Recent compliant of headache and radiology findings are suggestive of Frontal space occupying lesion, favoring Meningioma.
Cerebral aspergillosis (mimicking meningioma)
Gross Findings:
An approximately 4x4x3 cm size greyish-brown mass was received.
Histopathology:
Dense fibrous mass with many foci of chronic inflammatory cells, along with few granulomas and giant cells. Granular/caseous necrosis is not seen. Acid fast bacilli are not seen on ZN stain. PAS stain highlights the occasional fungal elements in giant cells and granulomas.
Points of Pathoclinics:
- Here the clinical history of long standing steroid is important to raise the possibility of fungal infection. Neuroimaging findings are not looks specific for fungal fibrous mass. Pathological confirmation is the key in the management as this patient require aggressive antifungal treatment.
- ZN Stain and PAS stain are necessary in any granulomatous inflammatory lesion.
- Altered/difficult morphology of fungi may require a fungal culture.