Pseudocystic form of neurocryptococcosis in pregnancy. Case report.

We report a case of neurocryptococcosis which is unique in the literature because the patient had a pseudocystic form of the disease during pregnancy and without any evidence of AIDS. The clinical picture was that of intracranial hypertension and the epidemiological background was highly suggestive of cysticercosis. CT showed multiple round hypodense lesions in the basal ganglia and cerebellum, without contrast enhancement. Since a scolex was not visible, the diagnosis of neurocysticercosis was considered probable. CSF examination was not performed in view of its high risk. The patient had progressive downhill course. Autopsy disclosed multiple gelatinous pseudocysts in the cerebral and cerebellar gray matter, containing abundant Cryptococcus neoformans. Meningeal involvement was minimal. The child was delivered by caesarean section and was free of infection, but died later of hyaline membrane disease. The neuroimaging appearances of this rare instance of the pseudocystic form of neurocryptococcosis mimicked closely neurocysticercosis and only postmortem examination allowed correct diagnosis. The pseudocystic form has so far only been reported in AIDS.

Pituitary carcinoma with liver metastases and Cushing syndrome. Report of a case.

A 38-year-old woman complained of headache, visual impairment, and diabetes insipidus for 18 months prior to rapid onset of Cushing syndrome and amenorrhea. An autopsy disclosed a pituitary carchinoma invading the right cavernous sinus and two liver metastases. The tumor cells were chromophobic and agranular, with scarce polymorphism and rare mitoses. A review of the literature showed that the association of Cushing syndrome to pituitary carcinomas increases in direct proportion to the occurence of metastases. Such association was noted in almost half of the reported cases of pituitary carcinomas with extracranial dissemination.