A case of cerebellar tuberculoma

We report a case of cerebellar tuberculoma presenting with headache, without any specific data. A 22-year-old male had headache for recent three months. Because of detection of the tubercle bacillus in his sputum, he was suspected the pulmonary tuberculosis and the tuberculous meningitis. On admission the cerebrospinal fluid revealed no abnormal data and the tubercle bacillus was not detected in the culture. We started medication for the tuberculosis. MRI demonstrated a mass lesion at the right cerebellum, suggesting the presence of a tuberculoma. He underwent total removal of the tumor via the supracerebellar route. Histological examination revealed tuberculoma when there are no abnormal data. The intracranial tuberculoma may be confused with an intracranial neoplasm. It is important to make an overall evaluation to diagnose tuberculosis; for instance, compromised high age, HIV, and the type of steroid administered, will increase intracranial tuberculoma. In this report, we describe a cerebellar tuberculoma without any abnormal data, suggesting that intracranial tuberculoma should be considered in the differential diagnosis of any intracranial mass lesion.     

Cerebral sparganosis: a diagnostic challenge

Cerebral sparganosis is a rare cestode larval parasitic infestation of the nervous system. We report a 28-year-old female from South India with a temporo-occipital mass lesion, which mimicked a tuberculoma on imaging. She received antituberculous therapy for 7 months. Surgical excision of the mass revealed a parasitic abscess containing larval form of Sparganum mansoni. Cerebral sparganosis can closely mimic tuberculoma or neoplastic lesions. Hence, in areas endemic for tuberculosis, such as India, it is appropriate to suggest that histological diagnosis be sought in tuberculoma mimicking lesions, especially when the lesion is not responding to treatment.     

Tuberculoma mimicking a pinealoma. Case report

Computerized tomography (CT) revealed obstructive hydrocephalus and a pineal mass in a 14-year-old girl who presented with headaches and a Parinaud's syndrome. Although there was no major evidence of extracranial tuberculosis, and cerebrospinal fluid obtained during third ventriculostomy contained no leukocytes, suboccipital transtentorial biopsy of the lesion revealed it to be a tuberculoma. Serial CT scans showed resolution of the lesion following subtotal resection and antituberculous therapy. The implications of this case with regard to difficulties in the diagnosis of cerebral tuberculoma and the management of pineal region tumors are discussed.     

Intramedullary spinal tuberculoma: a case report

STUDY DESIGN: A case report showing an intramedullary thoracic spinal tuberculoma secondary to pulmonary tuberculosis in a 16-year-old patient with findings of subacute spinal cord compression. OBJECTIVES: The significance and the use of magnetic resonance imaging in the diagnosis of intramedullary tuberculoma, and the treatment of the patient that involves surgically the excision of intramedullary lesion followed by appropriate antituberculous therapy. SUMMARY OF BACKGROUND DATA: Tuberculomas of spinal cord are rare entities. The possibility of intramedullary tuberculoma should be seriously considered when an intraspinal mass is found, provided that pulmonary tuberculosis is present in the history of the patient. METHOD: Th4-Th5 laminectomy was performed. Intramedullary tuberculoma was excised through a myelotomy. Antituberculous treatment was applied after the surgery. RESULTS: Excellent clinical outcome was obtained with a combination of both medical and surgical treatments. CONCLUSION: The intramedullary spinal tuberculoma, although a rare entity, must be considered in the differential diagnosis of the spinal cord compression in patients with a history of tuberculosis, human immunodeficiency virus, and those who have a bad socioeconomic condition and bad nutrition habit. When confronted with a progressing neurologic deficit, a combination of microsurgical resection and antituberculous chemotherapy with the avoidance of steroids should be the choice of treatment for intramedullary tuberculomas.     

Intramedullary spinal tuberculoma--case report

A healthy 33-year-old man presented with an intramedullary tuberculoma of the thoracic spinal cord manifesting as a 2-month history of progressive paraparesis and sphincter dysfunction. Magnetic resonance imaging showed ring enhancement of the intramedullary thoracic lesion with perifocal edema. General physical examination was unremarkable with no signs of inflammation except for a positive finding by the tuberculin skin test. Total resection of the intramedullary mass was performed through a posterior myelotomy following T11-12 laminectomy. Histological examination revealed a granulomatous lesion that contained Langhans giant cells, inflammatory cells, and caseating necrosis. Acid-fast bacilli staining of the specimens was positive, and cultures grew Mycobacterium tuberculosis. Postoperatively, the paraparesis and sphincter dysfunction improved sufficiently for the patient to return to his ordinary activities. Intramedullary spinal tuberculoma is rare, but must be considered in the differential diagnosis of spinal cord compression.     

Tuberculoma Arising in the Inguinal Portion of the Spermatic Cord: A Case Report

A 50-year-old man was treated with excisional surgery for an asymptomatic inguinal Spermatic cord mass. The lesion was proved to be tuberculous, and there was no apparent coexisting active disease elsewhere in the body. In addition to an intraoperative frozen-section examination, clinical findings of a strongly positive tuberculin skin test and normal erythrocyte sedimentation rate are considered to be helpful in establishing the diagnosis of a tuberculoma arising in either the scrotal or inguinal position.     

Intracranial tuberculoma and the CT scan

Computerized tomography (CT) has greatly influenced the diagnosis and management of intracranial tuberculomas and has helped us to formulate guidelines for the management of these lesions. Solid and ring-enhancing lesions seen on CT scans are diagnostic of tuberculoma if supported by other clinical and ancillary criteria. Conservative management of intracranial tuberculoma is usually indicated because serial CT scans have shown complete disappearance of these lesions with antituberculous therapy. Only lesions associated with raised intracranial pressure and CT evidence of a mass effect should be considered for surgery. Nonresponse to antituberculous therapy, as judged by serial CT scanning, should raise doubts regarding the diagnosis of a tuberculomatous lesion, and therefore such lesions should be subjected to surgery and histopathological confirmation. Representative clinical cases illustrating the principles of diagnosis and management of intracranial tuberculoma with the help of CT scanning are briefly described and discussed.     

Intracranial tuberculomas mimicking a malignant disease in an immunocompetent patient

We present the unusual occurrence of multiple systemic and two central nervous system tuberculomas in an immunocompetent young patient. A large left frontal epidural tuberculoma with transcalvarian extension was removed surgically and chemotherapy was initiated. The patient remained on a chemotherapy with INH, RMP, and EMB and was followed clinically and with MRI scans for 24 months. Findings. The clinical presentation and neuroimaging studies initially suggested malignant disease. Surgical resection of the left frontal lesion was required to relieve the mass effect. The histological evaluation showed a granulomatous inflammation with epithelial and Langhans giant cells, but no acid-fast bacilli. Cultures of the specimens yielded a mixed infection with Corynebacterium species and Staphylococcus epidermidis. Based on the histological findings, chemotherapy for tuberculosis was initiated. Subsequently, Mycobacterium tuberculosis was cultured from the surgical specimen and sputum. Interpretation. Parenchymal CNS tuberculosis with or without extracerebral manifestations may present as a space-occupying lesion. Because a tuberculoma is rarely suspected especially if there is atypical morphology, biopsy is required to establish the diagnosis and expedite specific treatment.     

Tuberculoma of the mediastinal lymph nodes with spinal caries

A 65-year-old male presented with a chief complaint of back pain. Chest computed tomography (CT) demonstrated partially calcified enlargements of the anterior mediastinal lymph nodes and pleural effusion in both lungs. His spondylous lesion rapidly progressed and developed into quadriparesis approximately 2 months after he noticed the back pain. We could not determine whether the lesion was an invasion of the spinal cord by a carcinoma of unknown primary or malignant lymphomas. Therefore, we performed a lymph node biopsy using a thoracoscope for a definitive diagnosis. Histopathology showed tuberculoma with epithelioid cell growth and images of previous scars. However, the staining method for tubercle bacillus did not reveal the presence of tubercle bacillus. As in this case, not all cases of tuberculoma present tubercle bacillus. Therefore, even with poor, suspicious findings for tuberculosis, we should always consider tuberculosis. Old tuberculoma may relapse and rapidly progress. Therefore, we concluded that a biopsy should be performed when tuberculoma is suspected.     

En plaque intradural extramedullary spinal tuberculoma and concurrent intracranial tuberculomas: paradoxical response to antituberculous therapy. Case report

Spinal intradural extramedullary tuberculoma is a rare entity. Rarer still are extensive en plaque intradural extramedullary tuberculomas occurring concurrently with multiple intracranial tuberculomas as a paradoxical response to chemotherapy for tuberculosis (TB). The authors describe the case of a 21-year-old man who was treated for tuberculous meningitis. Three months after the episode of meningitis, while undergoing chemotherapy for TB, he developed features of thoracic myelopathy. Investigations revealed an extensive en plaque intradural extramedullary lesion spanning seven segments in the lower thoracic spine. Magnetic resonance imaging of the brain revealed multiple asymptomatic intracranial tuberculomas. Even after further treatment with antituberculous chemotherapy was initiated, the lesion failed to respond. The authors performed a laminectomy and excised the en plaque intradural extramedullary lesion. The patient's condition responded well to this treatment. Although the appearance of intracranial tuberculoma as a paradoxical response to chemotherapy has been previously reported, no authors have reported on the development of an extensive en plaque intradural extramedullary tuberculoma in conjunction with asymptomatic multiple intracranial tuberculomas as a paradoxical response. In cases in which patients present with compressive myelopathy following therapy for tuberculous meningitis, it is important to consider in the differential diagnosis that intradural extramedullary tuberculoma may be a paradoxical response to chemotherapy. The authors' experience and their review of the literature indicate that surgery has a definitive role to play in the management of spinal intradural extramedullary tuberculoma.     

Cystic tuberculomas of the brain--two case reports

A 19-year-old male presented with raised intracranial pressure and a peripherally enhanced multinodular lesion with a large subjacent cyst in the right medial frontal lobe. Surgery revealed a solid tuberculoma and an underlying cyst lined with normal brain tissue. A 22-year-old male with a history of tuberculous meningitis and hydrocephalus presented with an exophytic brain stem and a left temporal tuberculoma, which were excised in two stages. The temporal tuberculoma had a peripherally located cyst that was lined with tuberculous tissue. Intracranial tuberculomas are an important part of the differential diagnosis where tuberculosis is endemic and in immunocompromised patients. Cystic tuberculomas are uncommon. The cysts may be centrally or peripherally intralesional, or either subdural and extralesional, or occur between the lesion and the brain. The type of cyst is important to recognize preoperatively, so that adequate precautions can be taken during the excision of these lesions.     

Intramedullary tuberculoma of the conus: a case report

Tuberculomas of the spinal cord are rare. The objective of this study was to illustrate the diagnosis and treatment of tuberculomas of the conus medullaris. They must be suspected in patients with a clinical context and a typical spinal cord mass lesion. Treatment is primarily medical. Surgery is reserved for cases of rapid neurological deterioration or doubts concerning the diagnosis. We report a case of intramedullary tuberculoma of the conus in a 27-year-old woman with paresthesias and weakness of the lower limbs who had been treated for pulmonary tuberculosis. The spinal MR showed a characteristic intramedullary ring-enhancing lesion. She improved neurologically one month after the beginning of the antituberculous drugs and a laminectomy. Seven months later, the patient is asymptomatic and the lesion has nearly completely disappeared completely.     

Tuberculoma of the cervical spinal canal mimicking en plaque meningioma

A previously healthy, HIV-negative, 40-year-old man presented with a 2-month history of progressive weakness of his left arm. Magnetic resonance imaging revealed an intradural, extramedullary plaque-shaped lesion at C6-T1 levels with high contrast enhancement. Based on the patient's clinical and radiologic findings, it was believed that the patient had an en plaque meningioma, and he was operated on. Histologic examination of the mass revealed granulomas with multinucleated and Langhans-type giant cells, typical of a tuberculoma. Intradural extramedullary tuberculomas should be considered in the differential diagnosis of en plaque meningioma as a rare entity.     

Tuberculoma of the conus medullaris: case report

OBJECTIVE AND IMPORTANCE: Intramedullary spinal tuberculoma is a rare form of central nervous system tuberculosis. This article describes an affected patient who presented with left leg paresis. CLINICAL PRESENTATION: A 46-year-old man presented with a 7-day history of left leg weakness. The patient's medical history included infection with pulmonary tuberculosis 15 years previously, at which time he had been treated with antituberculosis therapy. The neurological examination performed at admission revealed left leg paresis with Grade 2/5 power in all muscle groups. The patient reported no urinary or bowel problems. INTERVENTION: Surgery was performed with the patient in the prone position. The procedure involved laminectomies at T11, T12, and L1, followed by a midline myelotomy. The mass was excised completely. Histopathological examination revealed a granulomatous lesion that contained Langhans' giant cells, inflammatory cells, and evidence of caseating necrosis. The patient was prescribed a 6-month course of antituberculosis therapy with pyrazinamide, isoniazid, and rifampin. CONCLUSION: The outcome was favorable. Recently, a number of authors have reported success with medical management of intraspinal tuberculoma. Intraspinal tuberculoma produces a mass effect that can jeopardize spinal cord function. The optimal treatment is a combination of microsurgical resection and antituberculosis chemotherapy.     

Giant cerebellar tuberculoma mimicking a malignant tumor

Background

Isolated central nervous system (CNS) tuberculoma is rare. Central nervous system tuberculosis (TB) is associated with high morbidity and mortality despite modern methods of detection and treatment. The authors report a case of a giant cerebellar tuberculoma mimicking a malignant tumor and review the literature.

Observation

A six-year-old girl, with no past medical history, vaccinated for her age, presented with a three-month history of occipitocervical cephalalgia, complicated by gait disturbances. The MRI showed a left cerebellar tumor suggestive of a medulloblastoma. At surgery, a nodular, avascular lesion was found and pathological examination confirmed tuberculoma. Intracranial tuberculoma is an uncommon variety of central nervous system tuberculosis. The prognosis is related to the rapidity of diagnosis, surgical resection and the complementary antituberculosis treatment.

Conclusion

Intracranial tuberculoma is an uncommon variety of central nervous system infection. Prognosis is improved by a quick diagnosis, surgical removal, and associated antituberculoma therapy.     

Solitary intraventricular tuberculoma in adults

Summary Intracranial tuberculoma is typically located in the parenchyma. Lesions limited to the ventricular system are uncommon. It is difficult to make a differential diagnosis from other lesions if no systemic tuberculosis is present.This study investigates a case of solitary intraventricular tuberculoma in a 19-year-old female patient with an initial clinical symptom of progressive headache. Cranial computed tomography revealed a strongly enhanced lesion in the lateral ventricle. Histopathology of the tumor demonstrated chronic inflammation, caseous necrosis, epithelioid cells and Langhans giant cell. The culture study grew M. Tuberculosis.Solitary intraventricular tuberculoma in adults is extremely rare. Medical treatment is the preferred management method of this disease, and surgical intervention should be considered in certain situations.     

Tuberculome hypophysaire isolé : un diagnostic souvent oublié

Hypophyseal tuberculoma is extremely rare and difficult to diagnose without a clearly suggestive context. Its radiologic features are not specific and are better recognized on MRI with a mass of a variable signal related to the percentage of caseous necrosis. A frequently associated thickening of the pituitary stalk suggests tuberculosis, requiring the search for another tuberculosis location. This paper reports an original case of hypophyseal tuberculoma since it occurred with no other tubercular infection, which delayed the diagnosis despite thickening of the pituitary stalk on MRI.     

Intracardiac tuberculoma

We examined a case of endocardial tuberculoma at the proximal superior vena cava and the right atrium in a 17-year-old male patient. He had frequent palpitations and general weakness for about 7 months and was referred for evaluation of incessant atrial tachyarrhythmia. Results of echocardiography and magnetic resonance imaging showed an intracardiac mass, which was excised using cardiopulmonary bypass. Histology of the mass was consistent with the diagnosis of tuberculoma. The patient's postoperative course was uneventful and he was discharged with antituberculous medication. Five months after the operation, the patient was well without tachycardia, and follow-up echocardiography showed complete disappearance of the mass.     

Sellar tuberculoma: Report of two cases

Summary Hypophyseal tuberculomas are exceptionally rare. We report two patients with sellar tuberculoma but with no evidence of concurrent extrasellar disease. Although the lesion is often mistaken for adenoma, there are characteristic radiological features: intense enhancement on contrast CT and thickening of the pituitary stalk on MRI in 86% of cases. Accurate diagnosis is important because pituitary tuberculoma is curable.     

Diagnostic challenges in a patient with myocardial tuberculoma: A case report

IntroductionTuberculosis can affect any organ of the body, including the heart.Presentation of caseAn 18-year old woman presented with a multifocal tuberculosis infection involving abdominal lymph nodes, a sternotomy wound, an abscess of the abdominal wall and most notably a myocardial tuberculoma. Establishing the diagnosis of the myocardial tuberculoma was challenging mainly due to the location within the heart. Initially a diagnostic percutaneous femoral vascular catheter guided biopsy of the right atrial mass was performed, but later open surgery involving median sternotomy was needed. The patient recovered fully after surgery and nine months treatment with anti-tuberculosis drugs.DiscussionThe optimal length of treatment for myocardial tuberculoma is unknown. Medical treatment for six months might be enough regardless whether surgery is performed or not.ConclusionMyocardial tuberculoma requires culture from the infected tissue for confirmed diagnosis and might be successfully treated with anti-tuberculosis drugs only. Indications for surgery include uncertain diagnosis, poor response to medical treatment or cardiac complications.