RESUMO
Background: Lhermitte-Duclos disease (LDD) or dysplastic gangliocytoma of the posterior fossa is a slow-growing and extremely rare mass lesion that involves the Purkinje neurons and the granular layer of the cerebellum. It is characterized by specific neuroradiological features and secondary hydrocephalus. However, documentation of surgical experience is scarce. Case Description: A 54-year-old man with LDD manifesting as progressive headache is presented with vertigo and cerebellar ataxia. Magnetic resonance imaging demonstrated a right cerebellar mass lesion with the characteristic "tiger-striped appearance." We decided to perform partial resection with reduction of tumor volume improving symptomatology as a result of the mass effect in the posterior fossa. Conclusion: Surgical resection is a good alternative for the management of LDD, especially when neurological compromise exists due to mass effect.
RESUMO
Dysplastic gangliocytoma of the cerebellum (DGC) or Lhermitte-Duclos Disease is a rare lesion (World Health Organization [WHO] grade I) characterized by thickened folia and replacement of the internal granular layer by abnormal ganglion cells. More commonly, the compromised patients are young adults presenting ataxia, seizures, obstructive hydrocephalus, and increased intracranial pressure. Dysplastic gangliocytoma of the cerebellum is intimately associated with Cowden syndrome, a hereditary disorder caused by a germline mutation in the PTEN tumor suppressor gene on chromosome 10q23. Large neurons of DCG show vesicular nuclei with prominent nucleoli. Expansion of the internal granular layer determines vacuolization of the molecular layer and white matter, which can be related to the bright stripes identified on T2-weighted magnetic resonance imaging. Herein, the authors report a female patient who developed long- time recurrence of DGC and discuss pathological findings and differential diagnosis of this rare cerebellar lesion.
Assuntos
Humanos , Feminino , Adulto , Síndrome do Hamartoma Múltiplo/diagnóstico , Neoplasias Cerebelares/diagnóstico , Ganglioneuroma/cirurgia , Ganglioneuroma/diagnóstico , Recidiva , Síndrome do Hamartoma Múltiplo/complicações , Síndrome do Hamartoma Múltiplo/terapia , Ganglioneuroma/fisiopatologiaRESUMO
Introducción. El gangliocitoma displásico del cerebelo fue descrito originalmente en 1920 por Lhermitte y Duelos, autores a quienes se les debe el epónimo de esta enfermedad. Es una entidad rara, caracterizada por ser una masa tumoral unilateral de la corteza cerebelosa, de crecimiento muy lento, que produce un aumento de la presión intracraneana. En 1991 Padberg y col. describieron la asociación de la enfermedad Lhermitte-Duclos y el síndrome de Cowden (SC). Aún no se ha comprendido completamente la biología molecular que asocia a estas enfermedades, sin embargo se ha comprobado en estudios modelos animales (ratones) mutaciones del gen homólogo de fosfatasa y tensina suprimido del cromosoma 10 (PTEN). Las imágenes de resonancia magnética son características de esta entidad, de tal manera que permiten hacer el diagnóstico preoperatorio sin la necesidad de estudios histopatológicos, permitiendo una evaluación y manejo neuroquirúrgico adecuados. Caso clínico. Se informa el caso de una mujer de 17 años con enfermedad de Lhermitte-Duclos del hemisferio cerebeloso derecho no asociado a SC, en quien el diagnóstico se estableció en el transoperatorio con improntas de la lesión cerebelosa. Conclusión. No existen publicaciones previas que describan las características cito lógicas de la lesión, y en este caso sí fue posible estudiarlas.
Introduction. Dysplastic cerebellar gangliocytoma was first described in 1920 by Lhermitte and Duelos, authors who gave their name to the entity. It is a rare condition, which is characterized by a very slowly growing unilateral tumor mass of the cerebellar cortex, producing increased intracranial pressure. In 1991 Padberg et al. described the association of Lhermitte-Duclos disease and Cowden syndrome. The relationship between these 2 entities has been associated with mutations of the phosphatase and tensin homolog deleted on chromosome (PTEN) gene. Magnetic resonance imaging findings are the hallmark of this entity, and the diagnosis is established without hystopathologic studies. Case report. We inform a case of a 17 years old girl with Lhermitte-Duclos of the right cerebellar hemisphere without Cowden syndrome.