A Rare Case of COVID-19-Associated Solitary Aspergillus Brain Abscess.

Surgically operated case of solitary Aspergillus brain abscess caused by Aspergillus fumigatus in coronavirus disease 2019 (COVID-19) patient is not reported. The authors report a case of 33-year-old diabetic female patient presented with generalized seizure followed by left hemiparesis. Patient was treated with steroids for COVID-19 pneumonia. Initial imaging revealed a right frontal lobe infarct that later confirmed as a case of frontal lobe abscess. Patient underwent craniotomy and thick yellow pus was drained. Abscess wall was excised. Postoperatively patient improved with Glasgow coma scale 15/15 and Medical Research Committee grade 5 power of all limbs. Microbiological examination of pus was done. The gram stain showed numerous pus cells with acute angle branching hyphae. Gomori methenamine silver (GMS) preparation showed filamentous black colored hyphae. Mycelial colonies appeared on chocolate agar after 48 hours of incubation. Cellophane tape mount from the plate showed conical shaped vesicle with conidia arising from the upper third of vesicle. Light green velvety colonies appeared on Sabouraud Dextrose Agar that later turned into smoky green. The isolate was identified as Aspergillus fumigatus . The hematoxylin and eosin stain of abscess wall section showed extensive areas of necrosis with few fungal hyphae. GMS stain of abscess wall showed fungal hyphae that are septate and showing acute angled branching which are consistent with Aspergillus species. Patient was treated with voriconazole. Imaging done after 8 months of surgery revealed no residue. Surgical excision of life-threatening solitary Aspergillus brain abscess along with antifungal medication voriconazole carries good result. The authors believe that decreased immunity in patient has contributed to the development of this rare disease. This is a rarest case of surgically operated solitary brain abscess caused by Aspergillus fumigatus in COVID-19 patient.

A Rare Case of Giant Intradiploeic Epidermal Cyst of the Frontal Bone with Intracranial Extension.

Calvarial intradiploeic epidermal cyst are very rare neoplasms which can have intracranial extension. These cysts can attain a large size and can cause lytic destruction of the calvarium resembling malignancy. Since these lesions are benign complete excision is curative. We report the case of a 77-year-old male patient who presented with a large swelling on the forehead. Computed tomography and magnetic resonance imaging showed an expansile lytic lesion with intracranial extension. Complete excision of the lesion with cranioplasty was done. Histopathology was consistent with the epidermal cyst. These cysts attaining gigantic proportions are very few in literature.

Rare neurohypophyseal tumor presenting as giant pituitary macroadenoma with cavernous sinus invasion - A case report and review of literature.

BACKGROUND: Granular cell tumors (GCTs) of the pituitary are rare tumors of posterior pituitary that can present as giant pituitary macroadenoma due to the slow indolent growth of the tumor. We are reporting this case due to the rarity of GCT and usually these tumors are confined to the suprasellar region since they are arising from the pituitary stalk. GCTs that attain such giant size with cavernous sinus invasion are still rarer. CASE DESCRIPTION: A 38-year-old female who presented with progressive deterioration of vision and on evaluation by magnetic resonance imaging showed a giant pituitary macroadenoma with bilateral cavernous sinus invasion. The patient underwent pterional craniotomy and near-total excision of the lesion was done due to high vascularity and firmness of the tumor. Histopathology examination of the lesion showed spindle to globular cells with granular cytoplasm and was reported as GCT of the pituitary. CONCLUSION: GCTs are WHO grade1 non-neuroendocrine tumors arising from neurohypophysis and infundibulum. Complete excision is usually difficult due to the high vascularity, firm consistency, and local invasion of the tumor to the cavernous sinus and optic apparatus.

Pediatric Intracranial Tumors over a 5-Year Period in a Tertiary Care Center of North Kerala, India: A Retrospective Analysis.

BACKGROUND: Pediatric brain tumors are unique in terms of distribution, clinical presentation, pathologic types, management, and prognosis. There are not many studies from India which have looked into the epidemiology of pediatric brain tumors. AIMS: This study aimed to analyze the epidemiology of pediatric brain tumors in North Kerala and compare it with data from the rest of India and other countries. MATERIALS AND METHODS: This is a retrospective study of 5-year data of pediatric brain tumors which were operated in a tertiary referral center in North Kerala, India, from 2009 to 2013. The data were procured from the departments of neurosurgery and pathology of the institution. The data were tabulated and analyzed using SPSS software. RESULTS: A total of 71 children had histologically proven brain tumors during the 5-year period. There were 34 boys and 37 girls. Distribution in different age groups was as follows: infancy -5 (7%), 1-5 years -22 (31%), 6-10 years - 21 (29.6%), and 11-18 years - 23 (32.4%). The most common tumors were primitive neuroectodermal tumors (PNETs). In infancy, the number of high-grade tumors was more, whereas in the 11-18 years' age group, there were a significantly higher number of low-grade tumors (P = 0.04). DISCUSSION: Pediatric brain tumors were distributed almost equally in both sexes. PNET was the most common. We could not get statistical significance in many of our values due to small sample size. CONCLUSION: This study highlights the need for diligent collection of data and maintenance of a registry for brain tumors to study the disease in the Indian population.