Cerebellar tuberculomas

Case contributed by A.Prof Frank Gaillard

Presentation

Headaches.

Patient Data

Age: 15 years
Modality: CT

Multiple conglomerate regions of enhancement are seen within the left cerebellar hemisphere with vasogenic oedema. 

Modality: MRI

A cluster of peripherally enhancing nodules is present in the left cerebellar hemisphere with surrounding vasogenic oedema. The center of the lesions does not demonstrate restricted diffusion but does appear low on T2 weighted images. 

Case Discussion

The patient went on to have surgery.

Histology

MICROSCOPIC DESCRIPTION:

Sections of the cerebellum show necrotising granulomatous inflammation. There are well-defined crowded granulomas, comprising nodular aggregates of epithelioid histiocytes and multinucleated giant cells. Areas of necrosis are seen in the neuropil. The granulomas are surrounded by lymphocytes, plasma cells and some neutrophils. No tumour is identified. The Gram stain shows no bacteria. The Grocott stain shows no fungi. The Ziehl-Neelsen stain shows two acid fast bacilli, in keeping with mycobacterial infection.

FINAL DIAGNOSIS:

Necrotising granulomatous inflammation with acid fast bacilli, in keeping with mycobacterial infection (tuberculoma)

 

MYCOBACTERIUM CULTURE: MGIT bottle: POSITIVE

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Case Information

rID: 46939
Case created: 25th Jul 2016
Last edited: 16th Sep 2016
Inclusion in quiz mode: Included

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