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Tumor-like mass lesion – an under-recognized presentation of primary angiitis of the central nervous system
  1. Eamonn S Molloy (eamonn.molloy{at}ireland.com)
  1. Cleveland Clinic, United States
    1. Aneesh B Singhal (asinghal{at}partners.org)
    1. MGH, United States
      1. Leonard H Calabrese (calabrl{at}ccf.org)
      1. Cleveland Clinic, United States

        Abstract

        Objective: To describe the occurrence of mass lesions (ML) in primary angiitis of the central nervous system (PACNS) and assess the utility of diagnostic testing and treatment.

        Methods: We examined the case records of the Cleveland Clinic (CC), Massachusetts General Hospital (MGH), and the English language medical literature, for biopsy-proven PACNS cases presenting as a solitary ML. Relevant clinical variables were extracted and analyzed with JMP software.

        Results: We identified a total of 38 ML: 8/202 (4.0%) CC/MGH patients and 30/535 (5.6%) PACNS patients identified from the medical literature. A higher percentage, (13/45; 29%) was seen in the amyloid-related angiitis subset. Poorer outcomes were reported in the amyloid group, with 5 deaths. Of the non-amyloid group, better outcomes were seen in the group treated with corticosteroids and cyclophosphamide as compared with the group treated with corticosteroids alone.

        Conclusions: Although rare, PACNS should be considered in the differential diagnosis of ML; greater awareness of this manifestation may facilitate more prompt diagnosis and treatment. Biopsy evidence of angiitis is required for diagnosis; specimens should routinely be stained for amyloid. While excision of the lesion may be curative, aggressive immunosuppressive therapy is associated with favorable outcomes and may obviate the need for surgery.

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