Sahu C, Bhargava N, Singh V, Dwivedi P. Giant Tuberculomas of Brain: Rare Neoplastic Mimic.
J Pediatr Neurosci 2021;
15:204-213. [PMID:
33531933 PMCID:
PMC7847125 DOI:
10.4103/jpn.jpn_78_19]
[Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Revised: 11/18/2019] [Accepted: 03/30/2020] [Indexed: 11/04/2022] Open
Abstract
Objective
Tuberculosis continues to be a major infectious disease in developing parts of the world. Primarily central nervous system tuberculosis manifests as meningitis, tuberculoma, or a brain abscess; however, rarely it may manifest as a large neoplastic mass such as lesion known as giant tuberculoma. Especially in central parts of India, the incidence of giant tuberculoma is quite high in pediatric population that too in posterior fossa of brain. Often, they are wrongly reported as neoplastic masses on imaging. The objective of this study was to evaluate different imaging appearances of a giant tuberculoma.
Materials and Methods
In this prospective study, all cases of giant tuberculoma presenting to a large tertiary care center in central India for 2 years (duration 2016-2018) were imaged and followed up. A total of nine patients, six females and three males, aged 4-16 years were studied on a 3-Tesla Siemens magnetic resonance imaging (MRI) scanner.
Results
In total, nine patients were included with 11 giant tuberculomas. Of 11, eight were infratentorial and three were supratentorial in location. On T2-weighted image sequence, these lesions showed central hypointensity with a peripheral hyperintense rim. Most observed finding on T1-weighted image sequence was central isointensity with peripheral hyperintense rim. Advanced imaging sequences such as magnetic resonance spectroscopy and magnetization transfer were also applied.
Conclusion
To the best of our knowledge, this is the largest series of giant tuberculoma in the pediatric population reported so far in any part of the world. We have described the various MRI imaging findings of this lesion in great details. Management of such rare cases and pertinent literature is reviewed briefly.
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