Presentation
Headaches.
Patient Data
Multiple conglomerate regions of enhancement are seen within the left cerebellar hemisphere with vasogenic edema.
A cluster of peripherally enhancing nodules is present in the left cerebellar hemisphere with surrounding vasogenic edema. 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 necrotizing 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 tumor 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:
Necrotizing granulomatous inflammation with acid fast bacilli, in keeping with mycobacterial infection (tuberculoma)
MYCOBACTERIUM CULTURE: MGIT bottle: POSITIVE