An unusual pediatric case of an intradiploic epidermoid cyst with cranial bone invasion

A Hole in the Head: An Intradiploic Epidermoid Cyst With A Calvarial Defect

“…Concerning features include congenital defects, midline or cranial suture line locations, lesions that feel tethered to the skull, palpable bony “step-offs,” the presence of clear fluid that may represent cerebrospinal fluid, or a history of head trauma in that location. 3,4 The original examination findings for this patient are unknown because his cyst had been surgically manipulated preceding our first assessment. At the time of presentation to the authors’ clinic, no prominent indications that the cyst traversed the skull were apparent; however, the case was unusual enough to warrant ultrasound imaging before surgery.…”

“…Ultrasound was unable to detect the calvarial defect, highlighting the need for additional imaging modalities, such as CT or MRI for conclusive diagnosis, with CT providing the best visualization of bone. 3 When evaluating a concerning cranial lesion, it is worthwhile to maintain a high degree of suspicion and obtain thorough imaging to exclude an intracranial connection because this will prevent attempted excision of an intracranial lesion in the dermatology clinic and promote appropriate referral to neurosurgery.…”

“…They most commonly occur subcutaneously but can occasionally occur within the central nervous system, presumably as a result of ectodermal inclusion during neural tube closure in the third to fifth week of embryogenesis or potentially by the introduction of epidermal cells during trauma. [1][2][3] Epidermoid cysts represent fewer than 2% of all intracranial tumors, and of these, 90% are located in the intradural space beneath the calvarium with the remainder located in the diploic space (the marrowcontaining area within the bony calvarium). 3 The intradiploic variety may present in a dermatology clinic similarly to a cutaneous epidermoid cyst, so it is important for dermatologists and dermatologic surgeons to be aware of its existence and recognize warning signs that the cyst may connect to deeper cranial structures before attempting excision.…”

“…[1][2][3] Epidermoid cysts represent fewer than 2% of all intracranial tumors, and of these, 90% are located in the intradural space beneath the calvarium with the remainder located in the diploic space (the marrowcontaining area within the bony calvarium). 3 The intradiploic variety may present in a dermatology clinic similarly to a cutaneous epidermoid cyst, so it is important for dermatologists and dermatologic surgeons to be aware of its existence and recognize warning signs that the cyst may connect to deeper cranial structures before attempting excision.…”

Skull and scalp ultrasound in children: a review

“…Внутрикостные образования располагаются в диплоэ и могут вызывать значительные эрозивные повреждения костных пластинок, имитируя эозинофильную гранулему [46]. С помощью УС оценивают их локализацию, размеры, признаки кровотока по ЦДК, состояние наружной и внутренней костных пластинок (целостность, продавливание в полость черепа, деструкция) [45][46][47][48]. УС-признаки дермоида/эпидермоида свода черепа представлены в табл.…”