Long-term follow-up of vanishing tumors in the brain: how should a lesion mimicking primary CNS lymphoma be managed?

Clin Neurol Neurosurg. 2012 Nov;114(9):1217-21. doi: 10.1016/j.clineuro.2012.02.053. Epub 2012 Mar 22.


Objectives: The spontaneous disappearance of a tumor is referred to as a vanishing tumor. Most vanishing tumors in the brain are eventually diagnosed as malignant tumors or multiple sclerosis. However, their long-term clinical course remains unclear. This study aims to elucidate the management of vanishing tumors in the brain.

Patients and methods: We defined a vanishing tumor as a case in which the tumor spontaneously disappeared or decreased to less than 70% of the initial tumor volume before definitive diagnosis and treatment (other than steroid treatment). Ten cases of vanishing tumors are reviewed.

Results: Nine patients underwent biopsy at least once. Five patients, all of whom had malignant tumors (primary central nervous system lymphoma: 4, germinoma: 1) that recurred in 4-45 months (median: 7 months), underwent a second biopsy after the reappearance of the tumors. Five patients (tumefactive demyelinating lesion: 1, undiagnosed: 4) who had no relapse are alive, and their median follow-up time is 44 months. No cases have yet been reported of malignant brain tumors that recurred more than 5 years after spontaneous regression.

Conclusions: Patients with vanishing tumors should be followed up carefully by magnetic resonance imaging for at least 5 years, even after the disappearance of an enhancing lesion.

MeSH terms

  • Adult
  • Aged
  • Biopsy
  • Brain Neoplasms / diagnosis
  • Brain Neoplasms / pathology
  • Brain Neoplasms / therapy*
  • Central Nervous System Neoplasms / diagnosis
  • Central Nervous System Neoplasms / pathology
  • Central Nervous System Neoplasms / therapy*
  • Demyelinating Diseases / pathology
  • Disease Progression
  • Female
  • Follow-Up Studies
  • Humans
  • Inflammation / pathology
  • Lymphoma / diagnosis
  • Lymphoma / pathology
  • Lymphoma / therapy*
  • Magnetic Resonance Imaging
  • Male
  • Middle Aged
  • Neoplasm Recurrence, Local / prevention & control
  • Neoplasm Regression, Spontaneous / pathology*
  • Steroids / therapeutic use


  • Steroids