Intracranial Cryptococcoma—Clinicopathologic Correlation and Surgical Outcome: A Single-Institution Experience

Uppar, Alok Mohan; Raj, A.R. Prabhu; Konar, Subhas; Kandregula, Sandeep; Shukla, Dhaval; Devi, Bhagavatula Indira; Yasha, C; Chandrashekar, N.

doi:10.1016/j.wneu.2018.04.056

Cited by 9 publications

(18 citation statements)

References 37 publications

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“…Cladophialophora bantiana was seen in 6 patients, Cryptococcus neoformans in 5 patients, Cryptococcus gattii in 1 patient, and Fonsecaea pedrosoi in 1 case. All of the above pathogens have been reported from our institute as part of a case series or case report by Garg et al, 11 Uppar et al, 37 and Madhugiri et al 19…”

Section: Fungal Pathogensmentioning

confidence: 90%

Intracranial fungal granuloma: a single-institute study of 90 cases over 18 years

Mishra¹,

Prabhuraj²,

Shukla³

et al. 2019

Neurosurgical Focus

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OBJECTIVEIntracranial fungal granuloma (IFG) remains an uncommon entity. The authors report a single-institute study of 90 cases of IFG, which is the largest study until now.METHODSIn this retrospective study, all cases of IFG surgically treated in the years 2001–2018 were included. Data were obtained from the medical records and the pathology, microbiology, and radiology departments. All relevant clinical data, imaging characteristics, surgical procedure performed, perioperative findings, and follow-up data were recorded from the case files. Telephonic follow-up was also performed for a few patients to find out their current status.RESULTSA total of 90 cases consisting of 64 males (71.1%) and 26 (28.9%) females were evaluated. The mean patient age was 40.2 years (range 1–79 years). Headache (54 patients) was the most common presenting complaint, followed by visual symptoms (35 patients), fever (21 patients), and others such as limb weakness (13 patients) or seizure (9 patients). Cranial nerve involvement was the most common sign (47 patients), followed by motor deficit (22 patients) and papilledema (7 patients). The mean duration of symptoms before presentation was 6.4 months (range 0.06–48 months). Thirty patients (33.3%) had predisposing factors like diabetes mellitus, tuberculosis, or other immunocompromised status. A pure intracranial location of the IFG was seen in 49 cases (54.4%), whereas rhinocerebral or paranasal sinus involvement was seen in 41 cases (45.6%). Open surgery, that is, craniotomy and decompression, was performed in 55 cases, endoscopic biopsy was done in 30 cases, and stereotactic biopsy was performed in 5 cases. Aspergilloma (43 patients) was the most common fungal mass, followed by zygomycosis (13 patients), chromomycosis (9 patients), cryptococcoma (7 patients), mucormycosis (5 patients), and candida infection (1 patient). In 12 cases, the exact fungal phenotype could not be identified. Follow-up was available for 69/90 patients (76.7%). The mean duration of the follow-up was 37.97 months (range 3–144 months). The mortality rate was 52.2% (36/69 patients) among the patients with available follow-up.CONCLUSIONSA high index of suspicion for IFG should exist for patients with an immunocompromised status and diabetic patients with rhinocerebral mass lesions. Early diagnosis, aggressive surgical decompression, and a course of promptly initiated antifungal therapy are associated with a better prognosis.

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Section: Fungal Pathogensmentioning

confidence: 90%

Intracranial fungal granuloma: a single-institute study of 90 cases over 18 years

Mishra¹,

Prabhuraj²,

Shukla³

et al. 2019

Neurosurgical Focus

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“…But these findings are not specific [10]: Glioma and tumefactive demyelination may have similar radiological manifestation. Most previous cases, whether immunosuppressed or immunocompetent, were misdiagnosed as neoplasms before brain biopsy or resection [8,10]. In this case, fever was not recorded and regular laboratory tests of blood and CSF did not show signs of infection during the first admission: That is why we ignored the possibility of infectious disease at first.…”

Section: Discussionmentioning

confidence: 83%

“…CSF profiles can be normal or show unspecific changes. Lung CT scans do not always show typical pulmonary changes [6,8]. On brain MRI, the lesion may present as low signals on T1 weighted images and high signals on T2 weighted images or T2 FLAIR.…”

Section: Discussionmentioning

confidence: 99%

Central nervous system Cryptococcoma mimicking demyelinating disease: a case report

Jie

Zhang

2020

BMC Neurol

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Background: Cerebral cryptococcomas is a rare form of central nervous system cryptococcosis. Most previous cases were mistaken for neoplasm before surgery. We present a case of cerebral cryptococcomas whose radiological profiles resembled demyelinating disease, especially tumefactive demyelinating lesion. Case presentation: A 40-year-old male was admitted for 1-week-long unconsciousness. Brain MRI revealed a rim-enhanced mass within the corpus callosum body. Central nervous system demyelinating disease was suspected. Empirical corticosteroid treatment led to some improvement, but his condition deteriorated 2 months later. Brain MRI revealed punctate new foci. Cryptococcus neoformans was detected in cerebrospinal fluid. Cryptococcus antigen test was positive in his current and previous cerebrospinal fluid samples. The patient died despite standard antifungal treatment. Conclusion: Diagnosis of cerebral cryptococcomas is challenging. It may mimic demyelinating diseases.

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“…C. neoformans was responsible for 74% of the 34 cases in which an organism was isolated and speciated [19,[22][23][24][26][27][28][29][30]32,34,36,37,39,41,[44][45][46][47]50,[52][53][54]. Among the nine cases which implicated C. gattii as the infectious etiology, only four provided explicit details as to the method for identifying the organism, either via isolation from a clinical specimen or genotypic testing [18,31,40,48].…”

Section: Causative Pathogensmentioning

confidence: 99%

“…Alternatively, surgical intervention was performed less often in patients with more than one lesion (38%) despite high rates of perilesional edema (71%). Management of intracranial pressure (ICP) was described in only a few cases, but of those, ventricular shunts were placed in three patients [18,22,43], whereas another two patients underwent external ventricular drain (EVD) implantation [42,52] as a result of failure to control ICP with serial LPs [26], clinical deterioration [30], or development of hydrocephalus [50].…”

Section: Treatment Detailsmentioning

confidence: 99%

Cerebral Cryptococcomas: A Systematic Scoping Review of Available Evidence to Facilitate Diagnosis and Treatment

et al. 2022

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Background: Recommendations for managing patients with cerebral cryptococcomas are scarce across multiple clinical guidelines. Due to the deficiency of high-quality data coupled with an increasing number of at-risk patients, the purpose of this review is to describe the demographic characteristics, causative pathogen, intracranial imaging, surgical and/or pharmacological interventions, as well as outcomes of patients with cerebral cryptococcomas to improve recognition and management. Methods: We conducted a scoping review in accordance with the PRISMA guidelines using PubMed and Web of Science. Reports were included if the following details were presented: (1) site of infection; (2) treatment details which at least include the specific antifungal therapy administered, if applicable; and (3) patient outcome. Results: A total of 40 records representing 47 individual patients were included, of which the median age was 48.5 years, 75% were male, and 60% reported a significant past medical, surgical, or social history. C. neoformans was isolated more often than C. gattii (74% vs. 26%, respectively). Patients most often presented with headache, altered mental status and/or confusion, and vomiting occurring over a median of 30 days; though few were noted to have significant findings on physical examination. More than 50% of patients had a single cerebral cryptococcoma lesion, whereas perilesional edema was present in 73% of cases. Surgical intervention occurred in 49% of patients. An amphotericin B-based formulation was administered as “induction” therapy to 91% of patients, but combined with flucytosine or fluconazole in only 58%, for an overall median of 42 days. Fifty two percent of patients received “maintenance” therapy for a median of 126 days, in which fluconazole was most often used. Corticosteroids were administered to approximately 30% of patients for a median of 31.5 days. Overall, mortality was 34%. Conclusion: Based on our findings, management should include antifungal therapy for a minimum of 6 months with considerations for concomitant corticosteroids in the setting of perilesional edema, as well as surgical intervention. Emphasis should be placed on providing well-documented treatment details in future case reports and series to allow for the development of more concise evidence-based recommendations.

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Intracranial Cryptococcoma—Clinicopathologic Correlation and Surgical Outcome: A Single-Institution Experience

Cited by 9 publications

References 37 publications

Intracranial fungal granuloma: a single-institute study of 90 cases over 18 years

Intracranial fungal granuloma: a single-institute study of 90 cases over 18 years

Central nervous system Cryptococcoma mimicking demyelinating disease: a case report

Cerebral Cryptococcomas: A Systematic Scoping Review of Available Evidence to Facilitate Diagnosis and Treatment

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