Kannui Seiji, Hara Keijirou, Shimada Kenji, Kouyama Yukio, Kumagai Hisajirou
Department of Neurosurgery, Takamatsu City Hospital, 2-36-1 Miyawaki-cho, Takamatsu-City, 760-8538 Kagawa, Japan.
No Shinkei Geka. 2005 Dec;33(12):1199-204.
A case of intracranial infectious granuloma extending into subcutaneous and subdural space mimicking malignant bone tumor was reported. A 49-year-old male was admitted to our service with complaint of left frontal subcutaneous and bone tumor. Neurological examination demonstrated mild disorientation only except for pre-existeng Schizophrenia. CT scan and Gadolinium-enhanced MRI revealed left frontal intraosseous and subdural mass accompanied with remarkable edema. Left frontal bone was destructed by this mass. However, inflammatory sign nor malignant tumor could be observed and left frontal craniotomy and removal of the tumor was performed. The tumor was solid, elastic hard and existing from intra-osseous, epidural and subdural space compressing the cortex. No abscesss cavity could be found. Histological examination revealed infectious granuloma accompanied by remarkable neutrophil infiltration only. The patient showed good post-operative course, and returned to previous condition, pre-existeng Schizophrenia only. Intracranial infectious granuloma extending into subcutaneous and subdural space destructing the bone was rare condition. From literature, similar cases could be found in granuloma arising from osteomyelitis. In this case, destructed bone beneath the epi- and subdural tumor support this route of infection.
报告了一例颅内感染性肉芽肿延伸至皮下和硬膜下间隙，酷似恶性骨肿瘤的病例。一名49岁男性因左额叶皮下及骨肿瘤主诉入院。神经系统检查仅显示轻度定向障碍，既往有精神分裂症病史。CT扫描和钆增强MRI显示左额叶骨内及硬膜下肿块，伴有明显水肿。该肿块破坏了左额叶骨。然而，未观察到炎症迹象或恶性肿瘤，遂行左额叶开颅肿瘤切除术。肿瘤质地坚实，有弹性，硬，存在于骨内、硬膜外和硬膜下间隙，压迫皮质。未发现脓肿腔。组织学检查仅显示伴有明显中性粒细胞浸润的感染性肉芽肿。患者术后恢复良好，仅遗留既往的精神分裂症，恢复至术前状态。颅内感染性肉芽肿延伸至皮下和硬膜下间隙并破坏骨质是一种罕见情况。从文献中可知，类似病例可见于骨髓炎引起的肉芽肿。在本病例中，硬膜外和硬膜下肿瘤下方骨质破坏支持了这种感染途径。
