Psammomatous Cavernous Malformation Presenting as Drug-Resistant Epilepsy: Case Illustration and Review of Literature.

Kanika Sharma, Piyush Kalakoti, John E Shaughnessy, Nestor De La Cruz, Rimal H Dossani, Peimin Zhu, Eduardo Gonzalez-Toledo, Christina Ledbetter, James B Pinskton, Anil Nanda, Rosario Maria Riel-Romero, Alireza Minagar, Christina Notarianni, Hai Sun

Journal: World neurosurgery 2017;93():120-6

PMID: 27283183

Full Text on Elsevier Science View on PubMed

Abstract

BACKGROUND

Psammoma bodies (PBs) are whorled, laminated hyaline spherules containing calcium deposits. Intracranially, the presence of PBs is associated with variants of meningioma and pituitary lesions, as well as aging choroid plexus. Limited information exists on their presence in vascular malformation.

RESULTS

In this report, we describe a case of an adolescent male with drug-resistant epilepsy that was surgically managed at our regional epilepsy center. The epileptogenic focus was determined to be emanating from an indolent right insular lesion. Histopathologic evaluation showed the abundance of intravascular and perivascular PBs. Immunohistochemical evaluation confirmed the vascular origin using vascular markers. The unusual presence of PBs in a vascular lesion was unanticipated.

CONCLUSIONS

Based on our case, we present the clinicoradiologic characteristics, supplemented with intraoperative findings, for this unusual lesion. In addition, because of the unusual presence of PBs in vascular lesions, we provide the findings of a systematic literature review to show the association of PBs with intracranial vascular lesions.

Address: Department of Neurosurgery, Louisiana State University Health Sciences Center, Shreveport, Louisiana, USA.; Department of Pathology, Louisiana State University Health Sciences Center, Shreveport, Louisiana, USA.; Department of Neurology, Louisiana State University Health Sciences Center, Shreveport, Louisiana, USA.; Department of Neuro-radiology, Louisiana State University Health Sciences Center, Shreveport, Louisiana, USA.; Department of Neurosurgery, Louisiana State University Health Sciences Center, Shreveport, Louisiana, USA. Electronic address: [email protected].

DOI: 10.1016/j.wneu.2016.05.093

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MeSH Terms: Adolescent, Diagnosis, Differential, Drug Resistant Epilepsy, Hemangioma, Cavernous, Central Nervous System, Humans, Male, Vascular Calcification