5-aminolevulinic enhanced brain lesions mimic glioblastoma: A case report and literature review

Rationale:Glioblastoma multiforme (GBM) is a highly malignant primary brain tumor for which maximal tumor resection plays an important role in the treatment strategy. 5-aminolevulinic (5-ALA) is a powerful tool in fluorescence-guided surgery for GBM. However, 5-ALA- enhancing lesion can also be observed with different etiologies.Patients concerns:Three cases of 5-ALA-enhancing lesions with etiologies different from gliomaDiagnoses:The final diagnosis was abscess in 1 patient and diffuse large B-cell in the other 2 patients.Interventions:Three patients received 5-aminolevulinic acid-guided tumor resection under microscope with intraoperative neuromonitoring.Outcomes:All of our patients showed improvement or stable neurological function outcomes. The final pathology revealed etiologies different from GBM.Lessons:The 5-aminolevulinic acid fluorescence-guided surgery has demonstrated its maximal extent of resection and safety profile in patients with high-grade glioma. Non-glioma etiologies may also mimic GBM in 5-ALA-guided surgeries. Therefore, patient history taking and consideration of brain images are necessary for the interpretation of 5-ALA-enhanced lesions.