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Magnetic resonance spectroscopy imaging characteristics of cerebral Blastomycosis.

Vachhani JA, Lee WC, Desanto JR, Tsung AJ - Surg Neurol Int (2014)

Bottom Line: There appeared to be peaks between 3.6 and 3.8 ppm over the enhancing area that were not present in the contralateral normal brain and thought to represent a "trehalose" peak.There appears to be a characteristic peak between 3.6 and 3.8 ppm that is thought to represent a "trehalose" peak.This peak is rather specific to fungi and can be helpful in differentiating fungal abscesses from pyogenic abscesses and malignant neoplasms.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurosurgery, Illinois Neurological Institute, Peoria, Illinois, 530 NE Glen Oak Avenue, Peoria, IL 61637, USA.

ABSTRACT

Background: Blastomycosis is a dimorphic fungus that is endemic to the midwest and southwestern United States. Involvement of the central nervous system (CNS) is thought to only represent 5-10% of cases of disseminated Blastomycosis.

Case description: A 54-year-old Caucasian female presented to the Neurosurgery service with a 1-day history of progressive right sided hemiparesis. Magnetic resonance imaging (MRI) demonstrated a 2 × 4 cm heterogeneous intracranial mass lesion involving the left motor cortex and extending into the ipsilateral parietal lobe. Single-voxel magnetic resonance spectroscopy (MRS) over the enhancing area demonstrated diminished N-acetyl aspartate (NAA) to creatine ratio (1.10), normal choline to NAA ratio (0.82), normal choline to creatine ratio (0.9), and a diminished myoinositol to creatine ratio (0.39). There appeared to be peaks between 3.6 and 3.8 ppm over the enhancing area that were not present in the contralateral normal brain and thought to represent a "trehalose" peak. Due to worsening symptoms and uncertain preoperative diagnosis, the patient underwent a left fronto-parietal craniotomy for open surgical biopsy with possible resection approximately one month after presentation. Pathological analysis confirmed the diagnosis of Blastomycosis.

Conclusion: We present the second documented case of intracranial Blastomycosis with MRS imaging. There appears to be a characteristic peak between 3.6 and 3.8 ppm that is thought to represent a "trehalose" peak. This peak is rather specific to fungi and can be helpful in differentiating fungal abscesses from pyogenic abscesses and malignant neoplasms.

No MeSH data available.


Related in: MedlinePlus

Hematoxylin and eosin stain at ×200 magnification
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Figure 6: Hematoxylin and eosin stain at ×200 magnification

Mentions: Hematoxylin and eosin staining showed chronic granulomatous inflammation with caseating necrosis, multinucleated giant cells, and epithelioid histiocytic cells [Figure 6] Periodic acid-Schiff staining showed broad based budding yeast, compatible with Blastomycosis [Figure 7]. The specimen was sent to the Centers for Disease Control and they confirmed the diagnosis of Blastomycosis.


Magnetic resonance spectroscopy imaging characteristics of cerebral Blastomycosis.

Vachhani JA, Lee WC, Desanto JR, Tsung AJ - Surg Neurol Int (2014)

Hematoxylin and eosin stain at ×200 magnification
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4061578&req=5

Figure 6: Hematoxylin and eosin stain at ×200 magnification
Mentions: Hematoxylin and eosin staining showed chronic granulomatous inflammation with caseating necrosis, multinucleated giant cells, and epithelioid histiocytic cells [Figure 6] Periodic acid-Schiff staining showed broad based budding yeast, compatible with Blastomycosis [Figure 7]. The specimen was sent to the Centers for Disease Control and they confirmed the diagnosis of Blastomycosis.

Bottom Line: There appeared to be peaks between 3.6 and 3.8 ppm over the enhancing area that were not present in the contralateral normal brain and thought to represent a "trehalose" peak.There appears to be a characteristic peak between 3.6 and 3.8 ppm that is thought to represent a "trehalose" peak.This peak is rather specific to fungi and can be helpful in differentiating fungal abscesses from pyogenic abscesses and malignant neoplasms.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurosurgery, Illinois Neurological Institute, Peoria, Illinois, 530 NE Glen Oak Avenue, Peoria, IL 61637, USA.

ABSTRACT

Background: Blastomycosis is a dimorphic fungus that is endemic to the midwest and southwestern United States. Involvement of the central nervous system (CNS) is thought to only represent 5-10% of cases of disseminated Blastomycosis.

Case description: A 54-year-old Caucasian female presented to the Neurosurgery service with a 1-day history of progressive right sided hemiparesis. Magnetic resonance imaging (MRI) demonstrated a 2 × 4 cm heterogeneous intracranial mass lesion involving the left motor cortex and extending into the ipsilateral parietal lobe. Single-voxel magnetic resonance spectroscopy (MRS) over the enhancing area demonstrated diminished N-acetyl aspartate (NAA) to creatine ratio (1.10), normal choline to NAA ratio (0.82), normal choline to creatine ratio (0.9), and a diminished myoinositol to creatine ratio (0.39). There appeared to be peaks between 3.6 and 3.8 ppm over the enhancing area that were not present in the contralateral normal brain and thought to represent a "trehalose" peak. Due to worsening symptoms and uncertain preoperative diagnosis, the patient underwent a left fronto-parietal craniotomy for open surgical biopsy with possible resection approximately one month after presentation. Pathological analysis confirmed the diagnosis of Blastomycosis.

Conclusion: We present the second documented case of intracranial Blastomycosis with MRS imaging. There appears to be a characteristic peak between 3.6 and 3.8 ppm that is thought to represent a "trehalose" peak. This peak is rather specific to fungi and can be helpful in differentiating fungal abscesses from pyogenic abscesses and malignant neoplasms.

No MeSH data available.


Related in: MedlinePlus