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|LETTERS TO EDITOR
|Year : 2018 | Volume
| Issue : 2 | Page : 553-555
Giant pericallosal lipoma presenting with psychosis
Yaxiong Li1, Xin Wang2, Fengshi Fan1
1 Department of Neurosurgery, The First Hospital of Hebei Medical University, Shijiazhuang, Hebei Provence, China
2 Department of Pathology, The First Hospital of Hebei Medical University, Shijiazhuang, Hebei Provence, China
|Date of Web Publication||15-Mar-2018|
Dr. Yaxiong Li
Department of Neurosurgery, The First Hospital of Hebei Medical University, 56# Shi-Gang Road, Hebei - 050000
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Li Y, Wang X, Fan F. Giant pericallosal lipoma presenting with psychosis. Neurol India 2018;66:553-5
A 44-year old woman presented with changes in behavior, hypologia, emotional lability, and a bad temper of 3-month duration. Neurological examination was normal. A calcified cystic lesion was noted in the midline frontal region and extending to both bodies of the lateral ventricles on computed tomography (CT) [Figure 1]. Magnetic resonance imaging (MRI) revealed a large pericallosal lipoma and severe dysgenesis of the corpus callosum. The mass was having a high fat signal on T1 and T2-weighted images and was not enhanced by gadolinium injection [Figure 2]a,[Figure 2]b,[Figure 2]c,[Figure 2]d,[Figure 2]e,[Figure 2]f. Microsurgery was performed through an interhemispheric approach. The mass was not attached to the falx and was identified behind the pericallosal artery, which was surrounded by mural calcifications on both the sides. The lesion was partially removed and showed a mild vascularity on excising it. Pathologic examination confirmed the diagnosis of a lipoma [Figure 3]a and [Figure 3]b. Immunohistochemical staining for smooth muscle actin yielded negative results [Figure 3]c. S-100 and cluster of differentiation (CD) 34 positive cells were detected [Figure 3]d and [Figure 3]e. The postoperative course was uneventful. At a 6-month follow-up visit, the patient had made a good recovery, and has returned to her previous activities without any residual psychotic manifestations being present.
|Figure 1: Cranial CT shows an extremely low absorption area with a high-density area of the calcification (white arrow). Both anterior horns and bodies of the lateral ventricles are separated by the tumor|
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|Figure 2: A non-contrast MRI reveals an interhemispheric lesion, appearing hyperintense on T1 (a) and T2 (b) weighted imaging. There is associated significant dysgenesis of the corpus callosum (f). The mass is highly vascular and a pericallosal branch of the anterior cerebral artery is traversing through the lesion, as visualized on postgadolinium axial (c), coronal (d), and sagittal (e) MRI|
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|Figure 3: Histological features of the tumor. Photomicrograph (hematoxylin and eosin stained ×100) demonstrating mature adipose tissue with thickened blood vessels (a). The dark particles showing marked calcification in most parts (b). Immunohistochemical findings showing a positive staining for CD34 (c) and S-100 (d). In noncalcified areas, tumor cells are negative for smooth muscle actin (e)|
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Intracranial lipomas are rare congenital malformations, accounting for only 0.1–0.5% of all primary brain tumors. Approximately 30% of lipomas occur in the pericallosal region. Most intracranial lipomas are asymptomatic whereas some present with seizures and headache., A review of literature of the reported cases of corpus callosum lipoma with psychiatric symptoms is presented in [Table 1]. Our case illustrates that both neurosurgeons and psychiatrists should be aware of the occasional relationship between psychiatric manifestations and intracranial tumors.,,,,,
|Table 1: Summary of patients with lipoma of the corpus callosum presenting with psychiatric symptoms|
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Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form the patient has given her consent for her images and other clinical information to be reported in the journal. The patient understands that name and initial will not be published and due efforts will be made to conceal identity, but anonymity cannot be guaranteed.
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Conflicts of interest
There are no conflicts of interest.
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[Figure 1], [Figure 2], [Figure 3]