• Chao-Yuan Chang and Chun-Chung Chen.
• Neurosurgical Department, China Medical University Hospital, Taichung, Taiwan.
• Medicine (Baltimore). 2024 Jan 5; 103 (1): e34518e34518.

RationaleGlioblastoma 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 ConcernsThree cases of 5-ALA-enhancing lesions with etiologies different from glioma.DiagnosesThe final diagnosis was abscess in 1 patient and diffuse large B-cell in the other 2 patients.InterventionsThree patients received 5-aminolevulinic acid-guided tumor resection under microscope with intraoperative neuromonitoring.OutcomesAll of our patients showed improvement or stable neurological function outcomes. The final pathology revealed etiologies different from GBM.LessonsThe 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.Copyright © 2024 the Author(s). Published by Wolters Kluwer Health, Inc.

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