Work

A case of tumefactive demyelinating lesion mimicking cerebral parasite, infection or brain tumor

Year: 2026

Type: article

Abstract: Background Tumefactive demyelinating lesion (TDL) is a rare inflammatory central nervous system disorder that frequently mimics malignant brain tumors or infectious abscesses both clinically and radiologically. Due to its hypercellular nature, it presents a formidable diagnostic challenge, particularly during intraoperative frozen section analysis, often leading to inappropriate surgical interventions. Case Presentation We report a case of multifocal mass-like intracranial lesions initially suspected to be a high-grade glioma or cerebral abscess. Intraoperative frozen section evaluation faced a significant diagnostic gap, raising suspicion of an infarction or low-grade glioma due to dense foamy histiocyte infiltration. However, comprehensive permanent histopathological analysis successfully resolved the ambiguity; diffuse CD68 positivity, neurofilament-confirmed axonal preservation, and an intact glial fibrillary acidic protein (GFAP) framework definitively established the diagnosis of a TDL. Furthermore, serological workup revealed a seronegative status for both aquaporin-4 (AQP4) and myelin oligodendrocyte glycoprotein (MOG) antibodies, indicating a monophasic immune response. The patient was treated with high-dose intravenous corticosteroids, resulting in dramatic clinical recovery and radiological regression. Conclusion This case highlights that a meticulous multidisciplinary approach—integrating pathognomonic neuroimaging features, utilizing key immunohistochemical markers to bridge the frozen-permanent pathology gap, and performing comprehensive serological testing—is crucial to confirm a diagnosis of seronegative monophasic TDL. Recognizing this distinct clinical entity is vital to prevent aggressive surgical over-treatment or unnecessary long-term immunosuppression, thereby ensuring optimal patient outcomes.

Source: Interdisciplinary Neurosurgery

DOI: 10.1016/j.inat.2026.102358

Authors: Tae Geon Kim, Hyun Woo Kim, Eui Gyu Sin

Institutions: Konyang University, Konyang University Hospital

Language: English

Topic: Multiple Sclerosis Research Studies

Subfield: Clinical Neurology

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: gold

Estimated APC paid: $1,910