The large right temporal lesion demonstrates contradictory findings. The lesion exerts significant mass effect and demonstrates enhancement on conventional imaging. The spectroscopy studies demonstrate central lactate. No clear cut elevation in choline was demonstrated. The pattern of enhancement is incomplete. The contradictory findings raise the possibility that this lesion may not be neoplastic in nature. Consider a tumofactive demyelinating lesion as well as neoplasm for this lesion.
The patient went on to have a biopsy.
Histopathology and special stains are in favor of demyelinating disease process. Section show white matter changes exhibiting gliosis, reactive astrocyte and numerous lipid-laden macrophages.
Special stains (LFB-PAS & MBP) show loss of myelin and relative preserved of axons (NFP).