Giant cerebral tuberculoma

A large mass lesion in the left cerebral hemisphere with marked adjacent vasogenic oedema simulating tumoural mass lesion,. The thin marginalregular peripheral wall enhanced usuallyenhancement generally argues against thea tumour, the calcificationfavouring infection. Calcification can be seen in both tumour and infectious lesionlesions.

The patient went on to have a resection.

Histology

Shows serial sections examined from the specimen received reveal pieces of tissue showing multiple variable size granulomata. Each granuloma is formed of epithelioid macrophages, lymphocytes, and a few Langhans giant cells. ThereTuberculomas (confirmed pathologically) are wide areas of caseous necrosisusually smaller, but can be this large. No evidence of malignancy in serial sections was examined.

Acknowledgments: Dr.Ali Shraf Al-dine (neurosurgery), Dr. Abdulatif Magram (radiology specialist), Dr. Wael Al-Absi (pathology specialist).

Large marginal enhancing intra-axial collection mass/collection with peripheral enhancement is seen in the left frontal and parietal lobe involveinvolving the left basal ganglia with areas of calcification in the medial aspect surrounded by edemaoedema involving the frontal, parietal as well as temporal lobes and crossing the midline in the frontal region, compressing the left lateral ventricle with midline shift, edema. Extensive vasogenic oedema extended to the brain stem upper part  withwith mild dilated right lateral ventricle.

Multiple large masses of white to yellowish colorcolour cheeses-like appearance indicate necrotic caseationcaseous necrosis.