Giant Posterior Fossa Tuberculoma Mimicking Atypical Teratoid/Rhabdoid Tumor in a Child: Illustrative Case
4 affiliations
- 1Department of Neurosurgery Sher‐i‐Kashmir Institute of Medical Sciences Srinagar India
- 2Department of Pathology Sher‐i‐Kashmir Institute of Medical Sciences Srinagar India
- 3Department of Neurosurgery Ibrahim Cardiac Hospital & Research Institute Dhaka Bangladesh
- 4Department of Neurology, Neurosurgery & Neurogenetics, Department of Clinical and Translational Research ChromoMed Institute Santo Domingo Dominican Republic
Abstract
Intracranial tuberculomas are rare manifestations of extrapulmonary tuberculosis that can closely mimic malignant posterior fossa tumors in children, particularly in tuberculosis‐endemic regions. The radiological and clinical overlap with aggressive neoplasms such as atypical teratoid/rhabdoid tumor (AT/RT) poses a significant diagnostic challenge. A 5‐year‐old immunocompetent boy presented with progressive headache and irritability. Magnetic resonance imaging (MRI) of the brain revealed a large (45 × 38 mm) lesion in the cerebellar vermis and left hemisphere with mass effect on the fourth ventricle and brainstem, causing obstructive hydrocephalus. A ventriculoperitoneal (VPMP) shunt was placed for hydrocephalus management. Subsequently, left suboccipital craniectomy with tumor decompression was performed. Intraoperative crush biopsy was initially reported as atypical rhabdoid tumor. However, final histopathological examination revealed extensive granulomatous inflammation with epithelioid cell granuloma, Langhans‐type giant cells, and macrophages. Immunohistochemistry showed CD68 positivity (confirming macrophagic nature), EMA negativity (ruling out meningothelial tumor), and vimentin positivity in fibrotic tissue. Acid‐fast bacilli (AFB) staining was positive. The final impression was chronic granulomatous pathology consistent with tuberculosis. This case underscores the importance of maintaining a high index of suspicion for CNS tuberculoma in the differential diagnosis of posterior fossa space‐occupying lesions in children, particularly in endemic regions. Intraoperative crush biopsy may be misleading, and definitive histopathological examination with special stains is essential to avoid misdiagnosis and inappropriate treatment. Early confirmation of tuberculosis can dramatically alter management from aggressive oncological therapy to curative antitubercular treatment.
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BibTeX
@article{hela2026giant,
title = {{Giant Posterior Fossa Tuberculoma Mimicking Atypical Teratoid/Rhabdoid Tumor in a Child: Illustrative Case}},
author = {Aamir Hussain Hela and Romana Makhdoomi and Nayil Khursheed and Nazmin Ahmed and Shazieya Akhter and Syed Sabina and Vishal Chavda and Mohsin Fayaz},
journal = {Clinical Case Reports},
year = {2026},
month = oct,
doi = {10.1002/ccr3.73631},
url = {https://doi.org/10.1002/ccr3.73631},
note = {CC BY},
}
RIS
TY - JOUR
TI - Giant Posterior Fossa Tuberculoma Mimicking Atypical Teratoid/Rhabdoid Tumor in a Child: Illustrative Case
AU - Aamir Hussain Hela
AU - Romana Makhdoomi
AU - Nayil Khursheed
AU - Nazmin Ahmed
AU - Shazieya Akhter
AU - Syed Sabina
AU - Vishal Chavda
AU - Mohsin Fayaz
PY - 2026
DA - 2026/10/23
JO - Clinical Case Reports
DO - 10.1002/ccr3.73631
UR - https://doi.org/10.1002/ccr3.73631
AB - Intracranial tuberculomas are rare manifestations of extrapulmonary tuberculosis that can closely mimic malignant posterior fossa tumors in children, particularly in tuberculosis‐endemic regions. The radiological and clinical overlap with aggressive neoplasms such as atypical teratoid/rhabdoid tumor (AT/RT) poses a significant diagnostic challenge. A 5‐year‐old immunocompetent boy presented with progressive headache and irritability. Magnetic resonance imaging (MRI) of the brain revealed a large (45 × 38 mm) lesion in the cerebellar vermis and left hemisphere with mass effect on the fourth ventricle and brainstem, causing obstructive hydrocephalus. A ventriculoperitoneal (VPMP) shunt was placed for hydrocephalus management. Subsequently, left suboccipital craniectomy with tumor decompression was performed. Intraoperative crush biopsy was initially reported as atypical rhabdoid tumor. However, final histopathological examination revealed extensive granulomatous inflammation with epithelioid cell granuloma, Langhans‐type giant cells, and macrophages. Immunohistochemistry showed CD68 positivity (confirming macrophagic nature), EMA negativity (ruling out meningothelial tumor), and vimentin positivity in fibrotic tissue. Acid‐fast bacilli (AFB) staining was positive. The final impression was chronic granulomatous pathology consistent with tuberculosis. This case underscores the importance of maintaining a high index of suspicion for CNS tuberculoma in the differential diagnosis of posterior fossa space‐occupying lesions in children, particularly in endemic regions. Intraoperative crush biopsy may be misleading, and definitive histopathological examination with special stains is essential to avoid misdiagnosis and inappropriate treatment. Early confirmation of tuberculosis can dramatically alter management from aggressive oncological therapy to curative antitubercular treatment.
SN - 2050-0904
ER -