Takeshima H, Kaku T, Ushio Y
Department of Neurosurgery, Kumamoto University School of Medicine.
Neurol Med Chir (Tokyo). 1999 Mar;39(3):242-5. doi: 10.2176/nmc.39.242.
A 75-year-old male presented with the complaint of headache. Magnetic resonance (MR) imaging demonstrated a low-signal intensity area on both T1- and T2-weighted images with ring-like enhancement and adhesion of the dura appearing as dural tail sign. Follow-up MR imaging demonstrated spontaneous regression, so the preoperative diagnosis was malignant lymphoma. Histological examination revealed typical granuloma. Treponema pallidum hemagglutination assay tests of serum and cerebrospinal fluid were positive for active syphilis. The enhanced mass totally disappeared after 4 months of erythromycin therapy. The final diagnosis was cerebral gumma. The incidence of syphilis is increasing, so cerebral gumma should be included in the differential diagnosis of hypovascular tumors that involve both the parenchyma and dura even in the presence of spontaneous regression.
一名75岁男性因头痛就诊。磁共振成像（MR）显示在T1加权像和T2加权像上均为低信号强度区域，伴有环状强化，硬脑膜粘连表现为硬脑膜尾征。随访MR成像显示病变自发消退，因此术前诊断为恶性淋巴瘤。组织学检查显示为典型肉芽肿。血清和脑脊液梅毒螺旋体血凝试验检测结果显示活动性梅毒呈阳性。红霉素治疗4个月后，强化肿块完全消失。最终诊断为脑树胶肿。梅毒发病率正在上升，因此即使存在自发消退的情况，脑树胶肿也应列入累及脑实质和硬脑膜的低血供肿瘤的鉴别诊断中。
