Kelly Adrian, Mpanza Phila, Lekgwara Patrick, Otto Dion
Department of Neurosurgery, Dr. George Mukhari Academic Hospital, Sefako Makgatho Health Sciences University, Pretoria, South Africa.
Department of Neurosurgery, Dr. George Mukhari Academic Hospital, Sefako Makgatho Health Sciences University, Pretoria, South Africa.
World Neurosurg. 2018 Oct;118:5-8. doi: 10.1016/j.wneu.2018.06.226. Epub 2018 Jul 6.
Fungal mass lesions in the central nervous system are, as a group, extremely rare. In this group cryptococcomas are the most common mass lesions seen. These cryptococcomas/mucinous pseudocysts are commonly only 3-10 mm in diameter and occur almost exclusively in the basal ganglia through contiguous spread from a basal meningitis through the Virchow-Robbin perivascular spaces. In rare cases a chronic granulomatous process may lead to formation of mass lesions that have a tumoral appearance.
A 19-year-old male presented to our Neurosurgical Unit with a 5-month history of progressive morning headaches. He also complained of progressive weakness of his R upper limb of 3 months' duration. The patient was found to be human immunodeficiency virus negative with a CD4 count of 1763. The patient had no other medical problems. Examination revealed a monoplegia of his R upper limb. While being optimized for surgery, the patient demonstrated progression of his upper limb monoplegia despite preoperative steroid therapy aimed at decreasing the perilesional vasogenic edema. He was booked for emergency resection of 2 lobar mass lesions. Histopathology analysis revealed the 2 specimens had similar features. These specimens were representative of gliotic brain parenchyma involved by extensive cryptococcosis.
Diagnosing the tumoral form of cryptococcosis in immunocompetent patients is a challenge. Primary and secondary brain tumors are usually the first hypotheses in these cases. Thorough preoperative investigation through cerebrospinal fluid sampling and detailed magnetic resonance imaging may lead to consideration of this diagnosis before the histopathologic analysis has been conducted.
中枢神经系统的真菌性肿块病变总体极为罕见。在这一类别中，隐球菌瘤是最常见的肿块病变。这些隐球菌瘤/黏液性假囊肿通常直径仅3 - 10毫米，几乎仅通过基底脑膜炎经Virchow - Robbin血管周围间隙的连续扩散发生于基底神经节。在罕见情况下，慢性肉芽肿过程可能导致形成具有肿瘤外观的肿块病变。
一名19岁男性因进行性晨起头痛5个月就诊于我们的神经外科病房。他还主诉右上肢进行性无力3个月。该患者人类免疫缺陷病毒检测为阴性，CD4细胞计数为1763。患者无其他内科问题。检查发现右上肢单瘫。在为手术进行优化准备期间，尽管术前使用类固醇治疗以减轻病变周围血管源性水肿，但患者右上肢单瘫仍有进展。他被安排紧急切除2个脑叶肿块病变。组织病理学分析显示这2个标本具有相似特征。这些标本代表了广泛隐球菌病累及的胶质化脑实质。
在免疫功能正常的患者中诊断隐球菌病的肿瘤形式具有挑战性。在这些病例中，原发性和继发性脑肿瘤通常是首先考虑的诊断。在进行组织病理学分析之前，通过脑脊液采样和详细的磁共振成像进行全面的术前检查可能会促使考虑这一诊断。
