Craniocerebral vegetal foreign body granuloma: a case report and review of literature

Abstract

Objective Craniocerebral vegetal foreign body granuloma is rare lesion which is very difficult to diagnose clinically, and is easy to be misdiagnosed. This article aims to reveal the clinical manifestations and histopathological features of it. Methods A case of cerebral vegetal foreign body granuloma was reported focusing on the following aspects: clinical manifestations, histopathological features and immunophenotype and the relevant literature was reviewed. Results A 23-year-old male patient presented with paroxysmal stiffness accompanied by convulsion of extremities and no response for calling for 7 years. Cranial MRI scan demonstrated a small nodular mixed signal shadow about 1.60 cm in length located in the frontal cortex under the anterior horn of the left compartment with gliosis near frontal lobe. A resection was performed, and a lesion (about 3 cm × 2 cm) was found in the bottom of the left frontal lobe. The lesion was greyish brown, tenacious, irregular bordered, partly calcified and with rich blood supply. There was no tumor or parasite but proliferation of fibrous tissue, hyaline degeneration, calcification, infiltration of lymphocytes and plasma cells in the granuloma lesion under microscope. The immunohistochemical staining showed the lesion was positive for vimentin (Vim) and CD68, while negative for glial fibrillary acidic protein (GFAP), S⁃100 protein (S-100) and epithelial membrane antigen (EMA). Conclusion Clinical manifestations of craniocerebral vegetal foreign body granuloma are various according to the occurrence in different parts. Besides, its imaging features are various depending on the kind of foreign body and the persistent duration. However, histopathological observation and immunohistochemical staining facilitate its diagnosis and identification from tumor and parasitic disease. Furthermore, the type of plant can also be distinguished roughly.

Keywords

• Granuloma, foreign-body
• Plants
• Brain injuries
• Immunohistochemistry
• Pathology