Tumor-like neurosarcoidosis: Pearls and pitfalls

Abstract

Introduction: Tumor-like neurosarcoidosis is rare. It is found in 10% of cases of neurosarcoidosis (Cacoub et al., 2000) [1]. Observation: A 56-year-old woman presented with partial seizures, progressive right hemiparesis and aphasia. Brain magnetic resonance imaging (MRI) revealed an hypointensity in T1 and an hyperintensity in T2 in the fronto-parieto-occipital region with mass effect, thickening of meninges and nodular enhancing lesions in contact with the cerebral falx. Serological, immunological tests and tumor markers were negative. Serum angiotensin converting enzyme was elevated. Histopathological study of meningeal biopsy revealed non-caseating epithelioid and giant cell granulomas. Thus, the diagnosis of tumor-like neurosarcoidosis was confirmed. No other localization of the disease was detected. The patient was treated with corticosteroids and anti-epileptics. The outcome was favourable. Conclusion: Tumor-like neurosarcoidosis is a challenging diagnosis. Sarcoidosis should be considered in the differential diagnosis of cerebral mass lesions, especially when diagnostic tests for more common etiologies are negative.

Keywords

• Neurosarcoidosis
• Tumor
• Diagnosis
• Neuroimaging
• Treatment