PMC8492417_01
Preoperative radiological examinations Head CT Without Contrast (2013) revealed 4.4 x 5.9 x 5.6 cm cystic mass with calcified component in the suprasellar region extends superiorly and inferiorly suggesting cystic craniopharyngioma and non-communicating hydrocephalus
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F1
The patient had a history of surgical excision of craniopharyngioma [Figure 1] 8 years ago, and placement of VP shunt flat bottom type, medium pressure, on the right Kocher point due to postoperative hydrocephalus.
Preoperative radiological examination Brain MRI (2021) revealed 4 x 2.3 x 2.1 cm mass surrounding the ventricular drain which was attached in the anterior horn of the right lateral ventricle to the right frontal cortex. T1 (a) showed the mass was isointense, T2 (b) showed the mass was hypointense. After administration of gadolinium (c), the mass was highly heterogeneous contrast enhancement. There was perifocal edema around the tumor.
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F2
Brain magnetic resonance imaging (MRI) [Figure 2] revealed a 4 x 2.3 x 2.1 cm mass surrounding the ventricular drain which was attached in the anterior horn of the right lateral ventricle to the right frontal cortex.
Preoperative radiological examination MR Spectroscopy revealed elevation of Choline/Creatine and Choline/NAA ratio, suggesting a seeding metastatic process.
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F3
On MR Spectroscopy (MRS) [Figure 3], the Choline/Creatine and Choline/NAA ratio appeared to be elevated with Choline map also increased.
Histopathology examination revealed a large fibrotic area containing many granulomas (red arrow), consisting of epithelial cells surrounded by lymphocytes. Langhans giant cells (green arrow) were also seen at the periphery of the granuloma. There was no sign of malignancy. Histopathological findings were consistent with tuberculoma.
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F4
Histopathology examination [Figure 4] revealed a large fibrotic area containing many granulomas, consisting of epithelial cells surrounded by lymphocytes.