PMC5838848_01
(a and b) Cranial CT scan with bony reconstruction showing diffuse hyperostosis of the temporal bone, zygomatic bone with condylar involvement. (c and d) MRI T1 weighted images with gadolinium contrast enhancement axial and coronal sections showing diffuse enhancement in the temporal and infratemporal region. (e) Intraoperative resected specimen of the inner surface temporal bone showing hyperostosis and irregular surface, (f) Intraoperative image showing intradural granulomatous lesion as marked by the arrow
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F1
She underwent a computed tomography (CT) scan, which showed diffuse hyperostosis of the right frontal, squamous temporal, sphenoid and zygomatic bones, and an en-plaque ground glass lesion, involving the basitemporal bone [Figure 1a and b]. On magnetic resonance imaging (MRI), lesion showed a T1 hypointense and T2 hyperintense contrast-enhancing extra-axial lesion located in the right frontotemporal bone with dural thickening and possible brain parenchymal involvement [Figure 1c and d]. Diagnosis of an en-plaque meningioma was suspected and she underwent a right frontotemporal craniotomy and complete excision of the intracranial lesion and partial decompression of involved areas of bone [Figure 1e], with areas of dural involvement [Figure 1f] being reconstructed with a Fascia lata graft taken from the right thigh.
Shows a large well-formed granuloma within the brain parenchyma walled off by dense lymphomononuclear cells (a), and presence of neutrophilic abscesses surrounding an actinomycotic colony (b). These colonies are highlighted on Gram's (c and d), GMS (Gomori Methenamine-Silver) (e) and PAS (Periodic acid-Schiff) (f) stains
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F2
These findings on histopathological examination resulted in the final diagnosis of a chronic necrotizing granulomatous inflammation with Actinomyces-like organisms [Figure 2].