Atormac
Neurology India
menu-bar5 Open access journal indexed with Index Medicus
  Users online: 4745  
 Home | Login 
About Editorial board Articlesmenu-bullet NSI Publicationsmenu-bullet Search Instructions Online Submission Subscribe Videos Etcetera Contact
  Navigate Here 
 Search
 
  
 Resource Links
    Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
    Article in PDF (1,204 KB)
    Citation Manager
    Access Statistics
    Reader Comments
    Email Alert *
    Add to My List *
* Registration required (free)  

 
  In this Article
   References
   Article Figures

 Article Access Statistics
    Viewed2938    
    Printed98    
    Emailed4    
    PDF Downloaded38    
    Comments [Add]    

Recommend this journal

 


 
Table of Contents    
LETTER TO EDITOR
Year : 2013  |  Volume : 61  |  Issue : 2  |  Page : 178-179

Cerebral syphilitic gumma misdiagnosed as glioma: A case report and literature review


Department of Neurosurgery, The Affiliated Hospital of Luzhou Medical College, Luzhou, China

Date of Submission18-Feb-2013
Date of Decision19-Feb-2013
Date of Acceptance08-Mar-2013
Date of Web Publication29-Apr-2013

Correspondence Address:
Kun-liang Huo
Department of Neurosurgery, The Affiliated Hospital of Luzhou Medical College, Luzhou
China
Login to access the Email id

Source of Support: None, Conflict of Interest: None


PMID: 23644324

Rights and PermissionsRights and Permissions



How to cite this article:
Huo Kl, Liu Lt, Ming Y, Jing Hs, Chen Lg. Cerebral syphilitic gumma misdiagnosed as glioma: A case report and literature review. Neurol India 2013;61:178-9

How to cite this URL:
Huo Kl, Liu Lt, Ming Y, Jing Hs, Chen Lg. Cerebral syphilitic gumma misdiagnosed as glioma: A case report and literature review. Neurol India [serial online] 2013 [cited 2019 Dec 12];61:178-9. Available from: http://www.neurologyindia.com/text.asp?2013/61/2/178/111137


Sir,

A 38-year-old male presented with vertex bursting headache associated with projectile vomiting of 15 days duration. Neurological examination was normal. Patient had syphilitic infection for which he was treated. Brain magnetic resonance imaging (MRI) demonstrated an irregular nodule lesion in the right high parietal areas, hypointense on T1-weighted images and hyperintense on T2-weighted images with meningeal thickening and finger-like perilesional edema. Contrast study showed an intensely enhancing ring lesion considerable circular change in the lesion [Figure 1]a-c. A serum rapid plasma regain (RPR) titer was 1:8, Treponema pallidum hemagglutination assay (TPHA) titer was 1:640 and serology was negative human immunodeficiency virus (HIV). With a possible diagnosis of glioma, he underwent craniectomy and excision of the lesion. Pathological examination of the tissue demonstrated a vascular intimal hyperplasia and large quantities of inflammatory cell infiltration [Figure 2]a and b and a further Warthin-Starry stain found T. pallidum in the lesion. The pathologic diagnosis was cerebral syphilitic gumma. Postoperative cerebrospinal fluid (CSF) analysis revealed protein level of 0.468 g/L, chloride of 133.2 mmol/L, normal glucose and lactate values, and no demonstrable T. pallidum. After treatment, his symptoms are improving gradually and he has been having follow-up care.
Figure 1: (a - c) The brain magnetic resonance imaging demonstrated an irregular nodule closely associated with adjacent meninx was hypointense on T1WI and hyperintense on T2WI at the right vertex, with the meningeal thickening, extensive finger - like edematous zone around the lesion. Enhancement scan showed a considerable circular change in the lesion

Click here to view
Figure 2: (a - b) Pathological examination for pathological tissues demonstrated a vascular intimal hyperplasia and large quantities of inflammatory cell infiltration

Click here to view


Diagnosis of cerebral syphilitic gumma is mainly based on CSF findings and pathological examinations. [1],[2] We could not do preoperative CSF examination in this patient as we felt that he has features of raised intracranial pressure. Postoperative CSF analysis was normal and negative for T. pallidum. The diagnostic possibility of cerebral syphilitic gumma should have been considered in this patient in view of the history of exposure to syphilis and positive serology. However, cerebral syphilitic gumma is such a rare lesion to consider in the differentials and that made us to think of possible glioma in this patient. Newer imaging modalities such as diffusion tensor imaging (DTI) and nuclear magnetic resonance spectroscopy (NMRS) have been shown to be useful in characterizing different types of tumors. [3],[4] However, there are no studies showing the diagnostic utility of these imaging modalities in cerebral syphilitic gumma. Our patient demonstrates the need to keep cerebral syphilitic gumma in the differential diagnosis intracranial mass lesions, more so when there is history of exposure to syphilis.

 
  References Top

1.Darwish BS, Fowler A, Ong M, Swaminothan A, Abraszko R. Intracranial syphilitic gumma resembling malignant brain tumour. J Clin Neurosci 2008;15:308-10.  Back to cited text no. 1
    
2.Li JC, Mahta A, Kim RY, Saria M, Kesari S. Cerebral syphilitic gumma: A case report and review of the literature. Neurol Sci 2012;33:1179-81.  Back to cited text no. 2
    
3.Kinoshita M, Hashimoto N, Goto T, Kagawa N, Kishima H, Izumoto S, et al. Fractional anisotropy and tumor cell density of the tumor core show positive correlation in diffusion tensor magnetic resonance imaging of malignant brain tumors. Neuroimage 2008;43:29-35.  Back to cited text no. 3
    
4.Likavcanova K, Dobrota D, Liptaj T, Prónayová N, Mlynárik V, Belan V, et al. In vitro study of astrocytic tumour metabolism by proton magnetic resonance spectroscopy. Gen Physiol Biophys 2005;24:327-35.  Back to cited text no. 4
    


    Figures

  [Figure 1], [Figure 2]



 

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