Boa Sorte Anselmo Alves, Garcia Cesar Carvalho, Neto Mateus Reghin, de Oliveira Matheus Fernandes, Rotta Jose Marcus
Department of Neurosurgery, Instituto de Assistência Médica ao Servidor Público Estadual, Sao Paulo, Brazil.
Surg Neurol Int. 2022 Mar 31;13:114. doi: 10.25259/SNI_1243_2021. eCollection 2022.
Cryptococcosis is an invasive fungal infection primarily affecting lungs and potentially spreading to the central nervous. This fungal infection might be misdiagnosed as other infection diseases, such as tuberculosis; granulomatous diseases, like sarcoidosis; and even neoplastic diseases. Some previous reports described cases of cryptococcomas resembling brain tumors. In this paper, we present a very rare presentation of brain cryptococcoma mimicking a malignant glioma. To the best of our knowledge, this is the third case description in the literature.
A 64-year-old male patient presented at the hospital with a history of progressive frontal headache for 1 month, becoming moderate to severe, associated with visual changes, without nausea or vomiting. No fever was reported. He was a heavy smoker and denied other relevant previous medical data. Neuroimage disclosed a right temporal expansive lesion initially considered a malignant glioma. The patient underwent a right temporal craniotomy and biopsy revealed a cryptococcoma.
Cryptococcomas characteristics in magnetic resonance are quite nonspecific. They should always be included in differential diagnosis of expansive brain lesions, both malignant and benign. Therefore, once cryptococcomas may resemble like other intracranial expansive lesions, biopsy should always be carried out to clarify diagnosis and avoid inadequate treatment and definition of prognosis only based on radiological patterns.
隐球菌病是一种侵袭性真菌感染，主要影响肺部，并可能扩散至中枢神经系统。这种真菌感染可能会被误诊为其他感染性疾病，如结核病；肉芽肿性疾病，如结节病；甚至肿瘤性疾病。此前有一些报道描述了类似脑肿瘤的隐球菌瘤病例。在本文中，我们呈现了一例极为罕见的酷似恶性胶质瘤的脑隐球菌瘤病例。据我们所知，这是文献中的第三例病例描述。
一名64岁男性患者因进行性额部头痛1个月前来就诊，头痛程度逐渐加重至中重度，伴有视力改变，无恶心或呕吐。未报告发热情况。他是重度吸烟者，否认有其他相关既往病史。神经影像学检查发现右侧颞叶有一个占位性病变，最初考虑为恶性胶质瘤。患者接受了右侧颞叶开颅手术，活检显示为隐球菌瘤。
隐球菌瘤在磁共振成像中的特征相当不具特异性。在对脑内占位性病变（包括恶性和良性）进行鉴别诊断时，应始终考虑到隐球菌瘤。因此，一旦隐球菌瘤可能类似于其他颅内占位性病变，应始终进行活检以明确诊断，避免仅基于影像学表现进行不恰当的治疗和预后判断。
