Atormac
brintellex
Neurology India
menu-bar5 Open access journal indexed with Index Medicus
  Users online: 1274  
 Home | Login 
About Editorial board Articlesmenu-bullet NSI Publicationsmenu-bullet Search Instructions Online Submission Subscribe Videos Etcetera Contact
  Navigate Here 
 Search
 
  » Next article
  » Previous article 
  » Table of Contents
  
 Resource Links
  »  Similar in PUBMED
 »  Search Pubmed for
 »  Search in Google Scholar for
  »  Article in PDF (124 KB)
  »  Citation Manager
  »  Access Statistics
  »  Reader Comments
  »  Email Alert *
  »  Add to My List *
* Registration required (free)  

 
  In this Article
   Discussion
   References
   Article Figures

 Article Access Statistics
    Viewed4473    
    Printed104    
    Emailed2    
    PDF Downloaded135    
    Comments [Add]    
    Cited by others 6    

Recommend this journal

 


 
NEUROPATHOLOGICAL DISCUSSION
Year : 2006  |  Volume : 54  |  Issue : 1  |  Page : 100-101

13-year-old boy with cerebellar cystic mass


1 Departments of Neuropathology, NIMHANS, Bangalore, India
2 Departments of Neurosurgery, NIMHANS, Bangalore, India
3 Departments of NeuroImaging and Interventional Radiology, NIMHANS, Bangalore, India

Correspondence Address:
T C Yasha
Department of Neuropathology, National Institute of Mental Health and Neurosciences, Bangalore - 560 029
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0028-3886.25138

Rights and Permissions



How to cite this article:
Yasha T C, Shibu P, Srikanth S G, Shankar S K. 13-year-old boy with cerebellar cystic mass. Neurol India 2006;54:100-1

How to cite this URL:
Yasha T C, Shibu P, Srikanth S G, Shankar S K. 13-year-old boy with cerebellar cystic mass. Neurol India [serial online] 2006 [cited 2020 Sep 29];54:100-1. Available from: http://www.neurologyindia.com/text.asp?2006/54/1/100/25138


A 13-year-old boy presented to the neurosurgical services with complaints of bifrontal headache for 1 year and progressive deterioration of vision in both eyes. The headache had worsened for the past 1 month, associated with vomiting at the height of headache. Fifteen days prior to admission to the hospital his visual acuity worsened to an extent just to perceive light. General systemic examination was normal. The neurological evaluation revealed visual acuity of only perception of light, bilateral secondary optic atrophy, right sixth cranial nerve paresis, and left cerebellar signs. On cranial CT scanning an oval, hypodense [Figure - 1]A left cerebellar cystic mass was noted, nonenhancing with contrast [Figure - 1]B. Fourth ventricle was compressed with resultant hydrocephalus. With a clinical diagnosis of cystic cerebellar tumor, the cyst was excised by suboccipital craniectomy. The cyst ruptured during the surgery and was found to be lined by thin white membrane and filled with xanthochromic fluid.

Pathological examination

The resected material had a cystic zone with cerebellar folia adherent to it on the external surface. Microscopic examination of the cystic lesion revealed compressed cerebellar white matter lined by foamy histiocytes and reactive astrocytosis [Figure - 2]. The cerebellar folia had features of longstanding compression and the overlying meninges were markedly thickened. There was no mural nodule or a glioma. Internal to the histiocytic layer a thick multilamellar eosinophilic, chitinous wall and a syncitial germinal layer was present. The lumen had proteinaceous granular material admixed with erythrocytes and numerous brood capsules of Echinococcus granulosus in varying stages of evolution [Figure - 3]. Many oval to round calcific concretions were seen probably representing the degenerated parasitic ova.

Diagnosis: Hydatid cyst in cerebellum


  Discussion Top


E. granulosus (Hydatidosis) infestation is a zoonotic disease, humans getting infected accidentally as intermediate hosts. The disease is transmitted usually by food-borne contamination by eggs passed in faeces of definitive host, mainly dogs. E. granulosus infestation results in liver cysts in nearly half the cases and brain involvement is less than 5%. The symptomatology, depends crucially on the location of the cyst in the brain.[1] The infestation may be primary often presenting as solitary parenchymal cyst. Secondary involvement is due to cyst rupture or hydatid fluid dissemination from a distant organ, by haematogenous route. CNS echinococcosis is rare in infants and more common in children up to 15 year of age than in adults. The signs and symptoms include raised intracranial pressure, headache, vomiting, papilloedema, hemiparesis and occasionally seizures.[1] The cyst lodges frequently in the cerebral hemisphere, attaining a large size. Involvement of the cerebellar hemispere and presenting radiologically as a cystic mass, is usually mistaken for cerebellar astrocytoma as in the present case. Slight or lack of ring enhancement or marginal edema on MRI should arouse suspicion of hydatidosis, especially in paediatric age patients from the tropics.[2] Recently in vivo proton magnetic resonance spectroscopy has been able to identify intracranial hydatid and other parasitic cysts from other cystic lesions.[3],[4] Rupture of the cyst during surgery may trigger anaphylaxis followed by disseminated infection.[5] At our center, a female child was operated on thrice to resect the cysts and each time a new crop appeared again. Laboratory diagnosis by ELISA, immunoblot and indirect immunofluorescence to detect the antigen and immune complexes assist in diagnosis. Negative serological tests do not rule out the disease. Live cyst elicits negligible host reaction and surgical specimens rarely include brain tissue. The cyst undergoing degeneration, elicits epitheloid and giant cell reaction, finally leaving behind amorphous necrotic debris surrounded by dense gliosis. Following infestation by E. parasite , the host develops an immunological response protective against reinfection, but not effective against the lodged parasite. Evasion of the host immune attack against the parasite is mediated by the suppression of T-lymphocyte function and inhibiting macrophage-lymphocyte interaction.[6] Persistent production of 1L-4 as a result of chronic infection could lead to enhanced production of IgG4 antibodies, which probably act as blocking antibodies, binding with lipoprotein antigen B in hydatid cyst, thus down regulating the host response and protecting against anaphylaxixs.[7]

 
  References Top

1.Kammerer WS. Echinococcosis affecting the central nervous system. Sem. Neurol. 1993; 13: 144-147.  Back to cited text no. 1  [PUBMED]  
2.Nurchi G, Floris F, Montaldo C, Mastio F, Peitz T, Coraddu M. Multiple cerebral hydatid disease: Case report with magnetic resonance imaging study. Neurosurgery. 1992; 30: 436-438.  Back to cited text no. 2    
3.Konli A, Gupta RK, Poptani H, Roy R. In vivo proton magnetic resonance spectroscopy in a case of intracranial hydatid cyst. Neurology. 1995; 45: 562-564.  Back to cited text no. 3    
4.Jayakumar PN, Srikanth SG, Chandrashekar HS, Kovoor JM, Shankar SK, Anandh B. Pyruvate: an in vivo marker of cestodal infestation of the human brain on proton MR spectroscopy. J Magn Reson Imaging. 2003 Dec; 18(6):675-80.   Back to cited text no. 4    
5.Ozek MM. Complications of central nervous system hydatid disease. Paediatric Neurosurgery. 1994; 20: 84-91.  Back to cited text no. 5  [PUBMED]  
6.Riley EM, Dixon JB, Kelly DF, Cox DA. The immune response to Echinococcus granulosus: sequential histological observations of lymphoreticular and connective tissues during early murine infection. J. Comp. Pathology 1985; 95: 93-104.  Back to cited text no. 6  [PUBMED]  [FULLTEXT]
7.Craig PS, Current Research in Echinococcosis. Parasitology Today. 1994; 10: 209-211.  Back to cited text no. 7    


    Figures

[Figure - 1], [Figure - 2], [Figure - 3]

This article has been cited by
1 8-year old patient with giant hydatid cyst consulted with chest wall asymmetry
Saime Sündüs Uygun,Olgun Kadir Aribas,Sevgi Pekcan
Pediatrics International. 2015; 57(6): 1164
[Pubmed] | [DOI]
2 Surgical management of brainstem hydatid cyst—an unusual site
Vikram Muthusubramanian,Anil Pande,Madhabushi Chakravarthy Vasudevan,Ramamurthi Ravi
Surgical Neurology. 2009; 71(1): 103
[Pubmed] | [DOI]
3 Surgical management of brainstem hydatid cyst-an unusual site
Muthusubramanian, V., Pande, A., Vasudevan, M.C., Ravi, R.
Surgical Neurology. 2009; 71(1): 103-106
[Pubmed]
4 Unilobar multiple cerebral hydatid cyst: A rare disease
Joshi, M., Potode, R., Bhole, A., Joharapurkar, S.
Neurology India. 2008; 56(4): 483-484
[Pubmed]
5 Giant hydatid cyst in the posterior fossa of a child: A case report
Kayaoglu, C.R.
Journal of International Medical Research. 2008; 36(1): 198-202
[Pubmed]
6 Giant Hydatid Cyst in the Posterior Fossa of a Child: A Case Report
CR Kayaoglu
Journal of International Medical Research. 2008; 36(1): 198
[Pubmed] | [DOI]



 

Top
Print this article  Email this article
Previous article Next article
Online since 20th March '04
Published by Wolters Kluwer - Medknow