Tuberculomas or tuberculous granulomas are well defined focal masses that result from Mycobacterium tuberculosis infection and are one of the more severe morphological forms of tuberculosis. Tuberculomas most commonly occur in the brain (see: CNS tuberculosis) and the lung (see: pulmonary tuberculosis).
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Terminology
Tuberculomas should not be confused with the far less common tuberculous abscess.
Pathology
Macroscopic appearance
Macroscopically, a tuberculoma is a well defined firm nodule with central caseous necrotic center 2.
Microscopic appearance
Histologically it consists of a central core of caseating necrosis with a surrounding wall of a florid granulomatous reaction containing Langhans giant cells, epithelioid histiocytes and lymphocytes. Unlike tuberculous abscesses, organisms are uncommon or absent, and acute inflammatory infiltrate is not a prominent feature.
Radiographic Features
MRI
Tubercolomas may occur anywhere in the brain parenchyma, but tend to occur more often in a supratentorial location in adults and an infratentorial location in children.
Caseating and noncaseating tuberculomas may be differentiated on imaging.3
Caseating granulomas:
Core is T1 and T2 iso- to hypointense
Rim is T2 iso- to hyperintense
Enhancing rim
Noncaseating granulomas:
Entire lesion is T1 and T2 hypointense
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Homogenous enhancement
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