Giant Cerebral Tuberculoma Masquerading as Malignant Brain Tumor – A Report of Two Cases

Abstract

Giant cerebral tuberculoma is an uncommon but serious form of tuberculosis. We report two patients who had a single, large lesion on magnetic resonance imaging (MRI) of the brain. Both patients underwent neurosurgery for the excision of the mass lesion as neuroimaging findings were suggestive of a brain tumor. Tuberculoma was later diagnosed on histopathological examination. We want to highlight that cerebral tuberculomas can mimic malignant brain tumors, as the clinical, laboratory, and radiologic features of cerebral tuberculomas are nonspecific.

Cerebellar tuberculoma in an immunocompetent patient

“…The diagnosis is problematic because tuberculoma cannot be distinguished from other masses, however, the neuroimaging presentation can be diverse and non-specific (Agrawal et al, 2020). In many situations, biopsy remains the gold standard for intracranial tuberculoma for histopathology and acid-fast bacilli stain and culture can provide a conclusive diagnosis (Agrawal et al, 2020), (Nicolls et al, 2005). The patient in our case underwent surgical procedures to make a diagnosis and alleviate symptomatic or life-threatening mass effects (Marais et al, 2019).…”

“…Clinical characteristics alone are insufficient to distinguish tuberculoma from other types of brain tumors (Thwaites et al, 2009). Only 30% of cerebral tuberculoma patients have a suggestive chest radiograph (Agrawal et al, 2020). Also, tubercle bacilli are not always visible in the cerebrospinal fluid (CSF), so a CSF analysis may not be helpful (Agrawal et al, 2020).…”

“…Only 30% of cerebral tuberculoma patients have a suggestive chest radiograph (Agrawal et al, 2020). Also, tubercle bacilli are not always visible in the cerebrospinal fluid (CSF), so a CSF analysis may not be helpful (Agrawal et al, 2020). The diagnosis is problematic because tuberculoma cannot be distinguished from other masses, however, the neuroimaging presentation can be diverse and non-specific (Agrawal et al, 2020).…”

“…Also, tubercle bacilli are not always visible in the cerebrospinal fluid (CSF), so a CSF analysis may not be helpful (Agrawal et al, 2020). The diagnosis is problematic because tuberculoma cannot be distinguished from other masses, however, the neuroimaging presentation can be diverse and non-specific (Agrawal et al, 2020). In many situations, biopsy remains the gold standard for intracranial tuberculoma for histopathology and acid-fast bacilli stain and culture can provide a conclusive diagnosis (Agrawal et al, 2020), (Nicolls et al, 2005).…”

“…Cerebellar or brainstem tuberculoma is found at much lower rates in adults (Bouali et al, 2020). The radiological findings of CNS tuberculoma are nonspecific, and usually similar to other diseases (Agrawal et al, 2020). Therapeutic approaches and results depend on identifying the source of CNS infections (Imran et al, 2019).…”