Giant Tuberculomas Suggesting a Malignant Brain Tumor: About Two Cases

Tuberculoma is a common condition in developing countries. In some cases, it may mimic a glial lesion, making differential diagnosis challenging. The authors report two cases of giant tuberculoma in young patients aged 14 and 16. A literature review was conducted on these cases. Both patients underwent partial excision. Histology concluded tuberculoma. Anti-tubercular treatment was implemented. The evolution one year later was marked by the persistence of neurological disorders, although they had improved.

Intraventricular tuberculoma: A case report

Intracranial tuberculomas are one of the most serious formsof tuberculosis disease after meningitis tuberculosis. It incidence varies around 0.15% - 0.18% in the development world to 5% - 30% of intracranial masses in some under developments areas. These tuberculomas, of course ubiquitous, are mostly diagnosed in the adulthood and usually located in the cerebellum and the cerebral hemispheres. Intra ventricular involving is uncommon and just 10 cases had been described in the literature. We report a case of an intraventricular tuberculoma in a 26- year-old man and we discuss the pathogenesis and the radiological findings according this location.

Infratentorial Tuberculoma Mimics Tumor in Immunocompetent Adults: An Analysis of 11 Patients

Backgrounds: Tuberculoma is a granulomatous inflammatory process mimicking a neoplasm, both clinically and radiologically. Although those with an infratentorial origin are rare, this disease is still a diagnostic challenge using conventional workup. However, this disease should not be overlooked because it is essentially curable with proper diagnosis and therapy, usually, a Mycobacterium Tuberculosis (MTB) DNA test is performed. Methods: We retrospectively analyzed the clinical presentations, CSF results, and images of 11 MTB DNA positive and clinically cured cases of infratentorial tuberculoma. Results: Infratentorial tuberculoma usually deteriorated before antituberculosis treatment (ATT). Magnetic resonance imaging showed space-occupying lesions without specific features, 4 within the cerebellum and 7 within the brainstem. Evidence of systemic tuberculosis was found in only 1 case. Clinical manifestations included various combinations of focal signs and symptoms in the brain stem and cerebellum. Cerebrospinal fluid (CSF) findings were also nonspecific. The diagnoses of these cases were based on the positive tests of a nested polymerase chain reaction (N-PCR) assay. Trial therapy with antituberculous drugs resulted in clinical improvement, as documented by MRI in all patients. Conclusions: Infratentorial tuberculoma should be suspected in patients with infratentorial space-occupying lesions who live in geographic areas where tuberculosis is endemic.

Hypodense cerebellar tuberculoma on CT scan masquerading low grade glioma

We report a case of hypodense cerebellar tuberculoma in a 26 year old postpartum lady who presented with one episode of generalized tonic-clonic seizures and discuss the histopathology findings where on CT scan the lesion was suspected as low grade glioma.She was started on isoniazid,rifampicin,pyrazinamide,ethambutol and pyridoxine.She is asymptomatic and had no neurological deficits at follow up.

Cerebral tuberculoma:critical review of two cases

Central nervous system tuberculosis can have protean manifestations.We review the clinical and radiological findings in two cases of cerebral tuberculoma in immuoncompetent patients.These two cases represent the spectrum of variations of clinical and radiological features of cerebral tuberculoma and highlight the controversies in the approach to diagnosis and management.

Isolated intramedullary tuberculoma of the dorsal cord:a rare clinico-radiological entity

Tuberculous infection manifesting as an isolated intramedullary tuberculoma of the spinal cord is distinctly unusual.We report a case of a 35 year old woman presenting with an insidious onset of myelopathy,where MRI showed characteristic imaging findings suggestive of intramedullary tuberculosis.

Choroidal Tuberculoma in an Immunocompetent Young Patient

TUBERCULOSIS （TB） remains one of the leading causes of preventable morbidity and mortality from infectious disease worldwide.1 It is a chronic progressive granulomatous infection caused by Mycobacterium tuberculosis （M. tuberculosis）.

Suprasellar cistern tuberculoma presenting as unilateral ocular motility disorder and ptosis:A case report

BACKGROUND Intracranial tuberculoma is a rare and serious type of tuberculosis,which mostly occurs in the frontoparietal and cerebellar hemispheres,with predominance in the gray-white matter junction area,while tuberculomas only in the cistern are extremely rare with only a few reported cases in the literature.We describe a unique case of isolated tuberculoma in the suprasellar cistern,with only right ocular motility disorder and upper eyelid ptosis.CASE SUMMARY A 5-year-old boy without any medical history presented with right ocular motility disorder and upper eyelid ptosis one month ago.He had no history of fever,headache,vomiting,convulsions,or limb weakness.Neurological examination showed right third cranial nerve palsy with restrictions of eye movements and ptosis,pupil dilation and negative light reflex.Imaging suggested a spaceoccupying lesion in the suprasellar cistern with calcification and ring-enhancement.Moreover,no Mycobacterium tuberculosis was found in cerebrospinal fluid by polymerase chain reaction(PCR).The lesion was initially diagnosed as a tumor,while postoperative pathology combined with PCR indicated tuberculoma.The patient continued postoperative anti-tuberculosis treatment.At present,the patient's condition is stable and the symptoms are partially relieved compared with those before surgery.CONCLUSION This case confirmed that isolated intracranial tuberculoma can occur in the suprasellar cistern.Therefore,for space-occupying lesions in the suprasellar cistern,tuberculoma should be included in the differential diagnosis even if there is no history or indication of tuberculosis infection.

Mediastinal Tuberculoma Mimicking Malignant Cardiac Tumor:A Case Report

Background:The clinical manifestations of cardiac masses are diverse and lack specifi city.Here we report a cardiac mass detected by transthoracic echocardiography.Multimodality imaging and pathological fi ndings after the operation confi rmed the mass as mediastinal tuberculoma.Case presentation:A 45-year-old male patient was admitted to our hospital reporting chest tightness,weight loss,and dyspnea for 3 months after exercise.Transthoracic echocardiography showed that there were a large number of pericardial effusions and a soft tissue mass measuring 7.7 cm×4.5 cm in the upper mediastinum,which oppressed the right pulmonary artery and accelerated the blood fl ow of the left pulmonary artery.Contrast-enhanced ultrasonography showed degenerative inhomogeneous high enhancement of and an unclear boundary in the mass.Contrast-enhanced chest CT revealed punctate and patchy calcifi cation in and uneven enhancement of the mass and the lymph nodes around the aortic arch.The mass was diagnosed as a malignant mediastinal tumor.Pathological analysis of the mass revealed chronic granulomatous tuberculosis.The symptoms abated signifi cantly after antituberculosis treatment.The patient remained asymptomatic during follow-up.Conclusion:This report presents a rare case of mediastinal tuberculoma mimicking a malignant cardiac tumor.Multimodality imaging should be incorporated for differentiation of cardiac masses.

Pachymeningeal en Plaque Tuberculoma in Children: A Case Report

Pachymeningeal en plaque tuberculoma is a rare manifestation of tuberculosis and has a poor prognosis if not diagnosed early and treated adequately. The aim of the present paper is to collect the reported clinical and radiological signs in the literature and compare it with a personal observation to evaluate the possibility of a presumptive diagnosis. A 4-year-old boy presented at the pediatric emergency department with 7 days history of severe headache, vomiting blurred vision and had one partial seizure. His neurologic examination was notable for decreased visual acuity with bilateral papilledema and intact extra-ocular muscles. His neck was rigid. Neuroimaging revealed a multifocal dural-based mass on the fronto-parietal convexity with dense heterogeneous contrast enhancement and hydrocephalus. He has undergone a Ventriculoperitoneal shunt and surgical excision of the mass the next day. Outcome was favorable with antituberculosis therapy and corticosteroids. The clinical presentation and outcome were similar to the reported cases in the literature.

Neurocysticercosis (NCC) vs Central Nervous System (CNS) Tuberculoma in Children—Dilemma over Clinico-Radiological Diagnosis?

Background: Neurocysticercosis (NCC) and central nervous system (CNS) tuberculomas often overlap in clinical presentation and imaging. Though the aetio-pathology entirely differs in both the scenarios but there is great confusion in their clinico-radiological evaluation as the findings and appearances are similar in many ways. The stress should be laid out over the salient features of each entity in the background of their presentation. The study was conducted to highlight the differentiation of the clinico-radiological findings in both the entities. Material and Methods: Ten patients between 5 - 15 years (mean age 10.4 years) with complaints of headache and with or without seizures had undergone MRI alone or with CT examinations. Basic sequences of T1W, T2W, T2W FLAIR and T1W contrast studies were carried out in all the cases. CT was carried out in only three cases and contrast was given in two cases. Results: Eight patients were having ring enhancing lesions in post contrast studies in MRI and two had only cystic lesions ranging from 1 - 3 cm in diameter. Conclusion: Seven cases having tuberculomas were confirmed by both the modalities with one case inconclusive. Two cases were diagnosed as neurocysticercosis as per the results. The reasonable achievable target was the goal to differentiate between NCC and tuberculomas in the brain and it was achieved. Contrast MRI and spectroscopy brought out many findings for the distinct features in many cases.

Intraventricular Hemorrhage, a Rare Complication of a Cerebral Tuberculoma: Study of a Case in the Neurology Department of the University Hospital of Conakry

Intraventricular haemorrhage (IVH) is an extremely rare and poorly described complication of central nervous system Tuberculosis (CNS-TB). In this study, we report the case of a 42-year-old man who presented with a weakness of the left hemibody with diffuse headache, altered consciousness associated with fever. No notion of contagion was noted. Brain computed tomography (CT) showed a hematoma in the occipital horns of the lateral ventricles with peri-lesional oedema of the right hemisphere;after injection of contrast product (CP), there were ring-shaped contrasts in the occipital horn of the lateral ventricle and the right thalamus. Angioscan showed no aneurysms or vascular anomalies. Chest X-ray showed micronodular opacities less than 1.5 cm in size in relation to miliary. Xpert MTB/RIF of sputum and cerebrospinal fluid (CSF) showed Mycobacterium tuberculosis (MT). The patient’s course was favourable under antihypertensive and antitubercular treatment. Conclusion: This case illustrates the diagnostic difficulties of CNS-TB due to the polymorphism of the clinical and radiological presentation of CNS-TB.

Concurrent occurrence of both intracranial and intramedullary tuberculomas

Tuberculosis involving spinal cord in the form of intramedullary tuberculoma is uncommon,and the concurrent occurrence of cranial and intramedullary tuberculomas is extremely rare.We report a case of disseminated tuberculoma involving brain and spinal cord with miliary tuberculosis in a 32‑year‑old male presenting with fever,cerebellar signs and motor weakness of both upper and lower extremities.Based on magnetic resonance imaging and polymerase chain reaction,we diagnosed as tuberculoma.He completely recovered with conventional antituberculous treatment and steroids.The follow‑up of the patient showed disappearance of signs and symptoms.

Value of video-assisted thoracoscopic surgery in the diagnosis and treatment of pulmonary tuberculoma:53 cases analysis and review of literature

Tuberculoma of the lung is one of manifestations in tuberculosis and usually presents as a solitary pulmonary nodule(SPN).It is difficult to differentiate tuberculoma from SPN by other benign or malignant diseases.At present,the crucial role of video-assisted thoracoscopic surgery(VATS) in diagnosis and treatment of pulmonary diseases has been well acknowledged.Here,we reported 53 patients undergoing VATS resection for tuberculomas in our series.No postoperative mortality was found and only two patients experienced prolonged air-leakage(>7 d) and two had minor wound infections that were recovered after anti-tuber-culosis or antibiotic treatment.Anti-tuberculosis chemotherapy from 6 to 12 months was routinely used postoperatively.We conclude that VATS is a satisfactory tool for the diagnosis and treatment of tuberculoma and can also establish a reliable diagnosis for all patients with SPNs.

误诊为肺结核瘤的ANCA相关性血管炎临床分析

目的探讨抗中性粒细胞胞质抗体(ANCA)相关性血管炎的误诊原因及防范措施。方法回顾分析1例曾误诊的ANCA相关性血管炎的临床资料。结果本例因下肢红疹伴溃疡入院。曾行“鼻窦炎”手术,术前筛查发现肺部肿物行“肺部肿物切除术”,术后病理示肺结核瘤,抗结核治疗无效。入院后结合患者多系统受累表现及实验室、肾穿刺病理检查等诊断为ANCA相关性血管炎,给予糖皮质激素及调节免疫等治疗,症状缓解。结论ANCA相关性血管炎临床表现多样且不典型,易误诊。临床中应对疑似病例尽早行相关医技检查。

肺癌、肺结核球和炎性假瘤螺旋CT动态增强扫描的影像特征(附44例分析报告)

背景与目的:肺癌、肺结核球和炎性假瘤是最常见的孤立性肺结节(solitarypulmonarynodule,SPN),CT(computedtomography)是最主要的诊断方法,近年来关于它们的CT特征报道较多,但绝大多数都是从形态学上的分析,鉴别诊断较困难,本研究旨在观察肺癌、肺结核球和炎性假瘤的血供变化,找出它们的一些特征和规律,为诊断和鉴别诊断提供更多信息。方法:采用螺旋CT对115例肺部单个结节进行动态增强扫描,总结分析经手术治疗确诊病例44例,其中肺癌30例,肺结核球7例,肺炎性假瘤7例。结果:30例肺癌中轻度强化2例,中度强化14例,高度强化5例,显著高度强化2例,无强化7例。肺癌最高强化值开始出现在18～28s9例,30～39s17例,40～44s4例,平均32s。7例结核球中5例无强化,2例环状强化。7例炎性假瘤均呈显著高度强化,最高强化值均在100Hu以上,最高强化值出现的时间分别为26s、28s、30s、32s、33s、110s和122s。结论:螺旋CT动态增强扫描对肺癌、肺结核球、炎性假瘤的鉴别诊断有一定的帮助。

肝结核瘤的MRI征象

目的 分析肝结核瘤的MRI表现 ,探讨MRI在诊断和鉴别诊断中的价值。资料与方法 10例肝结核瘤患者行MR自旋回波序列T1WI、T2 WI和快速多层面干扰梯度回波序列动态增强扫描。结果 10例共 12个病灶 ,MRI表现 :(1)自旋回波序列 :T1WI上所有病灶为低信号 ,T2 WI上 10个病灶为不均匀低信号 (8个病灶为中心低信号而边缘为环形或片状的高信号 ,2个为低信号中见到点状高信号 ) ,另 2个病灶为高信号。 (2 )增强扫描 :动脉期10个病灶无强化 ,2个病灶边缘有轻度强化。门脉期和延迟期所有病灶均有不同方式的强化 ,主要为边缘强化和分隔强化。结论 MRI可反映肝结核瘤的病理改变过程 。

CT增强薄层扫描异形血管强化征对小肺癌诊断的价值

目的：探讨ＣＴ增强薄层扫描图像上显示的异形血管强化征对小肺癌诊断和鉴别诊断的临床价值。方法：用ＣＴ增强薄层扫描和常规ＣＴ增强扫描对比研究３７例直径＜３ｃｍ的小肺癌，并同期研究１８例需鉴别的肺炎性假瘤和肺结核球作对照，分析这３种病变的ＣＴ增强薄层扫描征象特点。结果：①ＣＴ增强薄层扫描能清晰显示小肺癌病灶内肿瘤血管的特征性表现一异形血管强化征，而常规ＣＴ扫描难以显示该征象；②肺炎性假瘤和肺结核球病灶内一般不出现该种病理血管征象。结论：异形血管强化征对小肺癌的诊断和鉴别诊断具有特殊意义。