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 glioma.

Diagnoses: 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.