Cerebral tuberculosis with features of granulation tissue and granuloma: a case report and review of literature

Abstract

Objective To investigate the clinicopathological features and differential diagnosis of cerebral tuberculosis with features of granulation tissue and granuloma. Methods The clinical and morphological features were studied in one case of cerebral tuberculosis, with review of literature. Results A 12-year-old boy presented with 2-month history of cough, expectoration, pain of muscle and fever. His brain magnetic resonance imaging (MRI) revealed multiple low-⁃density shadows in the meninges on the left frontal temporal and parieto-occipital lobes, and right parieto-occipital lobes, 2 mm to 7 mm in diameter. Nodular low-density shadows were detected in the left cerebellar hemisphere. Chest computed tomography (CT) showed moth - eaten bone destruction of the manubrium of sternum and the upper sternum, and soft tissue swelling. Spine CT showed bone destruction of the second lumbar vertebra, and paravertebral soft tissue swelling. The patient was given stereotactic operation with the guide of MRI at right parietal lobes. Chest wall mass biopsy was performed, and 3 months later, the chest wall sinus was excised. Microscopically, low magnification showed a nodule with clear boundary at right parietal lobes, high magnification displayed nodule composed of fibroblasts, foam cells, newborn capillaries with lymphocytes, plasmocytes and neutrophils. Purulent inflammation with a few multinucleated giant cells could be seen in thoracic wall mass, sternum and soft tissue. A large number of positive bacilli could be seen in the right parietal lobes and thoracic wall by acid-fast staining. Conclusion The morphology of cerebral tuberculosis with features of granulation tissue and granuloma may be atypical, and sometimes present with suppurative inflammation. When clinicial manifestation is also atypical, acid-fast staining should be done to avoid misdiagnosis. DOI：10.3969/j.issn.1672-6731.2011.05.010