Multi-syphilitic gummas in pituitary and cerebellopontine angle in a patient.

PURPOSE: Multi-syphilitic gummas in pituitary and cerebellopontine angle (CPA) are extremely rare and easily misdiagnosed especially in patients with antibiotic abuse. We write this paper for clinicians to better understanding of cerebral gumma. METHODS: We report a patient with syphilitic gummas in pituitary and left CPA. The definite diagnosis is made by histopathology after surgery. RESULTS: A 49-years-old woman suffered from headaches with tinnitus and hypoacusis in left ear. She was diagnosed with syphilis but untreated. There were no chancre and rashes in the course of disease. Syphilis serological tests were positive. Brain MRI found two masses located in the left CPA and hypophysial fossa. The two masses were removed successively. We found a large number of Treponemapallidum in paraffin-embedded specimens by immunohistochemical staining. CONCLUSIONS: Syphilitic gummas in pituitary and CPA are similar to benign or malignant brain tumors, easily leading to misdiagnosis. Gumma should be considered in differential diagnosis when a patient has unexplained nervous system symptoms or signs and imaging findings suggest intracranial mass in syphilis seropositive patients.

Spinal Intramedullary Syphilitic Gumma: An Unusual Presentation of Neurosyphilis.

BACKGROUND: Spinal syphilitic gumma is an unusual presentation of neurosyphilis, with a limited number of cases reported in the literature. Owing to its extreme rarity, the diagnosis and treatment of spinal syphilitic gumma and the relevant prognosis have not been outlined. CASE DESCRIPTION: A 65-year-old woman with a history of neck, shoulder, and back pain presented with progressive sensorimotor disturbance of the extremities. Serologic tests revealed the presence of syphilis. Magnetic resonance imaging demonstrated an intramedullary nodule at the C5 level. A suspected diagnosis of spinal intramedullary tumor was made, and surgical resection of the nodule was performed. Histologic and immunohistochemical findings revealed a syphilitic gumma. We also conducted a comprehensive review of the published literature in all languages regarding spinal syphilitic gumma. The clinical and radiologic features, laboratory findings, therapeutic strategies, and follow-up data were analyzed. CONCLUSIONS: Spinal syphilitic gumma can occur in the intramedullary region, and clinicians should be aware of this extremely rare entity, as it can be easily mistaken for more common neoplasms occurring at this site. The magnetic resonance imaging appearance of this entity has some suggestive characteristics, and a confident diagnosis depends on the pathology. Surgical resection can help to relieve acute spinal cord compression, and systemic antibiotic treatment for syphilis should be emphasized for long-term control.

A Singular Case of Neurosyphilis Manifesting Through a Meningovascular Chronic Inflammatory Process in Association with the Occurrence of Two Aneurysms Involving the Distal A2 Segment of Both Anterior Cerebral Arteries: A Case Report and Review of the Literature.

BACKGROUND: Although syphilis has become a rare disease in the Western world since the Second World War, it is believed to have infected 12 million people in 1999, with greater than 90% of cases occurring in the developing world. Moreover, since the year 2000, the rates of syphilis have been increasing in the United States, the United Kingdom, Australia, and Europe. Because of the mimic nature of the disease and the overall low rate of occurrence of its manifestations in advanced stages, a proper diagnosis may prove difficult. CASE REPORT: We report the case of a 41-year-old African man affected by neurosyphilis that manifested itself through a meningovascular chronic inflammatory process, with the peculiar feature of a bilateral aneurysm of probable mycotic origin involving the distal tract of A2 segment of both anterior cerebral arteries. CONCLUSIONS: Because of the mostly nonspecific nature of clinical manifestations of syphilis (particularly advanced syphilis) and its consequent tendency to masquerade as many other diseases, even a skilled physician may find its diagnosis quite challenging; thus, thorough clinical and radiologic investigations should be supported by serologic testing for syphilis in all cases of cognitive impairment. Mycotic intracranial aneurysms in association with neurosyphilis rarely are reported; however, they require early diagnosis and meticulous, individualized treatment. Because syphilis appears to be on the raise, further studies on the topic are warranted.

Cerebral gumma mimicking glioblastoma multiforme.

This article reports an unusual case of a syphilitic gumma with a clinical and radiographical presentation initially suggestive of glioblastoma multiforme. Pathological evaluation was essential in establishing the diagnosis of neurosyphilis and in excluding neoplastic involvement. Cerebral gumma should be considered as part of the differential diagnosis of a midline intracranial lesion observed on magnetic resonance imaging.

[A case of cerebral syphilitic gumma].

A 38-year-old man experienced an intermittent low-grade fever with generalized eruption, followed by rapidly progressive right hemiplegia. Neuroimaging revealed a ring-like enhanced mass in the left premotor cortex surrounded by marked perifocal edema. The syphilitic titer was high both in the serum and in the cerebrospinal fluid. Open biopsy of the lesion revealed the tumor consisted of inflammatory cells associated with plasmacyte infiltration to the perivascular region as well as to the dura, which is consistent with the definition of syphilitic gumma. The abnormalities in neurology and in neuroimaging improved dramatically after antisyphilitic treatment. Difficulties in differentiating a cerebral gumma from other diseases are discussed.

Cerebral gumma mimicking glioblastoma on magnetic resonance images--case report.

A 39-year-old female presented with a syphilitic cerebral gumma mimicking small glioblastoma multiforme manifesting as visual impairment. Magnetic resonance imaging showed a low signal intensity area on T1-weighted images and marked small ring-like enhancement less than 1 cm in diameter following the administration of gadolinium. The symptoms and radiological abnormalities improved several weeks after penicillin therapy. The small ring-like enhancement was probably caused by inflammation associated with treponemal infection. A mass with a small ring-like enhancement less than 1 cm in diameter is a useful finding indicating an inflammatory lesion rather than a glial tumor.

[Surgically treated syphilitic gumma of the brain. Computerized tomography findings]. / Gomme syphilitique cérébrale opérée. Données du scanner X.

Syphilitic gumma is now exceptional. Symptomatology is non-specific and frequently, as in the case reported here, the onset is marked by a localized or generalized convulsion. A space-occupying lesion is recognized by angiography and CT. The precise diagnosis is suggested by evidence of arteritis or of a hypodense mass outlined by contrast or slight calcifications and confirmed by positive serology in a patient with a suspected cerebral tumor. In some cases a positive diagnosis can be made only by pathological examination after surgical ablation of the gumma. An area of central necrosis is surrounded by a granulomatous layer rich in plasmocytes (the polyclonal nature of the secretion is shown by immunocytochemistry) and a peripheral fibroblastic zone. The arteries are ensheathed by a dense inflammatory infiltrate constituted almost entirely by plasmocytes and their lumens are either stenosed or filled with endarteritic debris. Surgical treatment should be combined with penicillin administration. For a patient in good general condition with a suspected gumma, medical treatment can be given initially, with follow-up by CT, neurosurgery being indicated only in case of failure of medical therapy. The rarity of gummata in relation to other tertiary syphilitic lesions remains unexplained. The patient reported here had multiple infections including one due to cytomegalovirus after ablation of the gumma, highly suggesting an immunity disorder.

Cerebral gumma. Case report.

A case of focal cerebral syphilitic gumma of the right temporal lobe is reported. Angiography showed moderate focal hypervascularity with stretched vessels, and irregularity of the vessel walls. Plain computerized tomography revealed an area of low density that enhanced strongly after intravenous administration of contrast medium.

An actual rare brain granuloma: cerebral gumma.

A case of cerebral gumma is reported. The appearance of this kind of lesion is exceptional at the present time. Gummas are the expression of localized meningovascular forms of neurosyphilis and their clinical symptoms and signs are similar to those of any other space-occupying intracranial lesion. Computed tomography scan showed a ring-enhancing lesion with intense cerebral edema. A criticism of computed tomography features of the reported cases in the literature is carried out. Surgical excision, whenever possible, is the treatment of choice since it achieves the removal of the mass and its histologic verification.

[Intraspinal syphilitic gumma causing spinal cord compression. Report of a case]. / Goma sifilítica intra-raquídea causando compressão medular. Relato de um caso.

A case of an syphilitic intraspinal gumma is reported. A 48 years-old woman developed severe spastic crural paraparesis of two months duration, associated with sensory and sphincteric disturbances. Myelography revealed an intraspinal tumor at T3 level. Surgical exploration by dorsal laminectomy showed a syphilitic gumma attached to the spinal cord. Clinical observations and laboratory studies are discussed. Revision and comments on previous reports are presented.