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Meningotheliomatous meningioma accompanied by aspergillosis at the skull base
T Sameshima1, Y Morita, M Yanagita
1Department of Neurosurgery, Miyazaki Medical College, Kiyotake, Japan.
Abstract:
A 73-year-old man was admitted because of right frontal headache and gradual loss of right visual acuity, which had been occurring for 1 year. He had been treated with corticosteroids under the diagnosis of retrobulbar optic neuritis at a nearby clinic. Magnetic resonance imaging (MRI) revealed a nodular lesion at the tuberculum sellae, which showed isointensity on T1-weighted images, iso- to low-intensity on T2-weighted images, and heterogeneous enhancement with Gd-DTPA. Meningioma was diagnosed, and surgery was performed but was limited to biopsy because of intraoperative detection of purulent inflammation of the nodule. Histologic examination revealed aspergillosis in a portion of the meningotheliomatous meningioma. The patient died of meningoencephalitis about 1 month after surgery in spite of extensive treatment with antifungal agents. MRI findings of meningioma and aspergillosis are similar, thus making preoperative diagnosis difficult. However, this case provides evidence that aspergillosis should be included in the differential diagnosis when a skull-base meningioma-like nodule is noted if sinusitis is revealed in the sphenoid sinus.
Insights
This case highlights a rare instance of fungal infection mimicking a brain tumor. Aspergillosis can present similarly to meningioma on MRI, emphasizing the need for careful diagnosis in skull base lesions.
Area of Science:
- Neurology
- Infectious Diseases
- Radiology
Background:
- Skull base lesions can present with varied symptoms, including headache and visual disturbances.
- Meningiomas are common primary tumors in this region, often diagnosed via Magnetic Resonance Imaging (MRI).
- Corticosteroid treatment for presumed inflammatory conditions can sometimes mask underlying infections.
Observation:
- A 73-year-old male presented with chronic headache and vision loss, initially treated for optic neuritis.
- MRI revealed a tuberculum sellae lesion with imaging characteristics suggestive of meningioma.
- Intraoperative findings showed purulent inflammation, leading to biopsy and subsequent diagnosis of aspergillosis coexisting with meningioma.
Findings:
- Histopathological examination confirmed the presence of aspergillosis within a meningotheliomatous meningioma.
- The imaging features of meningioma and intracranial aspergillosis can be indistinguishable on MRI.
- Despite antifungal treatment, the patient succumbed to meningoencephalitis approximately one month post-surgery.
Implications:
- This case underscores the importance of considering fungal infections, specifically aspergillosis, in the differential diagnosis of skull base masses.
- The presence of sinusitis, particularly sphenoid sinusitis, should raise suspicion for fungal etiology in meningioma-like lesions.
- Accurate preoperative diagnosis is crucial for appropriate management and improved patient outcomes in complex skull base pathologies.