Murota Yasuhiro, Tamura Kaoru, Tanaka Yoji, Aizawa Yuki, Kobayashi Daisuke, Matsuoka Yoshiyuki, Hashimoto Satoka, Inaji Motoki, Nariai Tadashi, Maehara Taketoshi
Department of Neurosurgery, Tokyo Medical and Dental University.
No Shinkei Geka. 2021 May;49(3):683-688. doi: 10.11477/mf.1436204443.
Cerebral tuberculoma is a rare and serious form of tuberculosis. Despite advancements in imaging and laboratory diagnostics, it is challenging to diagnose cerebral tuberculoma due to its insidious nature and nonspecific findings. A 56-year-old woman was referred to our hospital for headaches. The patient had previously undergone treatment for pulmonary tuberculosis, which had been completely cured 2 months prior to presentation. Brain MRI revealed an enhanced mass lesion with surrounding edema in the right frontal lobe. Although a mild increase in the serum carcinoembryonic antigen(CEA)level and a moderate accumulation of FDG on FDG-PET indicated inflammatory changes or a malignant brain tumor, other imaging and laboratory findings were nonspecific. The mass lesion was indistinguishable from a brain tumor. Hence, the patient underwent surgical removal, and the pathological diagnosis was tuberculoma. In patients with a history of tuberculosis, cerebral tuberculoma should be considered in the differential diagnosis of intracranial mass lesions, even if the original lesion is completely cured. A mild increase in the serum CEA level and a moderate accumulation of FDG on FDG-PET were considered indicative of intracranial inflammation and consistent with cerebral tuberculoma.
脑结核瘤是一种罕见且严重的结核病形式。尽管影像学和实验室诊断技术有所进步，但由于其隐匿性和非特异性表现，脑结核瘤的诊断仍具有挑战性。一名56岁女性因头痛被转诊至我院。该患者此前曾接受过肺结核治疗，在就诊前2个月已完全治愈。脑部MRI显示右侧额叶有一个强化的肿块病变，周围伴有水肿。尽管血清癌胚抗原（CEA）水平轻度升高以及氟代脱氧葡萄糖（FDG）-PET上FDG有中度积聚提示炎症改变或恶性脑肿瘤，但其他影像学和实验室检查结果均无特异性。该肿块病变与脑肿瘤难以区分。因此，患者接受了手术切除，病理诊断为结核瘤。对于有结核病史的患者，即使原发病灶已完全治愈，在颅内肿块病变的鉴别诊断中也应考虑脑结核瘤。血清CEA水平轻度升高以及FDG-PET上FDG中度积聚被认为提示颅内炎症，与脑结核瘤相符。
