Trigeminal Amyloidoma: Case Report and Review of the Literature

ABSTRACT

The authors present a case of amyloid infiltration involving the trigeminal nerve that mimicked a malignant cavernous sinus tumor with perineural tumor infiltration. A 64-year-old man presented with trigeminal nerve numbness. Imaging revealed a plaque-like enhancing lesion along the right lateral cavernous sinus extending anteriorly into Meckel's cave and involving the proximal V2 and V3 branches of the trigeminal nerve. The patient underwent an extradural frontotemporal craniotomy with middle fossa exposure of the cavernous sinus to diagnose and treat the presumed malignant cavernous sinus tumor. A reddish mass involving the lateral dural wall of the cavernous sinus was resected. The gasserian ganglion, V2, and V3, the latter of which was biopsied, were enlarged. Permanent histopathological studies showed microscopic eosinophilic, amorphous material, which stained positive for Congo red, and an absence of neoplastic cells. The final diagnosis was amyloidoma. Thus, amyloidomas can involve the trigeminal nerve or ganglia and should be considered in the differential diagnosis of a cavernous sinus lesion mimicking a tumor. Patients may have symptomatic improvement of trigeminal neuropathy with resection of the amyloidoma outside the nerve capsule that is compressing the nerve, while resection of the lesion from within the capsule may result in permanent trigeminal nerve dysfunction.

Gasserian ganglion - trigeminal - amyloidoma

REFERENCES

• 1 Laeng R H, Altermatt H J, Scheithauer B W, Zimmermann D R. Amyloidomas of the nervous system: a monoclonal B-cell disorder with monotypic amyloid light chain lambda amyloid production.  Cancer. 1998;  82 362-374
• 2 Borghi G, Tagliabue G. Primary amyloidosis in the gasserian ganglion.  Acta Neurol Scand. 1961;  37 105-110
• 3 Bornemann A, Bohl J, Hey O et al.. Amyloidoma of the gasserian ganglion as a cause of symptomatic neuralgia of the trigeminal nerve: report of three cases.  J Neurol. 1993;  241 10-14
• 4 Daly D D, Love J G, Dockerty M B. Amyloid tumor of the gasserian ganglion.  J Neurosurg. 1957;  14 347-352
• 5 DeCastro S, Sparks J R, Lapey J D, Freidberg S R. Amyloidoma of the gasserian ganglion.  Surg Neurol. 1976;  6 357-359
• 6 Kirch I E, Beaver H A, Lee A G, Green L K, Tang R A. Microbial keratitis as the manifestation of trigeminal amyloidoma at initial presentation.  J Neuroophthalmol. 1998;  18 192-195
• 7 Matsumoto T, Tani E, Fukami M, Kaba K, Yokota M, Hoshii Y. Amyloidoma in the gasserian ganglion: case report.  Surg Neurol. 1999;  52 600-603
• 8 O'Brien T J, McKelvie P A, Vrodos N. Bilateral trigeminal amyloidoma: an unusual case of trigeminal neuropathy with a review of the literature. Case report.  J Neurosurg. 1994;  81 780-783
• 9 Plogsties H R. On amyloid tumors of the gasserian ganglion [in German].  Acta Neurochir (Wien). 1964;  12 120-130
• 10 Vorster S J, Lee J H, Ruggieri P. Amyloidoma of the gasserian ganglion.  AJNR Am J Neuroradiol. 1998;  19 1853-1855
• 11 Yu E, de Tilly L N. Amyloidoma of Meckel's cave: a rare cause of trigeminal neuralgia.  AJR Am J Roentgenol. 2004;  182 1605-1606
• 12 Love S, Bateman D E, Hirschowitz L. Bilateral lambda light chain amyloidomas of the trigeminal ganglia, nerves and roots.  Neuropathol Appl Neurobiol. 1997;  23 512-515
• 13 Gandhi D, Wee R, Goyal M. CT and MR imaging of intracerebral amyloidoma: case report and review of the literature.  AJNR Am J Neuroradiol. 2003;  24 519-522
• 14 Bauer W H, Kuzma J F. Solitary “tumors” of atypical amyloidoma (paramyloid).  Am J Clin Pathol. 1949;  19 1097-1112
• 15 Eriksson L, Sletten K, Benson L, Westermark P. Tumour-like localized amyloid of the brain is derived from immunoglobulin light chain.  Scand J Immunol. 1993;  37 623-626
• 16 McKechnie S, Yang F, Harper C G et al.. Amyloidoma of a spinal root.  Neurology. 2003;  61 834-836
• 17 Consales A, Roncaroli F, Salvi F, Poppi M. Amyloidoma of the brachial plexus.  Surg Neurol. 2003;  59 418-423 discussion 423
• 18 Pizov G, Soffer D. Amyloid tumor (amyloidoma) of a peripheral nerve.  Arch Pathol Lab Med. 1986;  110 969-970