Subject(s)
Biopsy, Fine-Needle , Mesothelioma , Scrotum/pathology , Testicular Neoplasms , Aged, 80 and over , Diagnosis, Differential , Humans , Male , Mesothelioma/diagnosis , Mesothelioma/pathology , Testicular Hydrocele/diagnosis , Testicular Hydrocele/pathology , Testicular Neoplasms/diagnosis , Testicular Neoplasms/pathologyABSTRACT
BACKGROUND: Intracranial fungal granulomas are uncommon and their pathogenesis, clinical picture, and effectiveness of therapy remains unclear. METHODS: Thirty-two cases were studied retrospectively in two groups: (1) Rhinocerebral group (22 cases) had a chronic paranasal sinus (PNS) disease with secondary involvement of skull base, cranial nerves, and/or brain. The granulomas were adherent to dura, firm, avascular, and tough, requiring a knife to cut. (2) Primary intracranial group (10 cases) had no detectable PNS lesion at initial presentation. The granulomas were soft, suckable, and contained pus or necrotic material. RESULTS: Postoperative and overall mortality were 37.5% and 50%, respectively. Meningoencephalitis was the most common cause of death. Altered sensorium, pus in the granuloma, and/or severe brain edema were poor prognostic factors. All survivors except four have symptomatic residual or recurrent lesions. CONCLUSION: Early diagnosis with MRI or stereotactic biopsy, radical surgery, and high dose and chronic suppressive chemotherapy may improve overall results in these cases.
