Retrospective study of 23 pathologically proven cases of central nervous system tuberculomas.
BACKGROUND
Extrapulmonary manifestations of tuberculosis involving the central nervous system (CNS) due to haematogenous spread are not a rare entity. It presents as meningitis or tuberculoma. Tuberculoma is a granulomatous inflammatory process mimicking a neoplasm radiologically, so usually a biopsy is performed.


RESULTS
Our study consisted of 23 pathologically proven cases of tuberculomas between 1988 and 2003. Patients were discussed clinically, radiologically and histologically. Headache, fever, weight loss and weakness are the most common clinical manifestations. Our patient's ages vary from 3 to 67 years with a mean of 31.8 years. Ninety-five percent of patients had bad social, economic and nutritional conditions. None of them were infected by human immunodeficiency virus (HIV). All patients had similar contrast-enhancing lesions radiologically. The majority of tuberculomas were located supratentorially. Only one patient presented two foci of (cerebral and cerebellar) tuberculomas. Nineteen tuberculomas were intracerebral; two were located in the cerebellum and one was intramedullary. Among those lesions, one cavernous sinus tuberculoma and one sellar tuberculoma were identified. Only two patients underwent stereotactic biopsy and 21 patients underwent surgical excision. Histopathologic examination revealed granulomatous inflammation with central caseous necrosis in all patients.


CONCLUSIONS
Diagnosis of tuberculoma can be difficult, and in most of our cases, the clinical diagnosis was 'neoplasm'. For this reason, clinicians must always be aware of it and consider it in the differential diagnosis of central nervous system mass lesions.
Bayindir
Cicek
C
Department of Pathology, Division of Neuropathology, Istanbul Faculty of Medicine, Istanbul University, Temel Bilimler Binasi, 34390 Capa, Istanbul, Turkey.
Mete
Ozgür
O
Bilgic
Bilge
B
D000293:Adolescent; D000328:Adult; D000368:Aged; D000666:Amphotericin B / Q000627:therapeutic use; D000890:Anti-Infective Agents / Q000627:therapeutic use; D001927:Brain Diseases / Q000188:drug therapy / Q000453:epidemiology* / Q000473:pathology*; D002648:Child; D002675:Child, Preschool; D003937:Diagnosis, Differential; D005260:Female; D005334:Fever / Q000175:diagnosis / Q000453:epidemiology; D006261:Headache / Q000175:diagnosis / Q000453:epidemiology; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008581:Meningitis / Q000175:diagnosis* / Q000453:epidemiology*; D008875:Middle Aged; D009336:Necrosis / Q000473:pathology; D012189:Retrospective Studies; D012959:Socioeconomic Factors; D016862:Tuberculoma, Intracranial / Q000188:drug therapy / Q000453:epidemiology* / Q000473:pathology*
D000890:Anti-Infective Agents; D000666:Amphotericin B