OBJECTIVE: Spinal intramedullary tuberculoma (SIMT) is rare, accounting for 2/100,000 cases of tuberculosis and only 0.2% of all cases of central nervous system(CNS) tuberculosis. We share our experiences of 11 cases of this entity for improving diagnosis and conceptualize the management of this rare disease. METHODS: The clinical profile, radiological data and management of 11 cases of SIMT which were managed either conservatively or by surgical intervention during last 27 years (1987-2014) were analysed. RESULTS: Male:female ratio was 1.75:1. Five cases had associated pulmonary Koch's. Most common site was thoracic cord. Two cases had concurrent multiple intracranial tuberculoma. Most common presentation was paraparesis. X-ray myelography was performed in two patients in the initial period of study suggesting intramedullary pathology. In the subsequent nine cases who had magnetic resonance imaging (MRI), seven showed typical "target sign" and conglomerate ring lesion. Out of 8 surgically managed patients, 6 cases improved rapidly and in 2 patients gradual improvement was seen in follow-up. Most common indication of surgical excision was rapid neurological deterioration followed by diagnosis in doubt. Histopathology confirmed tuberculous etiology of the intramedullary lesion in all. Clinical and radiological improvement was seen in all 3 conservatively managed patients in follow-up. CONCLUSION: MRI findings of SIMT were specific and proven histologically correct. Surgical intervention may be indicated if there is no response to chemotherapy, the diagnosis is in doubt, or there is a rapid deterioration in neurological function because surgical outcome is good in these circumstances.
Diagnosis ; Drug Therapy ; Follow-Up Studies ; Humans ; Magnetic Resonance Imaging ; Myelography ; Paraparesis ; Pathology ; Rare Diseases ; Tuberculoma* ; Tuberculoma, Intracranial ; Tuberculosis

Adult ; Choroid ; pathology ; Humans ; Immunocompetence ; Male ; Tuberculoma ; diagnosis ; immunology ; Young Adult

Plant root hairs are commonly found artifacts in parasitology specimens and may be confused with helminthes by an untrained eye. We report a case of brain tuberculoma where the tissue sample was contaminated with root hair derived from tap water; the presence of this root hair, which mimicked a larva, led to diagnostic confusion. Therefore, tap water should be considered a source of root hair and vegetable matter.
Animals ; Brain Diseases/*diagnosis/pathology ; *Diagnostic Errors ; Helminthiasis/diagnosis ; Helminths/growth & development ; Humans ; Larva/anatomy & histology ; Male ; Middle Aged ; Plant Roots/*anatomy & histology ; Tomography, X-Ray Computed ; Tuberculoma/*diagnosis/pathology ; Water

We report a 63-years-old woman who developed a nodular lesion in right upper lobe (RUL) of lung after achieving a partial response with salvage chemotherapy for relapsed non-Hodgkin's lymphoma (NHL). Previously, she had been diagnosed as NHL and tuberculous lymphadenitis resulting a complete response with 8 cycles of CHOP regimen and anti-tuberculosis medication for 1 year. CT scan of the chest showed an irregular marginated soft tissue density in RUL with internal punctate calcifications and this lesion was difficult to discriminate between pulmonary tuberculosis and parenchymal involvement of NHL. Because the pulmonary infiltrations progressed despite empirical anti-tuberculosis medication, we performed bronchoscopic biopsy, showing diffuse large B-cell lymphoma. Thereafter, the pulmonary infiltrations were markedly improved with salvage chemotherapy. However, she died of refractory NHL despite high-dose chemotherapy with autologous peripheral blood stem cell transplantation.
Biopsy ; Diagnosis ; Drug Therapy ; Female ; Humans ; Lung ; Lymphoma ; Lymphoma, B-Cell ; Lymphoma, Non-Hodgkin* ; Pathology ; Peripheral Blood Stem Cell Transplantation ; Thorax ; Tomography, X-Ray Computed ; Tuberculoma* ; Tuberculosis ; Tuberculosis, Lymph Node ; Tuberculosis, Pulmonary

It should be stressed that intracranial tumors in childhood are common. If the leukemia are excluded, intracranial neoplasms are the relatively common type of neoplasms seen in childhood. There are many different kinds of tumor which occur within the cranial cavity. These different tumors grow at different rates of speed and the diversity of location is sufficient so that there is a broad spectrum of different clinical syndromes. However, it is important to recognize the earliest symptoms because of the possibility of operable management and high cure rate on some cases. The author analyzed 58 cases of intracranial neoplasm which were histologically confirmed after operation and autopsy, seen at the Department of Neurosurgery, Jung-Ang University, Sung-Sim Hospital and National Medical Center over the recent several years. These tumors were explored surgically and the diagnosis was made through histological examination. The cases were reviewed as to history, development and progression of the neurological features, laboratory findings, neuroradiological findings, operative methods and pathology. The author emphasized some interesting points and the following were presented here-in as the results. 1) Among 58 cases of intracranial neoplasms in Korean children below 15 years old, the most common tumor was astrocytoma(36%), and the next common tumors were craniopharyngioma(15.5%), ependymoma(12%), and medulloblastoma(10.3%) in that orders. It was interesting that 3 cases of tuberculomas were found in recent three years(1975-1977) and all were located in the cerebellum. A 5 years old boy who was operated for 4 th. Ventricle medulloblastoma confirmed by clinicopathological finding, had another tumor, craniopharyngioma which was found at the postmortem examination. 2) The tumors were occupied on the infratentorial region in 30(5.7%) cases and supratentorial region in 28(48.3%) cases. The most frequent tumor in supratentorial region was craniopharyngioma and in infratentorial region was cerebellar astrocytoma. And the glioma and medulloblatoma were common in turn. 3) Fifty eight cases comprised 36 males and 22 females with a ratio of 1.5 to 1. The age ranged from 5 months old to 15 years old with the peak in the incidence between 5-11 years of age. 4) The main clinical symptoms and signs were headache(84.5%), vomiting(77.6%), papilledema(67.2%), and cranial nerve dysfunction(62%). It was interesting points that neck stiffness(27.6%) and abdominal pain(15.5%) were frequent complaints which should not overlook for the symptoms of simple gastritis or tuberculous meningitis. 5) The results of operative management obtained as follows with excellent in 4, good in 8, fair in 13, and poor in 9 cases. The overall mortality rare was 41% and recurrence rate was 14% during 5 years follow up.
Adolescent ; Astrocytoma ; Autopsy ; Brain Neoplasms ; Cerebellum ; Child* ; Child, Preschool ; Cranial Nerves ; Craniopharyngioma ; Diagnosis ; Female ; Follow-Up Studies ; Gastritis ; Glioma ; Humans ; Incidence ; Infant ; Leukemia ; Male ; Medulloblastoma ; Mortality ; Neck ; Neurosurgery ; Pathology ; Recurrence ; Tuberculoma ; Tuberculosis, Meningeal

OBJECTIVETo evaluate the value of dynamic enhanced-CT in differential diagnosis of solitary pulmonary nodules.

METHODSSixty-three solitary pulmonary nodules were evaluated by dynamic enhanced multi-slice CT. Images were obtained before and at 20 s, 30 s, 45 s, 60 s, 75 s, 90 s, 120 s, 180 s, 300 s, 540 s, 720 s, 900 s and 1200 s after the injection of contrast media. All lesion enhanced parameters and morphological features were recorded. The differences between benign and malignant nodules were analyzed. The diagnostic sensitivity and specificity of solitary pulmonary nodules were evaluated by receiver operator characteristic analysis.

RESULTSCT enhancement value at 120 s [(29.5 ± 30.2) HU vs. (32.5 ± 14.7) HU, P = 0.023], washout at 20 min [(36.5 ± 24.6) HU vs. (15.6 ± 16.6) HU, P = 0.044], washout ratio at 20 min [(36.5 ± 24.6)% vs. (17.8 ± 14.5)%, P = 0.006], slope of washout at 20 min [(0.006 ± 0.005)%/s vs. (0.002 ± 0.0016)%/s, P = 0.001], type II (24/42 vs. 4/21, P = 0.004) and III (5/42 vs. 9/21, P = 0.005) curves were significantly different between benign and malignant nodules. Using the above mentioned parameters, the results of receiver operator characteristic analysis had a sensitivity of 64.3% and specificity of 84.2% for identification of malignant tumors. The morphological features including round-like, triangle-like, multi-angle, spiculation, light lobulation, the degree of edge (sharp, clear, blur), vessel convergence sign, vacuole sign, airing of bronchi, cut-off of the bronchi and depression of pleura were significantly different between benign and malignant nodules. The results of ROC analysis showed that the above mentioned morphological features had a sensitivity of 92.9% and specificity of 100% for differentiating malignant tumors from benign nodules. The results of ROC analysis showed that combination of morphological features and dynamic enhancement parameters had a sensitivity of 95.2% and specificity of 100% for identification of malignant tumors.

CONCLUSIONSDynamic enhanced CT images can evaluate morphological and enhancement features of solitary pulmonary nodules. Combination of morphological features and enhancement characteristics can improve the accuracy of diagnosis.

Adenocarcinoma ; diagnostic imaging ; Adult ; Aged ; Carcinoma, Squamous Cell ; diagnostic imaging ; Colonic Neoplasms ; pathology ; Contrast Media ; Diagnosis, Differential ; Female ; Hamartoma ; diagnostic imaging ; Humans ; Lung Diseases ; diagnostic imaging ; Lung Neoplasms ; diagnostic imaging ; secondary ; Male ; Middle Aged ; ROC Curve ; Radiographic Image Enhancement ; Sensitivity and Specificity ; Solitary Pulmonary Nodule ; diagnostic imaging ; Tomography, Spiral Computed ; methods ; Tuberculoma ; diagnostic imaging ; Tuberculosis, Pulmonary ; diagnostic imaging