Sebastian F Winter1,2,3, Deborah A Forst1,2, Derek H Oakley4, Tracy T Batchelor5, Jorg Dietrich1,2. 1. Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, Massachusetts, USA. 2. Division of Neuro-Oncology, Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA. 3. Department of Neurosurgery, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany. 4. Department of Pathology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA. 5. Department of Neurology, Brigham and Women's Hospital and Harvard Medical School, Dana-Farber/Harvard Cancer Center, Harvard Medical School, Boston, Massachusetts, USA.
Abstract
BACKGROUND: Intracranial foreign body granuloma (FBG) is a rare inflammatory reaction to retained foreign material, manifesting acutely or months to years following neurosurgical procedures. Radiographically, FBG can mimic tumor progression, and tissue biopsy may be required to guide management. MATERIALS AND METHODS: In this retrospective case series, we present unique clinico-radiographic and histopathological features of six neuro-oncological patients diagnosed with FBG between 2007 and 2019. RESULTS: All six patients (4 women and 2 men, aged 29-54 [median, 30.5] years) had undergone surgical resection of a low- (n = 4) or high-grade (n = 2) glioma. FBG manifestation postsurgery ranged from 1 day to 4 years and was predominantly asymptomatic (n = 5/6). Magnetic resonance imaging universally demonstrated one or multiple peripherally enhancing lesion(s) adjacent to the resection cavity. Histopathology in all (n = 4/4) resected specimens demonstrated an inflammatory reaction to foreign material, confirming FBG. CONCLUSION: Intracranial FBG constitutes a rare but challenging treatment-related condition effectively managed by surgery, with important therapeutic implications in neuro-oncology.
BACKGROUND:Intracranial foreign body granuloma (FBG) is a rare inflammatory reaction to retained foreign material, manifesting acutely or months to years following neurosurgical procedures. Radiographically, FBG can mimic tumor progression, and tissue biopsy may be required to guide management. MATERIALS AND METHODS: In this retrospective case series, we present unique clinico-radiographic and histopathological features of six neuro-oncological patients diagnosed with FBG between 2007 and 2019. RESULTS: All six patients (4 women and 2 men, aged 29-54 [median, 30.5] years) had undergone surgical resection of a low- (n = 4) or high-grade (n = 2) glioma. FBG manifestation postsurgery ranged from 1 day to 4 years and was predominantly asymptomatic (n = 5/6). Magnetic resonance imaging universally demonstrated one or multiple peripherally enhancing lesion(s) adjacent to the resection cavity. Histopathology in all (n = 4/4) resected specimens demonstrated an inflammatory reaction to foreign material, confirming FBG. CONCLUSION: Intracranial FBG constitutes a rare but challenging treatment-related condition effectively managed by surgery, with important therapeutic implications in neuro-oncology.
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Authors: Sebastian F Winter; Eugene J Vaios; Alona Muzikansky; Maria Martinez-Lage; Marc R Bussière; Helen A Shih; Jay Loeffler; Philipp Karschnia; Franziska Loebel; Peter Vajkoczy; Jorg Dietrich Journal: Oncologist Date: 2020-06-18