Fluorescence diagnosis of tumor cells in hemangioblastoma cysts with 5-aminolevulinic acid

Case report

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Peritumoral hemangioblastoma cysts are usually composed of fibrous tissue without tumor cells. The authors describe the first case in which fluorescence with 5-aminolevulinic acid (5-ALA) was used to diagnose a hemangioblastoma tumor in a peritumoral cyst wall. A 27-year-old woman with a homogeneous, enhanced nodular lesion in the right hemisphere of the cerebellum underwent surgical treatment. After the nodular lesion was removed, the cyst region was observed with the aid of a semiconductor laser with a peak wavelength of 405 ± 1 nm, which was powered using a fiberoptic cable. The cyst region was visualized with strong fluorescence, which disappeared after tissue removal. The fluorescent cyst consisted of tumor cells. The authors conclude that fluorescence diagnosis performed using 5-ALA can inform the choice of removing hemangioblastoma cysts.

Abbreviations used in this paper: 5-ALA = 5-aminolevulinic acid; PPIX = protoporphyrin IX.

Article Information

Address correspondence to: Satoshi Utsuki, M.D., Department of Neurosurgery, Kitasato University School of Medicine, 1–15–1 Kitasato, Sagamihara, Kanagawa 228-8555, Japan. email: utsuki@med.kitasato-u.ac.jp.

© AANS, except where prohibited by US copyright law.

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Figures

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    Contrast-enhanced axial T1-weighted MR image showing a homogeneous enhanced mass lesion with cyst in the right cerebellar hemisphere. The cyst wall showed no enhancement.

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    A: Intraoperative photograph of a peritumoral cyst wall shown by microscopy under white light after resection of a nodal lesion. A residual tumor cannot be identified. B: Peritumoral cyst wall is observed through a cut filter in this equal view; PPIX fluorescence was revealed when the excitation light, which had a peak wavelength of 405 nm, was irradiated. C: Graph of the laser spectrum of the fluorescence demonstrating the same peaks as the PPIX fluorescence at 635 and 704 nm.

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    Upper: Photomicrograph showing histological findings in the nodular lesion. The tumor proved to be a hemangioblastoma with stromal and capillary endothelial cells. Lower: Photomicrograph showing histological findings in the cyst wall, where fluorescence was observed. The tumor cells form a thin line to border the cyst wall, and gliosis surrounds the circumference. H & E, original magnification × 200 (upper) and × 100 (lower).

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