Cerebral amyloidomas are the rarest manifestation of cerebral amyloid deposition, typically appearing as solidly enhancing masses.
Reported numbers are low due to the rarity of this condition, making generalisations about epidemolgical features difficult. Generally, cases have been reported in patients of middle age (30 to 50 years of age) with perhaps a female predilection 1,2. Of the four manifestations of cerebral amyloid deposition, amyloidomas appear to be in the youngest cohort.
Clinical presentation is non-specific and depends on the location of the mass. Generally symptoms include focal neurological deficits, seizure, headaches and decline in cognitive function 1,2. This is in no way helpful in distinguishing cerebral amyloidomas form other intracerebral masses.
Cerebral amyloidomas are composed of large nodular masses of cerebral amyloid-β (Aβ) 1. These are centered in the white matter with deposits in the wall and surrounding blood vessels, with adjacent inflammatory cells 1.
Cerebral amyloidomas are characterized by nodular solid masses with vivid contrast enhancement, typically centered within the white matter, often abutting the lateral ventricles 1. They are and surrounded by a mantle of vasogenic oedema 1. They have most commonly been reported as solitary lesions centered in the white matter of the cerebral hemispheres, although cortical and even posterior fossa lesions have been described 1.
These masses typically grow only slowly if at all, and generally appear to exert less mass effect than one would expect from a similar sized tumour 1.
Amyloidomas generally are somewhat hyperattenuating, although hypoattenuating examples have been reported 1,2. Following administration of contrast, these masses usually enhance 2.
Signal characteristics of the mass are variable 1,2.
- T1: variable signal intensity, ranging from hypointense to hyperintense
- T2: variable signal intensity, ranging from hypointense to hyperintense
- vivid contrast enhancement
- peripheral radial enhancement is sometimes seen, thought to correlated with vessel wall cerebral amyloid-β deposition 1
- T2*/SWI: microhaemorrhages may be seen
Treatment and prognosis
Cerebral amyloidomas are benign and surgical resection, which is the treatment of choice for symptomatic individuals is generally curative, although recurrences have been documented 1. Even in asymptomatic individuals, resection or biopsy are usually undertaken as it is difficult to confidently differentiate these lesions from primary or secondary tumours 2. To date no specific medical therapy has been identified as useful 1.
The differential diagnosis of cerebral amyloidomas is largely that of tumours of the central nervous system, including:
- 1. Miller-Thomas MM, Sipe AL, Benzinger TL et-al. Multimodality Review of Amyloid-related Diseases of the Central Nervous System. Radiographics. 2016;36 (4): 1147-63. doi:10.1148/rg.2016150172 - Pubmed citation
- 2. Landau D, Avgeropoulos N, Ma J. Cerebral amyloidoma mimicking intracranial tumor: a case report. J Med Case Rep. 2010;4 (1): 308. doi:10.1186/1752-1947-4-308 - Free text at pubmed - Pubmed citation