Sameshima T, Morita Y, Yanagita M, Goya T, Wakisaka S, Nabeshima K
Department of Neurosurgery, Miyazaki Medical College, Kiyotake, Japan.
Brain Tumor Pathol. 1998;15(2):107-10. doi: 10.1007/BF02478892.
A 73-year-old man was admitted because of right frontal headache and gradual loss of right visual acuity, which had been occurring for 1 year. He had been treated with corticosteroids under the diagnosis of retrobulbar optic neuritis at a nearby clinic. Magnetic resonance imaging (MRI) revealed a nodular lesion at the tuberculum sellae, which showed isointensity on T1-weighted images, iso- to low-intensity on T2-weighted images, and heterogeneous enhancement with Gd-DTPA. Meningioma was diagnosed, and surgery was performed but was limited to biopsy because of intraoperative detection of purulent inflammation of the nodule. Histologic examination revealed aspergillosis in a portion of the meningotheliomatous meningioma. The patient died of meningoencephalitis about 1 month after surgery in spite of extensive treatment with antifungal agents. MRI findings of meningioma and aspergillosis are similar, thus making preoperative diagnosis difficult. However, this case provides evidence that aspergillosis should be included in the differential diagnosis when a skull-base meningioma-like nodule is noted if sinusitis is revealed in the sphenoid sinus.
一名73岁男性因右侧额部头痛及右眼视力逐渐下降1年入院。他曾在附近诊所被诊断为球后视神经炎并接受皮质类固醇治疗。磁共振成像（MRI）显示蝶鞍结节处有一个结节状病变，在T1加权图像上呈等信号，在T2加权图像上呈等至低信号，注射钆喷酸葡胺（Gd-DTPA）后呈不均匀强化。诊断为脑膜瘤，并进行了手术，但由于术中发现结节有脓性炎症，手术仅限于活检。组织学检查显示部分脑膜瘤样脑膜瘤存在曲霉菌病。尽管使用了抗真菌药物进行广泛治疗，患者仍在术后约1个月死于脑膜脑炎。脑膜瘤和曲霉菌病的MRI表现相似，因此术前诊断困难。然而，该病例提供了证据，即当蝶窦出现鼻窦炎且发现类似颅底脑膜瘤的结节时，曲霉菌病应列入鉴别诊断。
