Department of Radiology, Universiti Kebangsaan Malaysia Medical Centre, Cheras, Kuala Lumpur, Malaysia.
Department of Radiology, Hospital Kuala Lumpur, Kuala Lumpur, Wilayah Persekutuan, Malaysia.
BMJ Case Rep. 2022 Sep 15;15(9):e251672. doi: 10.1136/bcr-2022-251672.
Brainstem tuberculoma is diagnostically challenging as it lacks clinical clues and imaging mimics a high-grade glioma (HGG). We report the case of an adolescent girl diagnosed with brainstem HGG, who was referred to our centre for Gamma Knife. Initial MRI showed a pontomedullary junction, ring-enhancing lobulated lesion demonstrating distinct central hypointensity on T2-weighted (T2W) and fluid-attenuated inversion recovery (FLAIR) images with extensive vasogenic oedema. An alternative diagnosis of infection was entertained, and biopsy was suggested; however, the parents opted for a trial of alternative treatment. Suboccipital craniotomy and debulking were only performed 3 months later when her symptoms worsened, and MRI revealed enlargement of the lesion. A cheesy 'tumour' was noted intraoperatively; histopathological findings later confirmed chronic granulomatous inflammation. In an endemic area, a high index of suspicion of a tuberculoma is vital specifically in the presence of central T2W/FLAIR hypointensity of a ring-enhancing lesion.
脑干结核瘤在诊断上具有挑战性，因为它缺乏临床线索，影像学表现类似于高级别胶质瘤（HGG）。我们报告了一例被诊断为脑干 HGG 的青少年女孩，她被转介到我们中心接受伽玛刀治疗。初始 MRI 显示桥延髓交界处有一个呈环状增强、分叶状的病变，在 T2 加权（T2W）和液体衰减反转恢复（FLAIR）图像上表现为明显的中央低信号，伴有广泛的血管源性水肿。考虑到感染的另一种诊断，并建议进行活检；然而，家长选择了尝试替代治疗。仅在 3 个月后，当她的症状恶化且 MRI 显示病变增大时，才进行了枕下开颅术和肿瘤切除术。术中发现奶酪样“肿瘤”；随后的组织病理学检查证实为慢性肉芽肿性炎症。在流行地区，对于存在环状增强病变的中央 T2W/FLAIR 低信号的结核瘤，需要高度怀疑，特别是在存在中央 T2W/FLAIR 低信号的情况下。
