Related Experiment Videos
[A case of an intracerebral mass lesion consisting of traumatic granulation tissue]
M Wanibuchi1, T Uede, M Ishiguro
1Department of Neurosurgery, Kushiro City General Hospital.
Insights
This case report details a rare intracerebral granulomatous lesion in a patient with traumatic brain injury. The lesion, initially suspected as a tumor, was pathologically identified as granulation tissue from old hematomas.
Area of Science:
- Neurology
- Pathology
- Traumatology
Background:
- Traumatic brain contusions can lead to complex healing processes.
- Intracerebral lesions require accurate diagnosis to differentiate from tumors.
Observation:
- A 44-year-old male presented with headache and nausea.
- Imaging revealed a right frontal base mass with severe edema, T1/T2 hyperintensity, and contrast enhancement.
- Additional smaller enhanced lesions were noted in the temporal lobes.
Findings:
- Surgical removal of the right frontal mass was performed.
- Pathological diagnosis revealed intracerebral granulation tissue, hemosiderin-laden macrophages, and thickened capillaries.
- No reactive gliosis was observed.
Implications:
- The findings suggest granulation tissue formation as a rare sequela of traumatic brain injury and associated hematomas.
- This highlights the importance of considering post-traumatic changes in the differential diagnosis of intracerebral masses.
- Understanding the pathogenesis of granulation tissue formation in the brain is crucial for managing such rare cases.
Abstract:
We reported a rare case of an intracerebral granulomatous lesion accompanying severe edema formation in the healing stage of traumatic brain contusions. A 44-year-old male patient came to our outpatient clinic due to progressing headache and nausea. Upon computed tomographic examination, a low density mass with strong surrounding edema was detected at the right frontal base. Magnetic resonance images revealed a high intensity mass on both T1- and T2-weighted images at the right frontal base. Upon intravenous injection of a contrast agent, this lesion exhibited multifocal marginal contrast enhancement. Two additional small enhanced mass lesions were detected at the tip of the right temporal lobe and the medial portion of the left temporal lobe. We tentatively diagnosed it as a right frontal brain tumor and attempted the total removal of the right frontal mass. Unexpectedly, pathological diagnosis was intracerebral granulation tissue associated with accumulation of hemosiderin-laden macrophages and capillary wall thickening. In addition, there was no reactive gliosis. We speculated on the pathogenesis of intracerebral granulation tissue as follows. Since the patient was a heavy drinker and often fell down when he was drunk, it is likely that he might be suffering from intracerebral hematomas due to traumatic contusions. This assumption may be supported by the fact that an old subdural hematoma was observed during the operation and the radiological examination revealed multiple lesions. The gathering and proliferation of mesenchymal cells possibly derived from blood circulation probably began at the site of the damaged brain tissue, thus forming intracerebral granulation tissue.(ABSTRACT TRUNCATED AT 250 WORDS)