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LETTER TO EDITOR
Year : 2014  |  Volume : 62  |  Issue : 2  |  Page : 196-198

Abscess within a meningioma: Pathogenesis and rare case report


1 Department of Neurosurgery, Krishna Institute of Medical Sciences, Secunderabad, Andhra Pradesh; Department of Neurosurgery, Voluntary Health Services, Taramani, Chennai, Tamil Nadu, India
2 Department of Neurosurgery, Krishna Institute of Medical Sciences, Secunderabad, Andhra Pradesh, India
3 Department of Neuroradiology, Krishna Institute of Medical Sciences, Secunderabad, Andhra Pradesh, India

Date of Submission23-Jan-2014
Date of Decision24-Jan-2014
Date of Acceptance06-Apr-2014
Date of Web Publication14-May-2014

Correspondence Address:
Manas Panigrahi
Department of Neurosurgery, Krishna Institute of Medical Sciences, Secunderabad, Andhra Pradesh
India
Shyam Sundar Krishnan
Department of Neurosurgery, Krishna Institute of Medical Sciences, Secunderabad, Andhra Pradesh; Department of Neurosurgery, Voluntary Health Services, Taramani, Chennai, Tamil Nadu
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0028-3886.132398

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How to cite this article:
Krishnan SS, Panigrahi M, Pattanagare SG, Varma RD, Rao SI. Abscess within a meningioma: Pathogenesis and rare case report. Neurol India 2014;62:196-8

How to cite this URL:
Krishnan SS, Panigrahi M, Pattanagare SG, Varma RD, Rao SI. Abscess within a meningioma: Pathogenesis and rare case report. Neurol India [serial online] 2014 [cited 2021 Jun 15];62:196-8. Available from: https://www.neurologyindia.com/text.asp?2014/62/2/196/132398


Sir,

A 55-year-old lady presented with status epilepticus and features of raised intracranial pressure. She had a distinct history of urosepsis following a double-J (DJ) stent for auretric calculi just 2 weeks prior to the presentation. She was duly investigated and magnetic resonance imaging brain showed a contrast-enhancing extra-axial lesion with mass effect near the motor cortex and severe edema [Figure 1]. Preoperative diagnosis was dural based lesion probable metastasis. She underwent a standard frontoparietal craniotomy and excision of the lesion. The lesion was of dural origin with intratumoral abscess. The Gram stain revealed Gram-negative rods, which on culture proved to be Escheresia coli. [Figure 2]. The lesion itself was a psamomatous meningioma with no atypia. Patient was duly treated with appropriate antibiotic as per sensitivity and was discharged.
Figure 1: Magnetic resonance imaging showing left posterior frontal lesion which on T1-weighted images show a dural based isointense lesion (a), T2-weighted images shows a mixed intensity predominantly hyperintense (b) and on T1 contrast shows irregular peripheral contrast enhancement (c)

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Figure 2: Histopathology showing typical meningioma with inflammatory cell layer around the necrotic center (empty portion) (a), and under magnification (b). Gram stain of abscess within lesion shows Gram-negative bacilli (c)

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About 25 cases have been reported of tumor with abscess so far and only six have been reported with meningiomas [Table 1]. [1],[2],[3],[4],[5],[6] Intratumoral abscess in brain tumors is rare. Perisellar tumors like pituitary and craniopharyngiomas are the most common sites due to proximity to the paranasal sinuses. [7] Reasons that make intracranial tumors susceptible to abscesses cannot be extrapolated to meningiomas as well. Meningiomas are the most common site of intratumoral metastasis. [8],[9] We postulate that these very reasons and others make them susceptible to abscess formation: (1) Meningioma vascularity: (a) Predominant meningeal blood supply and being outside the blood brain barrier, (b) increased vasculature, making them act as sieves filtering out the pathogens in bacteremia, (c) the flow pattern: Main supplying artery entering the meningioma does not branch until it reaches the center where it bifurcates into arterioles and capillaries; hence, the entire branching to the periphery originates at the center giving adequate time for the pathogen to lodge and get entrapped, and (d) in case of parasagittal and falcine locations mainly due to the compression/occlusion of the draining veins hence stagnates the blood in the meningioma giving further chance for harboring the pathogen; (2) absence of the blood brain barrier; (3) absence of immune response; (4) rich nutritive environment, rich in lipids and glycogen with its indolent growth rate.

The source of infection varies, the most common causes being genitourinary, dental, respiratory infections and contiguous spread. Our patient had a definite genitourinary intervention following DJ stent placement. The following bacteremia might have induced an indolent meningioma to become a nidus for an abscess formation and the organism was also E. coli which is commonly found to infect ureteric stents. [10],[11] Abscess within the meningioma can result the asymptomatic incidental meningioma to become symptomatic. Meningiomas with abscess should be the differential diagnosis in extra-axial dural based lesions with cerebral edema in the presence of a source of infection. Patients with incidental asymptomatic meningiomas presenting with infection anywhere in the body should be treated aggressively with antibiotics to prevent abscess formation within the tumor.
Table 1: List of meningioma with abscess till date[1-6]

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 » References Top

1.Shimomura T, Hori S, Kasai N, Tsuruta K, Okada H. Meningioma associated with intratumoral abscess formation: Case report. Neurol Med Chir (Tokyo) 1994;34:440-3.  Back to cited text no. 1
    
2.Nassar SI, Haddad FS, Hanbali FS, Kanaan NV. Abscess superimposed on brain tumor: Two case reports and review of the literature. Surg Neurol 1997;47:484-8.  Back to cited text no. 2
    
3.Eisenberg MB, Lopez R, Stanek AE. Abscess formation within a parasagittal meningioma. Case report. J Neurosurg 1998;88:895-7.  Back to cited text no. 3
    
4.Yeates KE, Halliday W, Miyasaki J, Vellend H, Straus S. A case of ′circling seizures′ and an intratumoral abscess. Clin Neurol Neurosurg 2003;105:128-31.  Back to cited text no. 4
    
5.Young JP, Young PH. Meningioma associated with abscess formation: A case report. Surg Neurol 2005;63:584-5.  Back to cited text no. 5
    
6.Lind CR, Muthiah K, Bok AP. Peritumoral Citrobacter koseri abscess associated with parasagittal meningioma. Neurosurgery 2005;57:E814.  Back to cited text no. 6
    
7.Mohindra S, Gupta R, Mohindra S, Gupta SK, Radotra BD. Posterior-fossa intra-tumoural abscess: A report of three patients and literature review. Br J Neurosurg 2004;18:556-60.  Back to cited text no. 7
[PUBMED]    
8.Han HS, Kim EY, Han JY, Kim YB, Hwang TS, Chu YC. Metastatic renal cell carcinoma in a meningioma: A case report. J Korean Med Sci 2000;15:593-7.  Back to cited text no. 8
    
9.Smith TW, Wang SY, Schoene WC. Malignant carcinoid tumor metastatic to a meningioma. Cancer 1981;47:1872-7.  Back to cited text no. 9
[PUBMED]    
10.Yeniyol CO, Tuna A, Yener H, Zeyrek N, Tilki A, Coskuner A. Bacterial colonization of double J stents and bacteriuria frequency. Int Urol Nephrol 2002;34:199-202.  Back to cited text no. 10
    
11.el-Faqih SR, Shamsuddin AB, Chakrabarti A, Atassi R, Kardar AH, Osman MK, et al. Polyurethane internal ureteral stents in treatment of stone patients: Morbidity related to indwelling times. J Urol 1991;146:1487-91.  Back to cited text no. 11
    


    Figures

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This article has been cited by
1 When meningioma becomes an emergency: Nocardial brain abscesses superimposed on meningioma
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[Pubmed] | [DOI]



 

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