ArticleLiterature Review

Abscess superimposed on brain tumor: Two case reports and review of the literature

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Abstract

An abscess involving an already present brain tumor is a rare occurrence. Two cases of an abscess superimposed on a brain tumor are presented and discussed. The medical literature is reviewed, and all reported cases are compared to our own. Only 15 cases of an abscess associated with a brain tumor were found in the literature, to which we add 2 of our own. About 60% were intrasellar or parasellar tumors. The origin of such an abscess at this location is by direct extension of the germs from a contiguous infected sinus. Our 2 additional cases were away from the sinuses. One is an ependymoma of the posterior fossa, and the other, a falcotentorial occipital meningioma, each with a superimposed abscess. We propose an alternate route for the formation of an abscess in conjunction with a brain tumor.

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... Few cases of abscess within a craniopharyngioma have been reported [9,11,12]. There are few reported cases of abscess within an intra-axial tumor such as glioblastoma multiforme [9], astrocytoma [6,13], ependymoma [6,14], and medulloblastoma [6]. Mohindra and Gupta reviewed two cases of glioblastoma with abscess [6]. ...
... At present, our case is the third case of low-grade astrocytoma with abscess. There are few reported cases of abscess within an extra-axial tumor, most within meningioma [14][15][16][17][18][19][20]. Shimomura et al were the first to report a case of meningioma with abscess formation [15]. ...
... Shimomura et al were the first to report a case of meningioma with abscess formation [15]. Five cases of meningioma with abscess have been reported to date [14][15][16][17][18][19][20]. A few cases of abscess with brain metastasis have been reported [13,21,22]. ...
Article
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A rare case of low-grade astrocytoma associated with abscess formation occurred in a 52-year-old man presenting with Broca's aphasia. He underwent craniotomy and tumor removal under the impression of brain tumor with necrotic cystic change. Abscess accumulation within the intra-axial tumor was found intraoperatively. Literature related to brain abscess with brain tumor is reviewed, with an emphasis on abscesses with astrocytoma. We discuss the common brain tumors that are associated with abscess, pathogens that coexist with brain tumor, and the pathogeneses of coexisting brain abscess and tumor. It is very important to know how to differentiate between and diagnose a brain abscess and tumor, or brain abscess with tumor, preoperatively from clinical presentation and through the use of computed tomography, conventional magnetic resonance imaging, diffusion-weighted imaging or magnetic resonance spectroscopy.
... The central nervous system's purulent infections regularly appear in situations where there is no other associated intracranial pathology, likely most of the tumor lesions appeared without concomitant pathology; thus, the association of these entities is infrequent. The majority of secondarily infected neoplastic processes appear in the sellar or parasellar region secondary to direct infection spread of the paranasal cavity [1]. However, some diseases are seen as risk factors for acquiring tumoral infectious like urinary tract infection, bacteremia, meningitis, urologic sepsis, dental work procedures, and the chronic use of steroids [1,2,3,4,5]. ...
... The majority of secondarily infected neoplastic processes appear in the sellar or parasellar region secondary to direct infection spread of the paranasal cavity [1]. However, some diseases are seen as risk factors for acquiring tumoral infectious like urinary tract infection, bacteremia, meningitis, urologic sepsis, dental work procedures, and the chronic use of steroids [1,2,3,4,5]. ...
... Referring to meningiomas, we could mention that some specific factors like venous congestion, full blood supply, destruction of the brain-blood barrier, open gaps between capillaries and endothelial cells contribute to set up an unfavorable environment [1,2,3,6]. ...
Article
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Background Tumor infections are uncommon, and often misdiagnosed entity, with no pathognomonic signs or characteristic clinical presentation. A useful tool for its diagnostic approach is the magnetic resonance image. Treatment should include tumor removal plus infection management. Case description We present a patient who arrives at the emergency department with rapid neurological deterioration with no specific signs and symptoms, radiological behaved as multiple brain abscess associated with subdural hematoma. In the operating room, we diagnosed a tumor with an associated abscess. Conclusions It should be useful to consider in some scenarios, multiple alternative diagnoses when the clinical picture does not match with the classical presentation and exhaust the radiological armamentarium before planning a surgery when feasible. Also, we present the first case of an abscessed anaplastic (malignant) meningioma.
... The most common presenting symptom seen was headache, which was present in six cases including our own [8,[11][12][13][14]. Hemiparesis and seizures were also common and seen in four patients [3,4,6,9,14,16,18]. An infective source was identified in a total of ten cases. ...
... Six patients had operative interventions, either gynaecological, urological or dental, in the recent period prior to presentation and cultured corresponding organisms [2,5,6,[8][9][10]. The remaining four cases had associated urinary tract infections identified through urine cultures [3,4,12,18]. Despite investigation, eight remaining cases including our own had no clear infective source. ...
... The organisms cultured were also consistent with a majority abdominopelvic origin. Of the fifteen cases with a confirmed organism, ten were consistent with abdominopelvic microbiota with E. coli being the most common organism seen in five cases [3,9,13,18]. The clinical/biochemical inflammatory response seen to infection demonstrated a variable level of severity, from asymptomatic to occult sepsis and also a varied temporal relationship between infection and tumour identification. ...
Article
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Central nervous system (CNS) infection and neoplasm occur most often independently. Their concomitant presentation has been noted across different CNS tumours but is considered a rare entity. The phenomenon is mostly seen in relation to direct seeding of infection via frontal air sinuses. Here, we present an unusual case of an occipital meningioma associated with intraparenchymal paratumoural abscess formation. It is also the second documented to culture methicillin-susceptible Staphylococcus aureus. We then review and surmise the relevant literature of meningioma-associated abscess. We discuss the clinical presentations, aetiology, suspected pathogenesis, management and outcomes reported.
... About 60% were intra-sellar or parasellar tumors. [8] In our case, the location was at parietal lobe. ...
... [10] The pathogenesis of glioma associated with abscess formation is thought to be related to multiple factors, such as destruction of the blood-brain barrier (BBB), intra-tumoral necrosis, and tumor bleeding with hematoma. [8,11] Disruption of the BBB due to direct tumor invasion aids the invasion of microbes. Intra-tumoral necrosis and hematoma acting as a culture medium are also important in the development of abscess. ...
... There have been 27 cases of intracranial inflammation affecting primary intracranial tumors in the Englishlanguage literature since 1950 to present time, including our patient.Table 1 presents a list of authors, tumors, pathological agents, and the suspected mechanism of infection spread. The most frequent findings (14 cases) were abscesses of sellar and parasellar tumors (pituitary adenomas, craniopharyngiomas) [3, 5–7, 10, 12, 14, 17, 18, 21, 22], followed by primary brain tumors (9 cases) [1, 2, 4, 9, 11, 13, 15, 19] and meningiomas (4 cases) [8, 9, 16, 20]. The most commonly found microbial agent was S. aureus [4, 10, 17]. ...
... There have been 27 cases of intracranial inflammation affecting primary intracranial tumors in the Englishlanguage literature since 1950 to present time, including our patient.Table 1 presents a list of authors, tumors, pathological agents, and the suspected mechanism of infection spread. The most frequent findings (14 cases) were abscesses of sellar and parasellar tumors (pituitary adenomas, craniopharyngiomas) [3, 5–7, 10, 12, 14, 17, 18, 21, 22], followed by primary brain tumors (9 cases) [1, 2, 4, 9, 11, 13, 15, 19] and meningiomas (4 cases) [8, 9, 16, 20]. The most commonly found microbial agent was S. aureus [4, 10, 17]. ...
Article
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An intratumoral or peritumoral microbial intracranial abscess is an infrequent diagnosis. The development of this complication may not be preceded by apparent local or general infection in all cases. To identify this diagnosis by radiological (MRI) or laboratory investigations is very intricate. Nevertheless, the recommended life-saving strategy is early surgery with resolution of both the tumor and infection. If subsequent oncological treatment is required, it has to be adjusted for prevention of re-inflammation. The described patient suffered from an intracranial abscess superimposed on a Glioblastoma Multiforme. The confirmed etiological agent was Staphylococcus aureus. The suspected route of microbial migration and colonization in this tumor was bacteremia via agents from thrombophlebitis. The patient is in a good condition following surgery, antimicrobial treatment, and radiotherapy.
... There are scattered case reports, however, of abscess associated with both intrinsic and extra-axial tumors. The majority of these abscesses are associated with tumors in proximity to the skull base, and some even have documented erosion, particularly in the sellar region (14,18). In these situations, compromise of the protective coverings of the brain is implicated. ...
... In these situations, compromise of the protective coverings of the brain is implicated. There have been three reported cases of abscess associated with meningiomas: a left frontotemporal convexity with Staphylococcus aureus (19), a left frontal parasagittal abscess with Bacteroides oralis (24), and a right parietal parasagittal abscess with Escherichia coli (14). None of these tumors were adjacent to the skull base, and all were thought to have arisen by hematogenous spread from an abdominopelvic sepsis. ...
Article
This is the second report of a Citrobacter-associated brain abscess in an adult and the first report of its association with an intradural tumor. Excluding those associated with trauma, neurosurgical procedures, and proximity to the skull base, only seven other cases of abscesses associated with intracranial tumors have been published. Five of seven tumor-associated abscesses with a microbiological diagnosis involved gram-negative bacteria, a finding that may indicate a predilection of these microorganisms for intracranial tumors. A 78-year-old female patient presented with a 6-month history of confusion and personality changes. Her medical history included paroxysmal atrial fibrillation and a 10-day course of high-dose dexamethasone but no other predisposing conditions for sepsis. She was afebrile, had no focal neurological deficits, and had no systemic abnormalities on examination. Computed tomographic imaging revealed a noncalcified, homogeneously enhancing, 3-cm-diameter, extra-axial tumor associated with the right anterior falx cerebri. The tumor did not extend to the skull base. At craniotomy, 10 to 20 ml of thick pus was found around the posteroinferior surface of the tumor. On extended culture, this material demonstrated Citrobacter koseri growth, which was effectively treated with ceftriaxone followed by meropenem and one repeated abscess aspiration. No systemic source of the infection was found. The characteristic endothelial invasiveness of Citrobacter and related gram-negative bacteria may predispose to the formation of abscesses in association with intracranial tumors.
... [3][4][5] Furthermore, we must keep in mind the rare clinical condition of abscess formation within a tumor. [6][7][8][9][10][11] Even using advanced magnetic resonance (MR) imaging techniques including DWI, precise preoperative diagnosis of co-existing abscess and brain tumor seems difficult. ...
... Tumor bleeding or central necrosis would act as a culture medium for bacteria. [6][7][8][9][10][11] Those authors seem to be considering the mechanism of abscess formation as involving a metastatic brain tumor arising earlier and infection occurring there. In our case, we also thought that the initial lesion was a metastasis. ...
Article
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We present the case of a 68-year-old man with brain metastasis from lung cancer and a history of immune checkpoint inhibitor administration, with overlapping abscess within the metastatic lesion. He initially received antibiotic treatment under a diagnosis of brain abscess because of a hyper-intense area on diffusion-weighted imaging inside the gadolinium-enhanced wall. The size of the enhanced lesion did not change much, but the extent of perifocal edema decreased after antibiotic treatment. After 2–4 months, the lesion gradually enlarged, and imaging characteristics changed from single cyst to multiple cysts. Surgical resection was performed and pathological examination revealed the lesion as metastasis from the lung tumor. Smear preparation of the tumor contents detected Gram-positive bacilli, confirming the dual pathology of metastasis and brain abscess. Discussing the pathogenesis, we speculated that therapy with durvalumab (MEDI4736), an anti-PD-L1 antibody, induced immune status modification including immunosuppressive regulation, which might have promoted abscess formation.
... About 20 patients of intracranial tumours with adjoining abscesses have been reported, of which only one was located in the posterior fossa. 3 Three cases of the posterior fossa tumours containing abscesses have been described and the postulated pathophysiology is discussed. ...
... Peri-tumoural cysts are common in me-ningiomas, which probably get infected, causing peri-tumoural abscesses. 3 Intratumoural abscesses in meningiomas, 14,18 are unlikely owing to the firm, tough nature of tumour and high vascularity. ...
Article
Intraparenchymal posterior fossa neoplasms containing intratumoural abscesses are rare. Intrasellar or parasellar tumours are among the common neoplasms developing such a complication, as the result of direct extension of the microbial flora from the contiguous infected sinuses. All meningiomas reported with such a complication have been located parasagittally. A short series of three posterior fossa tumours, containing intra-tumoural abscesses, are described, of which only one was diagnosed pre-operatively. A haematogenous pathway was considered as the mode of spread in all three patients. Magnetic resonance imaging was performed in all patients and the features are discussed.
... A brain abscess within a brain neoplasm is a small entity. There are only about 20 cases of abscesses associated with intracranial tumors in the literature [6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24]. However, this combination is generally fatal. ...
... The coexistence of a brain abscess and a brain tumor is rare except for intrasellar lesions where direct extension of microbial flora from the sinuses occasionally results in this complication. We reviewed the global medical literature related to brain tumors in association with abscesses using MEDLINE and found 20 reports in English, excluding those associated with trauma and neurosurgical procedures [6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24]. The clinical characteristics of these cases and our case are outlined in Table 1. ...
Article
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The managements of brain abscesses and brain tumors including brain metastases differ greatly, especially in terms of surgical procedures. Therefore, differentiating between the two is essential for assuring optimal treatment. However, on rare occasion, these two lesions coexist. Only five cases with both a brain tumor and an abscess have thus, far been reported. We experienced a patient with a brain abscess within a cerebellar metastasis. A middle-aged man receiving treatment for bile duct cancer presented with headache and nausea. Computed tomography (CT) and magnetic resonance (MR) imaging revealed two lesions, one in each cerebellar hemisphere. Although these lesions appeared to be brain metastases, the right lesion showed high intensity on diffusion-weighted images (DWI), and magnetic resonance spectroscopy (MRS) findings suggested an abscess. Surgical puncture of the lesion identified it as a brain abscess histologically, and we thus, administered antibiotics. However, since the lesion grew, we performed a second surgery for removal, which histopathologically the lesion to be a well-differentiated adenocarcinoma. The final diagnosis was an abscess within a cerebellar metastasis. Modern diagnostic tools such as DWI and MRS are reportedly reliable for differentiating brain tumors from brain abscesses, though they are not specific in cases with both lesions. The present case highlights the importance of considering coexisting diseases prior to surgery when we encounter a lesion which has the imaging characteristics of both a tumor and an abscess. The patient may have a better outcome if, preoperatively, surgeons take into consideration the possibility of the coexistence of a brain tumor and a brain abscess. Copyright © 2015 Z. Published by Elsevier Ltd.. All rights reserved.
... Intracranial intratumoral and peritumoral abscesses and infections are uncommon. Most lesions are associated with tumors located in close proximity to the skull base and sellar region (13)(14)(15)(16). In these cases, direct spread of infection is secondary to a pathologic, traumatic, or iatrogenic breach of the protective barriers, the bone and the dura mater. ...
... Para el diagnóstico, existen estudios radiológicos como la tomografía computarizada del cráneo, donde se observan imágenes hiperdensas con una amplia base de implantación dural, que condiciona en la mayoría de los casos una reacción perióstica. En la RMN se comportan iso o hipointensivo en T1 con respecto a la materia gris, con comportamiento variable en T2 pero sobre todo hiperintenso y con realce en la administración de medio de contraste [6][7][8][9][10][11][12] . ...
Article
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Los meningiomas son los tumores cerebrales no gliales primarios más comunes, con una tasa de incidencia del 13-19% en series grandes de tumores intracraneales primarios13 Los meningiomas se consideran benignos, bien circunscritos y de crecimiento lento4. Están clasificados en grado I, grado II y III por la Organización Mundial de la Salud (OMS) para los tumores del sistema nervioso central9. La tasa de recurrencia de meningiomas atípicos (grado II de la OMS) es del 30-40%13. Resección quirúrgica del tumor y el implante dural es el tratamiento de elección1. Descripción del caso. Mujer de 42 años con antecedentes de tumor frontoparietal derecho que requiere craneotomía parietal derecha, resección subtotal de la lesión y colocación del sistema Ommaya; presenta convulsiones clónicas simples de hemicuerpo izquierdo, cefalea holocraneal y hemiparesia izquierda. Tomografía y resonancia magnética (RM) del cráneo, que realza con la administración de contraste, con edema perilesional, hernia transcalvaria y porción proximal del catéter Ommaya. Conclusiones. El presente caso de absceso meningioma parasagital atípico recurrente, es un caso raro en la literatura. La colocación de cualquier tipo de drenaje adyacente al tumor funciona como un cuerpo extraño y aumenta el riesgo de infecciones y, por lo tanto, de abscesos intratumorales, lo que infiere un pronóstico peor.
... The vascularity of meningioma, location outside the blood-brain barrier, and the rich nutritive environment provided by tumor cells make meningiomas susceptible to abscess formation, especially in the presence of foci of infection elsewhere in the body. [5][6][7][8] The vascular pattern of the meningioma is such that the feeding artery supplies the core of the meningioma and the branches supply the periphery facilitating entrapment of pathogen in the center of the tumor. In the presence of additional venous compression by tumor, especially in the parasagittal location, the stagnation of blood and pathogen in the center of the tumor is facilitated. ...
Article
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The association of meningioma with intra- and peritumoral brain abscess is rare. All cases reported in literature had some focus of infection in the body. We report a 56-year-old man with well-controlled diabetes mellitus found to have a space-occupying lesion upon evaluation for headache, vomiting, and clumsiness of right upper limb. Perioperatively, pus was found intra- and perilesionally around a thick, capsulated, dural-based, vascular lesion. Histopathology was suggestive of meningioma, and Escherichia coli was isolated upon culture.
... Preoperative diagnosis was established in only a few cases ( Table 1). 2,3,[14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33] The reported cases in the literature are diverse in terms of the source of infection. However, a careful analysis of cases reported in the literature suggests increased propensity of infection by gram-negative bacteria and organisms capable of anaerobic respiration, either obligate or facultative. ...
Article
Background: Abscess co-existing within a brain tumor is a rare entity. Case reports in literature primarily consist of sellar pathology and parenchymal lesions including meningioma, glioma, and metastases. We report a case of glioblastoma with an intra-tumoral abscess in a middle-aged lady with no prior invasive procedure or systemic focus of infection. Case description: A 45-year old lady presented with new onset generalized seizures and rapidly progressive left hemiparesis. Imaging showed right frontal necrotic lesion with peripherally enhancing wall with solid component posteriorly. There was no diffusion restriction within the lesion. She was non-toxic and there was no systemic focus of infection. With the provisional diagnosis of malignant glioma, she underwent surgical resection of the lesion. A differential of abscess, however, was considered pre-operatively because of the rapid increase in the size of the lesion. At surgery, there was a pus-filled cavity with few areas of greyish, soft, flimsy wall and thrombosed veins. This raised a strong suspicion of a co-existing abscess within a malignant glioma and was confirmed by histopathological and microbiological examination. Conclusions: It is important for neurosurgeons to be aware of this rare entity. The treatment protocol remains controversial and is primarily guided by expert opinion. It is important to aggressively treat the patient with antibiotics followed by adjuvant therapy for malignancy. The timing and administration of adjuvant therapy are unclear. We suggest a delay of chemotherapy until at least 4 weeks of therapy with sensitive antibiotics.
Article
We describe a case of a 38-year-old woman who presented with 'circling' seizures and was found to have an intracranial mass with features consistent with a meningioma. Three weeks prior to her presentation she underwent an uncomplicated vaginal hysterectomy. However, after discharge to home she developed a 4-day history of fever, chills and night sweats that eventually resolved. She underwent surgical removal of her intracranial mass without difficulty but intra-operative pathology showed features of acute cerebritis at the margins of the tumor. Further sectioning of the mass revealed evidence of an intratumoral abscess. Culture of the meningioma revealed heavy growth of Bacteroides fragilis. The patient was treated with intravenous antibiotics, discharged home in excellent health and has had no recurrence of seizures. In our case report we will review the historical literature on the incidence and features of intratumoral abscess. Although it is considered a rare event, our case demonstrates both common and unique features about this occurrence and highlights an unusual chain of events in the natural history of the patient's meningioma and the way in which it became clinically apparent.
Article
Introduction: Abscesses associated with tumors are a rare entity. Imaging to differentiate abscess from other entities is often non-diagnostic, and often the source of infection is unknown. We present an unusual case of peritumoral abscess infected with both gram-negative and gram-positive bacteria. Methods: A 70-year-old, previously healthy male presented with a 1-day history of right-sided facial weakness sparing the forehead, as well as concomitant right upper and lower extremity numbness. A homogenously enhancing mass with adjacent rim-enhancing lesion with diffusion restricting cavity seen on magnetic resonance imaging (MRI) raised the possibility of abscess. Results: Separate biopsy specimens of both the tumor and adjacent fluid collection during drainage of the collection confirmed World Health Organization (WHO) grade I meningioma and bacterial abscess containing Streptococcus constellatus, Fusobacterium species, Prevotella dentalis, and Parvimonas micra. The histologic diagnosis therefore confirmed the preoperative radiologic findings of two different but associated lesions. Investigations to determine a definitive source of infection were inconclusive, including urinalysis, blood cultures, respiratory cultures, endoscopy, and an orthopantomogram. Conclusions: Gram-negative and gram-positive bacteria can both be culprits in the formation of peritumoral abscess. Although the source of infection is unconfirmed, the presence of oropharyngeal flora in the abscess suggests a subclinical odontogenic infection with hematogenous spread to the tumor and adjacent brain.
Article
A rare case of meningioma associated with both intratumoral and peritumoral abscess formation occurred in a 38-year-old man presenting with signs and symptoms of elevated intracranial pressure, intracranial infection, and right temporal pole mass lesion. The mass lesion was totally removed, revealing a meningioma. Group B streptococcus and peptostreptococcus were cultured from both the tumor and peritumoral white matter. Hematogenous spread of the organisms related to recent dental work was the likely mechanism.
Article
The occurrence of an abscess in conjunction with a tumor in the brain is very rare. Only presumptions exist about their origin and manner of dissemination. Preoperative discrimination between a brain tumor with cystic degeneration and a brain abscess within a tumor may be difficult or even impossible. The purpose of this report is to demonstrate the difficulty of such discrimination using conventional CT diagnostics alone. Two patients with abscess formation in association with metastatic carcinoma in the cerebellum are presented and compared with similar cases in the literature. The etiology and the route of dissemination are discussed. In our first patient with previously diagnosed lung carcinoma and a CT showing suspected cerebellar metastasis only, an abscess caused by Propionibacterium acnes was found in the cerebellum and treated surgically. No tumor was recognised during the operation. Post-mortem examination six weeks later revealed the coexistence of remnants of a chronic abscess as well as metastatic lung carcinoma at the operation site. The second patient presented with an enhanced, ring-like cystic cerebellar lesion. During surgery, a purulent exudate with a coagulase-negative type of Staphylococcus species was found within the metastatic carcinoma of unknown origin. Both were radically excised and the patient recovered well. Neither patient had a history of previous infection and the pathway for abscess formation in both patients remained unclear. About 30 cases of abscesses associated with intracranial neoplasms were found in the literature. Including our own report, only three cases of abscesses within metastatic carcinoma have been published. Modern diagnostic tools reported to differentiate more reliably between an abscess and a tumor are diffusion-weighted MR and proton MR spectroscopy techniques. Brain imaging using CT alone may not reliably demonstrate both coexisting lesions or differentiate between them. It is important to know that a metastatic brain lesion can occur in association with a brain abscess and that tissue sampling for pathological as well as microbiological testing is of crucial importance for optimal therapy for both lesions.
Article
Advances in radiological techniques over the last two decades have enabled establishing well-defined clinical and radiological signs for the diagnosis of cerebral abscess. Conversely, no consensus has been reached on the appropriate therapeutic management. To date, there has been no published randomized therapeutic trial dedicated to cerebral abscesses, probably because of low incidence. Progress in bacterial epidemiology, imaging techniques allowing early diagnosis, and antibiotic therapy have however generated a shift towards more frequent use of shorter, exclusively medical, treatment. Based on a review of the literature, we present and discuss the treatments usually applied in specialized departments for non-immunocompromised patients.
Article
To describe a unique case of hematogenous seeding of a cavernous angioma with the commensal organism Mycoplasma hominis. A 40-year-old female patient presented with a severe headache and acute left facial nerve palsy. Imaging studies revealed a right frontal mass lesion with characteristics of a cavernous angioma. The patient underwent a craniotomy for cavernous angioma resection. Purulent material was noted at the time of resection, and no hemorrhage was observed. Despite antibiotic therapy, the patient required repeat craniotomies for subsequent abscess treatment. M. hominis was identified as the pathogen. M. hominis is a rare cause of brain abscesses and can be difficult to eradicate. Cavernous angiomas can be seeded hematogenously.
Article
A child with a right parieto-occipital astrocytoma, caped by a large acute pyogenic abscess with flimsy capsule, detected at emergency craniotomy, is presented. Patient succumbed to the disease three hours following surgery.
Article
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Abscess formation within a brain tumor is uncommon. Intrasellar or parasellar tumors are the most common neoplasms that develop such complications. Cerebral gliomas with abscesses are extremely rare. In this paper three rare cases of glioma associated with abscess formation are described. The diagnosis of brain tumor associated with abscess is particularly difficult by conventional neuroradiological studies. (99m)Tc-labeled sulesomab can be useful in the diagnosis of brain tumors with intratumoral abscesses. There are no precise guidelines for the diagnosis and treatment of cerebral gliomas associated with abscesses formation for the low number of cases reported to date. Appropriate treatment, aimed at radical surgery, and a suitable antibiotic-protocol, deferring adjuvant postoperative therapy, is associated with a more favorable outcome. A review of the pertinent literature is also performed. Copyright © 2015. Published by Elsevier Taiwan.
Article
Between March and December of 1997, 3 cases of infantile cerebral aspergillosis appeared in our hospital. All patients presented some kind of immunosuppression associated with clinical findings of intracranial hypertension. After surgery, all cases were histopathologically confirmed and had positive cultures of Aspergillus. The first case was a patient with a history of subtotal resection of supratentorial ependymoma which presented a new enhancing mass on a control CT scan. Brain tumor recidiva was suspected, although, an Aspergillus granuloma was encountered on the tumor bed. Both other cases were found in patients who underwent transplantation: one presented multiple cerebral lesions after a renal transplant, and the other, after a bone marrow transplant, developed a rhinocerebral aspergillosis. The discussion was focused on the clinical findings, images and treatment of this cerebral infectious disease.
Article
The coexistence of a primary brain tumor such as high-grade glioma and superimposed abscess is a rare entity and can present a diagnostic and therapeutic challenge. The concomitant abscess may not be recognized until surgery, and the overall course of treatment may require adjustment in the presence of a coinciding infection. In the present report we evaluate the diagnosis and treatment of a glioblastoma multiforme with an intratumoral abscess. A patient was diagnosed with a glioblastoma multiforme with a concomitantly superimposed multimicrobial abscess containing coagulase-negative Staphylococcus, Acinetobacter iwofii, and Propionibacterium species. The suspected infectious source was a dental abscess with presumed secondary seeding. The patient underwent a left anterior temporal lobectomy with debulking of the lesion. Although the adjuvant therapy schedule was adjusted to accommodate the course of antibiotics, the existence of a concurrent abscess did not preclude adjuvant radiation and chemotherapy. The patient responded well to antibiotic treatment with no evidence of recurrent infection. He underwent a second operation for additional debulking of the lesion approximately half a year after his initial surgery. The patient died 2 years after the initial diagnosis. There are insufficient guidelines on the treatment of a primary brain tumor with intratumoral abscess. In this report we present our therapeutic decisions in this rare case.
Article
A 45-year-old man presented with a rare case of glioblastoma associated with intratumoral abscess formation manifesting as headache and vomiting after an appendectomy. Computed tomography and magnetic resonance imaging demonstrated a ring-enhanced lesion mimicking malignant glioma. Craniotomy and tumor removal were performed. Abscess formation within the intra-axial tumor was found intraoperatively. Histological examination revealed glioblastoma with abscess, and the etiological agent was anaerobic Gram-negative bacilli. The suspected route of microbial migration and colonization in this tumor was bacteremia from appendicitis.
Article
Between March and December of 1997, 3 cases of infantile cerebral aspergillosis appeared in our hospital. All patients presented some kind of immunosuppression associated with clinical findings of intracranial hypertension. After surgery, all cases were histopathologically confirmed and had positive cultures of Aspergillus. The first case was a patient with a history of subtotal resection of supratentorial ependymoma which presented a new enhancing mass on a control CT scan. Brain tumor recidiva was suspected, although, an Aspergillus granuloma was encountered on the tumor bed. Both other cases were found in patients who underwent transplantation: one presented multiple cerebral lesions after a renal transplant, and the other, after a bone marrow transplant, developed a rhinocerebral aspergillosis. The discussion was focused on the clinical findings, images and treatment of this cerebral infectious disease.
Article
Brain abscess continues to be a life-threatening disease. On rare occasions, this pathol-ogy can be concurrent with an intracranial neoplasia; to date, only 27 cases have been reported in literature. Intratumoral bleeding/necrosis or gaps in the blood brain barrier are supposed to facilitate a bacterial/fungal superimposition by haematogenous spread from a distant infective focus. In this report, we describe a patient with a subclinical meningioma who developed a brain abscess in a distant cerebral region. We discuss the influence of his multiple risk factors, and whether or not the neoplasia might be consid-ered co-responsible in the pathogenesis of the abscess.
Article
A case is presented and 10 cases are reviewed in which abscess formation developed in an intrasellar tumor. The diagnosis was made preoperatively or before autopsy in only 1 patient. The mortality rate was greater than 50%. The most common presentation was headache, fever, and visual disturbances with an abnormal sella and sterile cerebrospinal fluid (CSF). Nonconstant findings included meningeal signs and leukocytosis of the CSF. Trans-sphenoidal removal of the tumor and drainage of the abscess with appropriate antibiotic therapy is recommended. (Neurosurgery, 5: 718--722, 1979).
Article
A rare case of abscess within a glioblastoma with an unusual presentation occurred in a 46-year-old female who developed right hemiparesis and seizure. Computed tomography and magnetic resonance imaging demonstrated hemorrhage which mimicked hemorrhagic infarction. However, the lesions developed ring enhancement. Aspiration showed one to be an abscess, which collapsed by drainage but later re-expanded. The mass was removed, and histological examination revealed glioblastoma.
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Focal intracranial infections due to Salmonella species are rare. We report a case of brain abscess caused by Salmonella enteritidis within a glioblastoma multiforme.
Article
✓ Nineteen meningiomas and schwannomas have been studied by fluorescence microscopy and electron microscopy. Increased cerebrovascular permeability to protein was demonstrated in each tumor. The anatomical explanation for this increased permeability to protein was found in open endothelial cell junctions, gaps between endothelial cells, and fenestrations in capillary endothelial membranes.
Article
✓ A case is reported of a young man with hypopituitarism but no initial evidence of tumor who had several episodes of recurrent aseptic meningitis. At operation an abscess within a craniopharyngioma was drained and tumor tissue removed. After several postoperative episodes of meningitis the patient recovered. A review of four comparable reports is presented.
Article
Three consecutive cases where abscesses were found within pituitary tumors are presented. In all cases, the diagnosis was made preoperatively and the patients were begun on stress doses of hydrocortisone and antibiotics before surgical drainage of the abscess. All patients recovered with minimal neurological deficits. Review of the literature reveals that the diagnosis is seldom made preoperatively or before autopsy and is associated with high mortality and morbidity. Early suspicion of a pituitary abscess leading to early treatment with antibiotics and operative drainage seem to be important factors in decreasing this high mortality and morbidity.
Article
A rare case of meningioma associated with intratumoral abscess formation occurred in a 64-year-old female presenting with septic meningitis and a right frontal mass lesion after a gynecological operation under spinal anesthesia. The mass lesion was totally removed and revealed as an incidental meningioma with an intratumoral abscess. Hematogenous infection of Bacteroides oralis was thought to be the cause of the intratumoral abscess formation.
Article
A Salmonella typhi abscess within a craniopharyngioma in a 28-year-old woman is reported. CT and MRI demonstration of cerebral edema adjacent to the tumor suggested an atypical presentation of craniopharyngioma.
Article
A pituitary adenoma with abscess formation is an extremely rare finding, only two eases having been found reeorded in the literature. Whalleyfl in 1952, reported the ease of a patient who presented a picture of fulminating meningitis, and who died before a diagnosis could be made. At autopsy an abseess in a pituitary adenoma was found as the cause of the acute meningitis. Asenjo 1 deseribed a ease in which the presence of an hypophysial adenoma with typieal elinieal and radiologieal findings was detected after the patient had been treated for acute sinusitis, and complained of sudden visual disturbance. Operative treatment was sueeessful. In the ease reported here, as in Whalley's 2 case, the presenting symptoms were those of acute intracranial pathology. The pituitary adenoma which was present was diagnosed only during the course of investigations which were performed in order to aseertain the cause of his acute illness. CASE REPORT
Les abds de l'hypophyse. Rev Otoneuroophthal
  • Lazorthes G Anduzeacher
Riser M, Lazorthes G, AnduzeAcher H. Les abds de l'hypophyse. Rev Otoneuroophthal. 1956;28:494-6.
Consi-derations sur les abces de I'hypophyse
  • B Montrieul
  • P Janny
  • L Pignide
Montrieul B, Janny P, Pignide L, Chabannes J. Consi-derations sur les abces de I'hypophyse. Neurochiru-rgie 1965;11:366-71.
Abscess formation within pituitary tumors
  • Nelson
Considèrations sur les abcès de l'hypophyse
  • Montrieul
Les abcès de l'hypophyse
  • Riser