Cerebral venous sinus thrombosis easily misdiagnosed as brain tumor: one case report

Abstract

Objective To investigate the clinicopathological features of cerebral venous sinus thrombosis (CVST) in order to reduce its misdiagnosis as brain tumors. Methods and Results A 46⁃year⁃old male was admitted to hospital due to headaches and inarticulate speech. Elevated levels of D⁃dimer detected in plasma. Head MRI suggested that it may be left temporal occipital lobe brain tumor with hemorrhage. Surgical resection of space⁃occupying lesions in the left temporal lobe was performed. Optical microscopy showed the structure of brain was loose, dissociated, necrosis, hemorrhage in the cortex, vessel proliferation. Neurons decreased significantly, and the remaining neurons showed hypoxic changes. Lots of foam cells infiltration, perivascular lymphocytic infiltration, mixed with thrombosis could be seen in the subarachnoid vena cava superficial vein vessel lumen. Immunohistochemical staining showed CD31 was positive indicateing vascular endothelial cells, CD163 and CD68 were positive in foam cells, glial fibrillary acidic protein (GFAP) was positive indicating reactive proliferation of glial cell, CD3 and CD20 were positive indicating lymphocyte, neurofilament protein (NF) was positive and showed that the axon was relatively well preserved. Ki⁃67 proliferation index was 5% (most of them were lymphocyte positive). Myelin staining showed no obvious demyelination. Final pathological diagnosis was cerebral superficial cortical vein thrombosis; subacute hemorrhagic cerebral infarction. Conclusions Diagnosis of cerebral venous sinus thrombosis requires comprehensive consideration of medical history, laboratory examinations and imaging, when imaging diagnosis is difficult, further pathological biopsy is needed to confirm the diagnosis. Early diagnosis and early treatment are beneficial to improve the patient's prognosis.

Keywords

• sinus thrombosis
• intracranial
• brain neoplasms
• immunohistochemistry