Cerebellum, Tuberculoma

Tuberculosis can affect the CNS in a diffuse (meningitis) or localized (tuberculoma) manner, most commonly in immunocompromised patients or those from endemic countries. Tuberculomas present as a mass that may reach several centimeters in size. Grossly, it has a cheese-like, “caseous” appearance. Microscopically, the centre of the tuberculoma consists of necrosis, whereby dead cells appear as amorphous, eosinophilic, granular material. There is a surrounding rim of epithelioid histiocytes, lymphocytes, plasma cells, and multinucleated giant cells (usually Langhans type). Acid fast bacilli may or may not be demonstrable by Ziehl-Neelsen stain. Prognosis is variable and depends on the promptness of treatment.