Contributed by Maysa Al-Hussaini, MD1, Ghassan Al-Shbool, MD2, Mohammed Samaha, MD3
Departments of 1Pathology and 2Internal Medicine, King Hussein Cancer Center (KHCC), and 3Department of Neurosurgery, Ibn Alhaytham Hospital.
A 27 year old female patient, presented with left hemiparesis. Brain MRI showed multiple cystic ring-enhancing lesions involving the cerebrum and cerebellum (Figure-1A). She has received anti-tuberculous treatment for a recent diagnosis with pulmonary tuberculosis, however, the brain lesions showed with no response. Investigations revealed no other medical conditions. She underwent craniotomy and one of the lesions was excised from the left parietal lobe. It consisted of an oval white to gray soft tissue mass with solid white cut surface measuring 1.2x0.8x0.9cm (Figure-1B).
Microscopic examination revealed a well-defined lesion (Figure-1C H&E X4) that consisted of well-defined chronic granulomatous inflammation (Figures-1D and 1E H&E X10, X20) located at the periphery surrounding a large center of necrosis (Figure-1F, H&E X40). No evidence of parasitic microorganisms could be seen. Special stains including PAS (Figure-1G, X40) and Ziehl-Neelsen (Figure-1H, X100) were performed. What is your diagnosis?"