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LETTERS TO EDITOR
Year : 2018  |  Volume : 66  |  Issue : 2  |  Page : 553-555

Giant pericallosal lipoma presenting with psychosis


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 Publication15-Mar-2018

Correspondence Address:
Dr. Yaxiong Li
Department of Neurosurgery, The First Hospital of Hebei Medical University, 56# Shi-Gang Road, Hebei - 050000
China
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0028-3886.227327

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How to cite this article:
Li Y, Wang X, Fan F. Giant pericallosal lipoma presenting with psychosis. Neurol India 2018;66:553-5

How to cite this URL:
Li Y, Wang X, Fan F. Giant pericallosal lipoma presenting with psychosis. Neurol India [serial online] 2018 [cited 2021 Oct 28];66:553-5. Available from: https://www.neurologyindia.com/text.asp?2018/66/2/553/227327


Sir,

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.[1] Approximately 30% of lipomas occur in the pericallosal region.[2] Most intracranial lipomas are asymptomatic whereas some present with seizures and headache.[3],[4] 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.[5],[6],[7],[8],[9],[10]
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.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Jabot G, Stoquart-Elsankari S, Saliou G, Toussaint P, Deramond H, Lehmann P. Intracranial lipomas: Clinical appearances on neuroimaging and clinical significance. J Neurol 2009;256:851-5.  Back to cited text no. 1
    
2.
Loddenkemper T, Morris HH, Diehl B, Lachhwani DK. Intracranial lipomas and epilepsy. J Neurol 2006;253:590-3.  Back to cited text no. 2
    
3.
Feldman RP, Marcovici A, LaSala PA. Intracranial lipoma of the Sylvian fissure. Case report and review of the literature. J Neurosurg 2001;94:515-9.  Back to cited text no. 3
    
4.
Fuga M, Tanaka T, Yamamoto Y, Hasegawa Y, Murayama Y, Takahashi-Fujigasaki J. Lipoma in the corpus callosum presenting with epileptic seizures associated with expanding perifocal edema: A case report and literature review. Case Rep Neurol Med 2015;2015:520208.  Back to cited text no. 4
    
5.
Macpherson RI, Holgate RC, Gudeman SK. Midline central nervous lipomas in children. Can Assoc Radiol J 1987;38:264-70.  Back to cited text no. 5
    
6.
Swayze VW, Andreasen NC, Ehrhardt JC, Yuh WT, Alliger RJ, Cohen GA. Developmental abnormalities of the corpus callosum in schizophrenia. Arch Neurol 1990;47:805-8.  Back to cited text no. 6
    
7.
David AS, Wacharasindhu A, Lishman WA. Severe psychiatric disturbance and abnormalities of the corpus callosum: Review and case series. J Neurol Neurosurg Psychiatry 1993;56:85-93.  Back to cited text no. 7
    
8.
Pinkofsky HB, Struve FA, Meyer MA, Patrick G, Reeves RR. Decreased multi-band posterior interhemispheric coherence with a lipoma on the corpus callosum: A case report of a possible association. Clin Electroencephalogr 1997;28:155-9.  Back to cited text no. 8
    
9.
Crippa JA, Hallak JE, Sanches RF, Zuardi AW, Araújo D, Santos AC. Lipoma adhered to the corpus callosum in a schizophrenic patient with severe positive symptoms that responded to clozapine. Acta Neuropsychiatr 2002;14:36-8.  Back to cited text no. 9
    
10.
Baumann CR, Regard M, Trier S, Schuknecht B, Siegel AM. Lipoma on the corpus callosum in a patient with schizophrenia-like episode: Is there a causal relationship? Cogn Behav Neurol 2006;19:109-11.  Back to cited text no. 10
    


    Figures

  [Figure 1], [Figure 2], [Figure 3]
 
 
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