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Giant Tuberculomas of Brain: Rare Neoplastic Mimic
Chandradev Sahu1, Nishant Bhargava2, Vivek Singh2
1Department of Neuroradiology, Pt. Jawahar Lal Nehru Memorial Medical College (PT JNMC), Raipur, Chhattisgarh, India.
Objective:
Tuberculosis continues to be a major infectious disease in developing parts of the world. Primarily central nervous system tuberculosis manifests as meningitis, tuberculoma, or a brain abscess; however, rarely it may manifest as a large neoplastic mass such as lesion known as giant tuberculoma. Especially in central parts of India, the incidence of giant tuberculoma is quite high in pediatric population that too in posterior fossa of brain. Often, they are wrongly reported as neoplastic masses on imaging. The objective of this study was to evaluate different imaging appearances of a giant tuberculoma.
Materials And Methods:
In this prospective study, all cases of giant tuberculoma presenting to a large tertiary care center in central India for 2 years (duration 2016-2018) were imaged and followed up. A total of nine patients, six females and three males, aged 4-16 years were studied on a 3-Tesla Siemens magnetic resonance imaging (MRI) scanner.
Results:
In total, nine patients were included with 11 giant tuberculomas. Of 11, eight were infratentorial and three were supratentorial in location. On T2-weighted image sequence, these lesions showed central hypointensity with a peripheral hyperintense rim. Most observed finding on T1-weighted image sequence was central isointensity with peripheral hyperintense rim. Advanced imaging sequences such as magnetic resonance spectroscopy and magnetization transfer were also applied.
Conclusion:
To the best of our knowledge, this is the largest series of giant tuberculoma in the pediatric population reported so far in any part of the world. We have described the various MRI imaging findings of this lesion in great details. Management of such rare cases and pertinent literature is reviewed briefly.
Insights
Giant tuberculoma, a rare form of tuberculosis, often mimics brain tumors in children, particularly in India. This study details its MRI imaging characteristics to aid diagnosis.
Area of Science:
- Neurology
- Infectious Diseases
- Radiology
Background:
- Tuberculosis (TB) is a significant global health issue, especially in developing nations.
- Central nervous system (CNS) TB commonly presents as meningitis, tuberculoma, or abscess.
- Giant tuberculoma, a rare neoplastic-like mass, is notably prevalent in pediatric posterior fossa in central India, often misdiagnosed as a tumor on imaging.
Purpose of the Study:
- To evaluate the diverse imaging appearances of giant tuberculoma.
- To improve diagnostic accuracy and differentiate giant tuberculoma from neoplastic masses.
Main Methods:
- A prospective study conducted over two years (2016-2018) at a tertiary care center in central India.
- Inclusion of nine pediatric patients (4-16 years) with giant tuberculoma.
- Utilized a 3-Tesla Siemens MRI scanner with advanced sequences like magnetic resonance spectroscopy and magnetization transfer.
Main Results:
- Eleven giant tuberculomas were identified in nine pediatric patients.
- Eight lesions were located in the infratentorial region, and three were supratentorial.
- Characteristic MRI findings included central hypointensity with a peripheral hyperintense rim on T2-weighted images and central isointensity with a peripheral hyperintense rim on T1-weighted images.
Conclusions:
- This study represents the largest series of pediatric giant tuberculoma reported globally.
- Detailed description of MRI imaging findings aids in the diagnosis of this rare condition.
- Brief review of management strategies and relevant literature is provided.
