Virginia Tech Carilion School of Medicine, 2 Riverside Circle, Roanoke, VA, 24016, USA.
Department of Neuroscience, Medical University of South Carolina, 171 Ashley Ave, Charleston, SC, 29425, USA.
BMC Neurol. 2020 Jun 5;20(1):230. doi: 10.1186/s12883-020-01814-0.
Intracranial necrotizing granulomatous space-occupying lesions are sparsely reported in literature. Variability in presenting symptomatology and radiographic features makes diagnostic work-up difficult.
This report presents the case of a 77-year-old female with sinusitis and fatigue who underwent an MRI revealing a posterior fossa lesion compressing the fourth ventricle. Subsequent contrast CT of the chest, abdomen, and pelvis was negative for primary malignancy. Histopathologic examination of the lesion following biopsy showed it to be a necrotizing granuloma in an antineutrophil cytoplasmic antibody (ANCA) negative patient. The most likely diagnosis was determined to be spontaneous necrotizing granuloma, a rare entity with only one previous report noted.
Spontaneous necrotizing granuloma of the CNS is a rare entity that represents an important differential consideration in the work-up of space occupying lesions of the CNS.
颅内坏死性肉芽肿性占位病变在文献中报道较少。临床表现和影像学特征的多样性使得诊断变得困难。
本报告介绍了一例 77 岁女性患者，有鼻窦炎和疲劳症状，行 MRI 检查显示后颅窝病变压迫第四脑室。随后进行的胸部、腹部和骨盆对比 CT 检查未发现原发性恶性肿瘤。活检后的组织病理学检查显示，该病变为抗中性粒细胞胞质抗体（ANCA）阴性患者的坏死性肉芽肿。最可能的诊断为自发性坏死性肉芽肿，这是一种罕见的疾病，此前仅有一例报道。
中枢神经系统自发性坏死性肉芽肿是一种罕见的疾病，在中枢神经系统占位性病变的诊断中需要考虑到这一重要的鉴别诊断。
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