Professional Documents
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183]
E-JCRT Correspondence
INTRODUCTION
In developed countries, about 4% of central nervous
system (CNS) lesions are caused by tuberculosis (TB).
Accurate diagnosis is the first step in the journey
towards a successful patient outcome, but this
becomes difficult in the absence of extracranial TB,
as seen in the case we report here. Many cases of
CNS tuberculoma (CNST) that resemble intracranial
tumors on imaging have been reported, but a solid
primary tumor (SPT) at diagnosis was absent in all
of them, and treatment was postponed until the
brain lesion pathology was determined.
CASE REPORT
A 51yearold woman complained of a sore under
her tongue. She had had difficulty chewing and
speaking, with pain in the anterior mandibular
teeth area, sore throat, episodic numbness on
the left side of the face, neck, tongue, gums, and
lip during the preceding month, and a 15pound
weight loss over four months. She denied having
fever, chills, night sweats or productive cough. She
had a history of heavy ethanol use and 30 packs of
cigarettes per year.
A b i o p s y o f t h e m o u t h l e s i o n re v e a l e d
moderatetopoorly differentiated squamous
cell carcinoma(stage T2N1M0). T1weighted
magnetic resonance(MR) images obtained one
month after the oral lesion biopsy revealed an
edematous gadolinium contrastenhancing mass
(maximal diameter 2.3cm) in the right cerebellar
hemisphere, extending to the tentorium and
showing characteristics[Figure1a] typical
of a brain metastasis (BM) [Figure1b]. The
T2weighted magnetic resonance imaging(MRI)
Abhijit L.
Salaskar,
Wael Hassaneen,
Cheryl H.
Keenan,
Dima Suki
Department of
Neurosurgery, The
University of Texas
MD Anderson Cancer
Center, Houston,
Texas, USA
For correspondence:
Dr. DimaSuki,
Department of
Neurosurgery,
Unit442, The
University of Texas
MD Anderson
Cancer Center,
1400 Holcombe
Blvd, Houston,
Texas77030, USA.
Email:dsuki@
mdanderson.org
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Figure 1: (a) Preoperative contrast-enhanced T1-weighted axial MRI of the brain showing a right cerebellar ring-enhancing lesion resembling a
metastatic lesion, (b) Preoperative contrast-enhanced T1-weighted axial MRI of the brain showing a histologically proven brain metastasis in the
right cerebellar hemisphere, (c) T1-weighted axial MRI of the brain showing the resection cavity with no evidence of enhancement, (d) Histologic
section from the resected cerebellar mass showing multiple granulomas composed of epithelioid histiocytes, lymphocytes, and Langhans giant
cells. (x100 magnification), (e) Gomori methenamine silver (GMS) stain showing round yeast (arrow) of a uniform 5 to 6 micrometers in diameter.
The morphology of the microorganisms is consistent with blastomyces a period
[Downloaded free from http://www.cancerjournal.net on Wednesday, November 23, 2016, IP: 111.94.137.183]
REFERENCES
1. GuptaRK, HusainM, VatsalDK, KumarR, ChawlaS, HusainN.
Comparative evaluation of magnetization transfer MR imaging and
in vivo proton MR spectroscopy in brain tuberculomas. Magn Reson
Imaging 2002;20:37581.
2. GuptaRK, PandeyR, KhanEM, MittalP, GujralRB, ChhabraDK.
Intracranial tuberculomas: MRI signal intensity correlation with
histopathology and localised proton spectroscopy. Magn Reson
Imaging 1993;11:4439.
3. GuptaRK, PoptaniH, KohliA, ChhabraDK, SharmaB, GujralRB. Invivo
localized proton magnetic resonance spectroscopy of intracranial
tuberculomas. Indian J Med Res 1995;101:1924.
4. ChangJM, LeeHJ, GooJM, LeeHY, LeeJJ, ChungJK, etal. False positive
and false negative FDGPET scans in various thoracic diseases. Korean
J Radiol 2006;7:5769.
5. MohantyA, SantoshV, AnandhB, KolluriVR, VasudevMK, HegdeT,
etal. Diagnostic efficacy of stereotactic biopsies in intracranial
tuberculomas. Surg Neurol 1999;52:2528.
Cite this article as: Salaskar AL, Hassaneen W, Keenan CH, Suki D.
Intracranial tuberculoma mimicking brain metastasis. J Can Res Ther
2015;11:653.
Source of Support: Nil, Conflict of Interest: None declared.