Fujishita Saho, Inoue Akihiro, Watanabe Hideaki, Nishikawa Masahiro, Taniwaki Mashio, Matsumoto Sayaka, Ochi Masayuki, Suemori Koichiro, Watanabe Akira, Kitazawa Riko, Shigekawa Seiji, Ohyagi Yasumasa, Kunieda Takeharu
Department of Neurology and Geriatric Medicine, Ehime University School of Medicine, Toon, Ehime, Japan.
Department of Neurosurgery, Ehime University School of Medicine, Toon, Ehime, Japan.
Surg Neurol Int. 2024 Sep 13;15:330. doi: 10.25259/SNI_614_2024. eCollection 2024.
Cryptococcal infections of the central nervous system are infrequent in immunocompetent hosts and usually present as meningitis. However, a fungal mass called a cryptococcoma may form, requiring caution in therapeutic intervention. Here, we report a rare case in which treatment of intraventricular cryptococcoma in an immunocompetent patient was facilitated by rapid pathological diagnosis.
A 58-year-old previously healthy man was admitted to our hospital with fever, headache, and gradually worsening hearing loss over 1 month. Cerebrospinal fluid analysis showed moderately elevated levels of protein and lymphocytic cells and decreased glucose. In addition, β2-microglobulin was highly elevated. Magnetic resonance imaging showed homogeneously enhanced lesions in lateral ventricles of the left and right hemispheres and the subarachnoid space, and F-fluorodeoxyglucose positron emission tomography revealed abnormal uptake corresponding to the lesion. A surgical excision was performed to achieve a definitive diagnosis. Intraoperative rapid pathology, including immunohistochemistry (IHC), yielded negative results for malignant tumor, suggesting the possibility of inflammatory granuloma. Additional targeted pathological diagnosis was immediately performed. Paraffin-embedded histopathological examination showed fibrocaseous granuloma and numerous fungal spores. within the granuloma were suggested by Fontana-Masson and Grocott staining and confirmed by polymerase chain reaction (PCR), leading to a diagnosis of cryptococcoma. Antifungal agents were started 3 days postoperatively. The patient has since been doing well, with no recurrence.
This pathology can be difficult to distinguish from a brain tumor, so early pathological diagnosis, including rapid pathology with IHC and PCR, may be crucial.
中枢神经系统隐球菌感染在免疫功能正常的宿主中并不常见，通常表现为脑膜炎。然而，可能会形成一种称为隐球菌瘤的真菌团块，这在治疗干预时需要谨慎。在此，我们报告一例罕见病例，通过快速病理诊断促进了对一名免疫功能正常患者的脑室内隐球菌瘤的治疗。
一名58岁既往健康的男性因发热、头痛及1个月内听力逐渐下降入住我院。脑脊液分析显示蛋白和淋巴细胞水平中度升高，葡萄糖降低。此外，β2微球蛋白高度升高。磁共振成像显示左右半球侧脑室及蛛网膜下腔有均匀强化的病变，氟脱氧葡萄糖正电子发射断层扫描显示与病变对应的异常摄取。进行了手术切除以明确诊断。术中快速病理检查，包括免疫组织化学（IHC），结果显示恶性肿瘤为阴性，提示炎性肉芽肿的可能性。立即进行了额外的靶向病理诊断。石蜡包埋组织病理学检查显示纤维干酪样肉芽肿和大量真菌孢子。Fontana-Masson和Grocott染色提示肉芽肿内有真菌孢子，聚合酶链反应（PCR）证实了这一点，从而诊断为隐球菌瘤。术后3天开始使用抗真菌药物。此后患者情况良好，无复发。
这种病理情况可能难以与脑肿瘤区分，因此早期病理诊断，包括使用IHC和PCR的快速病理诊断，可能至关重要。
