A diagnostic riddle in an immunocompetent adult: Meningioma or intracranial fungal granuloma?

Diagnostic features of the present case a) Contrast enhanced computed tomography (CECT) showing a well defined enhancing basi-sphenoidal lesion (arrow) with adjoining parenchymal edema and hydrocephalus; b) Postcontrast MRI T1 weighted sequence (coronal view) showing an enhancing extra-axial dural based mass lesion (arrow); c) Immediate postoperative non contrast CT scan shows regression of the lesion and a small hyperdense focus corresponding to focal hemorrhage (arrow); d) Numerous histiocytic granulomas with lymphocytic cuffing, foreign body and langhans type giant cells. [Hematoxylin and Eosin, 20x]; e) Septate, acute angle branching fungal hyphae (arrow) within a giant cell highlighted by Periodic acid Schiff (PAS) stain. [Periodic acid Schiff, 40x]; f) Post contrast CT images taken after one year of follow up show complete resolution of the lesion and regression of surgery associated changes