5-ALA Fluorescence In A Case Of Brain Abscess By Aggregatibacter Mimicking A Glioblastoma.

5-ALA Fluorescence In A Case Of Brain Abscess By Aggregatibacter Mimicking A Glioblastoma.

World Neurosurg. 2019 Feb 08;:

Authors: de Laurentis C, Del Bene M, Fociani P, Tonello C, Pollo B, DiMeco F

Abstract
BACKGROUND: At present, differential diagnosis of MRI enhancing lesions can still be challenging. Preoperative imaging is a valuable tool characterized by high informative value, even if false-positive and false-negative results are possible. In this context, 5-aminolevulenic acid (5-ALA) represents a significant adjunct in glioblastoma (GBM) surgery displaying an assumed specific accumulation only in tumor cells. However, it was anecdotally reported that in some cases it can be detected also in non-neoplastic lesions mimicking GBM, thus potentially leading to misdiagnosis. Moreover, precise identification of involved pathogens from intraoperative brain samples may remain difficult. We report the case of an abscess from Aggregatibacter mimicking a GBM both at preoperative imaging and intraoperatively, since showing 5-ALA fluorescence.
CASE DESCRIPTION: A 54-year-old man presented with intense cephalalgia, vomiting and scotomas in his left eye. The brain MRI demonstrated a right temporo-occipital rim-enhancing mass, highly suggestive for a GBM and for this reason the patient underwent 5-ALA guided complete removal. Histopathological analysis proved the lesion to be a bacterial abscess from Aggregatibacter as confirmed by polymerase chain reaction (PCR) on bacterial DNA.
CONCLUSIONS: 5-ALA fluorescence may not be specifically involved only in malignant tumor cells, thus raising the suspect for alternative diagnoses to GBM and inviting to caution in fluorescence-guided surgery.

PMID: 30743027 [PubMed - as supplied by publisher]

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