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Atypical craniocerebral eumycetoma: A case report and review of literature.

Rao KV, Praveen A, Megha S, Sundaram C, Purohith AK - Asian J Neurosurg (2015 Jan-Mar)

Bottom Line: Radiologically, they present as space-occupying lesions.Imaging showed a dural based lesions enhancing moderately on contrast.It is imperative to keep such atypical features of an infective etiology in mind because they may be one of differentials of "dural" based lesions where only a biopsy may suffice in the absence of significant mass effect to prove the diagnosis.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurosurgery, Nizam's Institute of Medical Sciences, Punjagutta, Hyderabad, Andhra Pradesh, India.

ABSTRACT
Craniocerebral eumycetomas are rare. They usually present with scalp swelling and discharging sinuses. Radiologically, they present as space-occupying lesions. We report a case of eumycetoma involving the left parietal cortex, bone, and subcutaneous tissue in a young male, farm laborer, who presented with seizures and blurring of vision. Imaging showed a dural based lesions enhancing moderately on contrast. To the best of our knowledge and belief, ours is the first published case in the English Literature where a eumycetoma has presented as a mass lesion without discharging sinuses. It is imperative to keep such atypical features of an infective etiology in mind because they may be one of differentials of "dural" based lesions where only a biopsy may suffice in the absence of significant mass effect to prove the diagnosis.

No MeSH data available.


Related in: MedlinePlus

(a) photomicrograph showing granule with pale center and splender-hopple phenomenon amidst suppurative inflammation. Hematoxylin and eosin ×4 Inset showing eosinophilic material in the periphery of the granule with neutrophils clinging to it Hematoxylin and eosin ×40. (b) Photomicrograph showing filamentous hyphae in the center of the granule periodic acid schiff ×40. (c) Photomicrograph showing filamentous hyphae in the centre of the granule and vesicles in the periphery-Gomori s methenamine silver stain ×40
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Figure 4: (a) photomicrograph showing granule with pale center and splender-hopple phenomenon amidst suppurative inflammation. Hematoxylin and eosin ×4 Inset showing eosinophilic material in the periphery of the granule with neutrophils clinging to it Hematoxylin and eosin ×40. (b) Photomicrograph showing filamentous hyphae in the center of the granule periodic acid schiff ×40. (c) Photomicrograph showing filamentous hyphae in the centre of the granule and vesicles in the periphery-Gomori s methenamine silver stain ×40

Mentions: A 26-year-old male farm laborer presented with chief complaints of 3–4 episodes of generalized tonic-clonic seizures, blurring of vision and headache of 5 months duration without any history of fever or any other constitutional symptoms. There were no neurological deficits on examination. Also, no scalp swelling or draining sinuses were evident. Computed tomography scan of the brain revealed a left parieto-occipital moderately enhancing, dural based lesion with significant mass effect. The overlying bone showed hyperostosis with intermittent punched out defects [Figure 1]. He was taken up for emergency surgical debulking and biopsy due to persistent mass effect. Intraoperatively, subcutaneous tissue was found to be densely adherent to the parietal bone. The dura was thickened and was an adherent to the bone that was punched out at various places [Figure 3]. The lesion was excised en bloc along with involved dura and bone. Postoperative period was uneventful. Subsequent magnetic resonance imaging (MRI) showed adequate excision along with a resolution of mass effect [Figure 2]. Histology showed dense collagen infiltrated by inflammatory infiltrate extending into bone and underlying brain parenchyma. There were multiple suppurating granulomas composed of neutrophils, lymphocytes, mononuclear cells and few multinucleated gaint cells. In the center of the abscess, there were granules measuring 2–4 mm with central pale color and Splender-Hopple phenomenon. The central pale area was composed of vesicles and septate hyphae, highlighted on Gomori methenamine silver stain and periodic acid-Schiff stain [Figure 4]. Tissue was submitted for culture, but it did not yield any growth. Based on the morphology, a diagnosis of pale grain mycetoma, probably Pseudallescheria spp. was made. The patient was started on anti-fungal therapy with itraconazole 200 mg twice a day. Patient was doing well at 3 months follow-up.


Atypical craniocerebral eumycetoma: A case report and review of literature.

Rao KV, Praveen A, Megha S, Sundaram C, Purohith AK - Asian J Neurosurg (2015 Jan-Mar)

(a) photomicrograph showing granule with pale center and splender-hopple phenomenon amidst suppurative inflammation. Hematoxylin and eosin ×4 Inset showing eosinophilic material in the periphery of the granule with neutrophils clinging to it Hematoxylin and eosin ×40. (b) Photomicrograph showing filamentous hyphae in the center of the granule periodic acid schiff ×40. (c) Photomicrograph showing filamentous hyphae in the centre of the granule and vesicles in the periphery-Gomori s methenamine silver stain ×40
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4352644&req=5

Figure 4: (a) photomicrograph showing granule with pale center and splender-hopple phenomenon amidst suppurative inflammation. Hematoxylin and eosin ×4 Inset showing eosinophilic material in the periphery of the granule with neutrophils clinging to it Hematoxylin and eosin ×40. (b) Photomicrograph showing filamentous hyphae in the center of the granule periodic acid schiff ×40. (c) Photomicrograph showing filamentous hyphae in the centre of the granule and vesicles in the periphery-Gomori s methenamine silver stain ×40
Mentions: A 26-year-old male farm laborer presented with chief complaints of 3–4 episodes of generalized tonic-clonic seizures, blurring of vision and headache of 5 months duration without any history of fever or any other constitutional symptoms. There were no neurological deficits on examination. Also, no scalp swelling or draining sinuses were evident. Computed tomography scan of the brain revealed a left parieto-occipital moderately enhancing, dural based lesion with significant mass effect. The overlying bone showed hyperostosis with intermittent punched out defects [Figure 1]. He was taken up for emergency surgical debulking and biopsy due to persistent mass effect. Intraoperatively, subcutaneous tissue was found to be densely adherent to the parietal bone. The dura was thickened and was an adherent to the bone that was punched out at various places [Figure 3]. The lesion was excised en bloc along with involved dura and bone. Postoperative period was uneventful. Subsequent magnetic resonance imaging (MRI) showed adequate excision along with a resolution of mass effect [Figure 2]. Histology showed dense collagen infiltrated by inflammatory infiltrate extending into bone and underlying brain parenchyma. There were multiple suppurating granulomas composed of neutrophils, lymphocytes, mononuclear cells and few multinucleated gaint cells. In the center of the abscess, there were granules measuring 2–4 mm with central pale color and Splender-Hopple phenomenon. The central pale area was composed of vesicles and septate hyphae, highlighted on Gomori methenamine silver stain and periodic acid-Schiff stain [Figure 4]. Tissue was submitted for culture, but it did not yield any growth. Based on the morphology, a diagnosis of pale grain mycetoma, probably Pseudallescheria spp. was made. The patient was started on anti-fungal therapy with itraconazole 200 mg twice a day. Patient was doing well at 3 months follow-up.

Bottom Line: Radiologically, they present as space-occupying lesions.Imaging showed a dural based lesions enhancing moderately on contrast.It is imperative to keep such atypical features of an infective etiology in mind because they may be one of differentials of "dural" based lesions where only a biopsy may suffice in the absence of significant mass effect to prove the diagnosis.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurosurgery, Nizam's Institute of Medical Sciences, Punjagutta, Hyderabad, Andhra Pradesh, India.

ABSTRACT
Craniocerebral eumycetomas are rare. They usually present with scalp swelling and discharging sinuses. Radiologically, they present as space-occupying lesions. We report a case of eumycetoma involving the left parietal cortex, bone, and subcutaneous tissue in a young male, farm laborer, who presented with seizures and blurring of vision. Imaging showed a dural based lesions enhancing moderately on contrast. To the best of our knowledge and belief, ours is the first published case in the English Literature where a eumycetoma has presented as a mass lesion without discharging sinuses. It is imperative to keep such atypical features of an infective etiology in mind because they may be one of differentials of "dural" based lesions where only a biopsy may suffice in the absence of significant mass effect to prove the diagnosis.

No MeSH data available.


Related in: MedlinePlus