dissemination from spinal cord gangliogliomas negative for BRAF V600E: report of two rare adult cases. Am J Clin Pathol. 2014; 142 (2): 254-60. Epub 2014/07/13. doi: 10.1309/AJCPIBSV67UVJRQV. PubMed PMID: 25015869; PubMed Central PMCID: PMCPMC4616006. |
[12] | Bradley JP, Kure K, Kawamoto HK. Bitemporal ganglioglioma: surgical management of an unusual intracranial and extracranial tumor. Plast Reconstr Surg. 2003; 111 (7): 2328-32. Epub 2003/06/10. doi: 10.1097/01.PRS.0000060798.99796.05. PubMed PMID: 12794476. |
[13] | F. Lakhdar M. Laghmari R. Gana R. Maaqili F. Bellakhdar. Gangliogliomes multiples intracrâniens: À propos d’un casMultiple intracranial ganglioglioma: Case report. Neurochirurgie. 2008; 54 (2): 97-100. doi: https://doi.org/10.1016/j.neuchi.2007.12.006. |
[14] | Mansour S, Luther E, Eichberg DG, Shah A, Echeverry N, Humayun Gultekin S, et al. Multifocal Intracranial Ganglioglioma in a Sexagenarian: Case Report and Review of the Current Literature. World Neurosurg. 2020; 138: 498-503. Epub 2019/12/27. doi: 10.1016/j.wneu.2019.12.084. PubMed PMID: 31877395. |
[15] | Vajramani GV, Dambatta S, Walker M, Grundy PL. Multiple gangliogliomas of the optic pathway. Br J Neurosurg. 2006; 20 (6): 428-30. Epub 2007/04/19. doi: 10.1080/02688690601101382. PubMed PMID: 17439099. |
[16] | Wang JL HC, Otero J, Puduvalli VK, Elder JB. Genetic characterization of a multifocal ganglioglioma originating within the spinal cord. World neurosurgery. 2016; 96: 608-e1. |
[17] | Song JY, Kim JH, Cho YH, Kim CJ, Lee EJ. Treatment and outcomes for gangliogliomas: a single-center review of 16 patients. Brain Tumor Res Treat. 2014; 2 (2): 49-55. Epub 2014/11/20. doi: 10.14791/btrt.2014.2.2.49. PubMed PMID: 25408925; PubMed Central PMCID: PMCPMC4231627. |
[18] | Majores M, von Lehe M, Fassunke J, Schramm J, Becker AJ, Simon M. Tumor recurrence and malignant progression of gangliogliomas. Cancer. 2008; 113 (12): 3355-63. Epub 2008/11/07. doi: 10.1002/cncr.23965. PubMed PMID: 18988291. |
APA Style
Akshay Vijay Kulkarni, Gyani Jail Singh Birua, Dhaval Gohil, Manish Beniwal, Dwarakanath Srinivas, et al. (2021). A Rare Case of Multifocal Intracranial Gangliogliomas: Mimicking Tuberculomas. Clinical Neurology and Neuroscience, 5(3), 50-54. https://doi.org/10.11648/j.cnn.20210503.13
ACS Style
Akshay Vijay Kulkarni; Gyani Jail Singh Birua; Dhaval Gohil; Manish Beniwal; Dwarakanath Srinivas, et al. A Rare Case of Multifocal Intracranial Gangliogliomas: Mimicking Tuberculomas. Clin. Neurol. Neurosci. 2021, 5(3), 50-54. doi: 10.11648/j.cnn.20210503.13
AMA Style
Akshay Vijay Kulkarni, Gyani Jail Singh Birua, Dhaval Gohil, Manish Beniwal, Dwarakanath Srinivas, et al. A Rare Case of Multifocal Intracranial Gangliogliomas: Mimicking Tuberculomas. Clin Neurol Neurosci. 2021;5(3):50-54. doi: 10.11648/j.cnn.20210503.13
@article{10.11648/j.cnn.20210503.13, author = {Akshay Vijay Kulkarni and Gyani Jail Singh Birua and Dhaval Gohil and Manish Beniwal and Dwarakanath Srinivas and Shilpa Rao}, title = {A Rare Case of Multifocal Intracranial Gangliogliomas: Mimicking Tuberculomas}, journal = {Clinical Neurology and Neuroscience}, volume = {5}, number = {3}, pages = {50-54}, doi = {10.11648/j.cnn.20210503.13}, url = {https://doi.org/10.11648/j.cnn.20210503.13}, eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.cnn.20210503.13}, abstract = {Gangliogliomas (GGs) are rare tumors of the central nervous system occurring in the young population (8.5-25 years). GGs are one of the most common cause of epilepsy associated with CNS tumors and significant proportion of them is refractory to antiepileptic medications. Multifocal gangliogliomas are very rare and only few handful cases are reported. A rare case of multiple spinal ganglioglioma has also been reported in the literature. We present a case of an adolescent girl who presented with multiple episodes of seizures. She was initially evaluated and diagnosed with multiple tuberculomas. She was managed with antiepileptics and antitubercular medications. Her seizure frequency had decreased; but despite prolonged and complete course of anti-tubercular treatment, the lesions were not subsiding in size. Antitubercular medications were restarted and subsequent scan showed progression in the size of the lesions; and hence biopsy was done from the largest lesion. Histopathology was suggestive of GG. Ganglioglioma can be multifocal and can mimic other lesions like tuberculosis, radiologically. Surgical excision of the lesion provides the best treatment option. It is still under consideration whether to remove all of the lesions or only ones with considerable size. She had another episode of seizure and is now planned for surgical excision of the other lesion.}, year = {2021} }
TY - JOUR T1 - A Rare Case of Multifocal Intracranial Gangliogliomas: Mimicking Tuberculomas AU - Akshay Vijay Kulkarni AU - Gyani Jail Singh Birua AU - Dhaval Gohil AU - Manish Beniwal AU - Dwarakanath Srinivas AU - Shilpa Rao Y1 - 2021/07/23 PY - 2021 N1 - https://doi.org/10.11648/j.cnn.20210503.13 DO - 10.11648/j.cnn.20210503.13 T2 - Clinical Neurology and Neuroscience JF - Clinical Neurology and Neuroscience JO - Clinical Neurology and Neuroscience SP - 50 EP - 54 PB - Science Publishing Group SN - 2578-8930 UR - https://doi.org/10.11648/j.cnn.20210503.13 AB - Gangliogliomas (GGs) are rare tumors of the central nervous system occurring in the young population (8.5-25 years). GGs are one of the most common cause of epilepsy associated with CNS tumors and significant proportion of them is refractory to antiepileptic medications. Multifocal gangliogliomas are very rare and only few handful cases are reported. A rare case of multiple spinal ganglioglioma has also been reported in the literature. We present a case of an adolescent girl who presented with multiple episodes of seizures. She was initially evaluated and diagnosed with multiple tuberculomas. She was managed with antiepileptics and antitubercular medications. Her seizure frequency had decreased; but despite prolonged and complete course of anti-tubercular treatment, the lesions were not subsiding in size. Antitubercular medications were restarted and subsequent scan showed progression in the size of the lesions; and hence biopsy was done from the largest lesion. Histopathology was suggestive of GG. Ganglioglioma can be multifocal and can mimic other lesions like tuberculosis, radiologically. Surgical excision of the lesion provides the best treatment option. It is still under consideration whether to remove all of the lesions or only ones with considerable size. She had another episode of seizure and is now planned for surgical excision of the other lesion. VL - 5 IS - 3 ER -