Diagnostic Dilemma: Cerebellopontine Angle Lipoma Versus Dermoid Cyst

Bertot, Brandon; Steele, William J.; Boghani, Zain; Britz, Gavin W.

doi:10.7759/cureus.1894

Cited by 7 publications

(10 citation statements)

References 27 publications

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“…This study found that conservative, nonoperative management of CPA/IAC lipoma has become increasingly more common and is associated with significantly reduced morbidity as compared to operative management. Lipomas of the CPA/IAC are extremely rare, with only 96 manuscripts reporting 202 CPA/IAC Lipomas prior to this study, and create a diagnostic dilemma for the surgeon, as these lesions may be mistaken for other, more common tumors of the CPA/IAC—for example, vestibular schwannomas, epidermoid cysts, meningiomas, arachnoid cysts, dermoid cysts, and hemangiomas 3,11 . Although lipomas characteristically appear as hypodense masses on computed tomography (CT) imaging, magnetic resonance imaging (MRI) enables improved evaluation of the mass for more accurate diagnostic assessment 12–14 .…”

Section: Discussionmentioning

confidence: 99%

Cerebellopontine Angle and Internal Auditory Canal Lipomas: Case Series and Systematic Review

et al. 2021

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Objectives/Hypothesis Cerebellopontine angle (CPA) and internal auditory canal (IAC) lipomas are rare, benign tumors comprising 0.08% of all intracranial tumors and can be mistaken for other, more common lesions of the CPA/IAC such as vestibular schwannoma. The purpose of this study was to review the literature and assess the evolution of CPA/IAC lipoma diagnosis and management. In addition, we present 17 new lipomas, matching the largest known case series of this rare tumor. Study Design Retrospective case series and systematic review. Methods Systematic review of the literature was performed using PubMed and Google Scholar. References from identified articles were also reviewed to identify potential additional manuscripts. Manuscripts and abstracts were reviewed to identify unique cases. For the case series, the charts of all CPA/IAC lipoma patients seen at a single institution from 2006–2019 were manually reviewed. Logistic regression and chi‐squared analysis were performed where appropriate. Results A total of 219 unique lipomas have been reported in the literature, including 17 presented in this study. Surgical management has been performed in 46% of cases and has been conducted less often in recent decades, likely due to improved radiographic diagnostic capabilities and understanding of surgical outcomes. Surgical management is associated with worse neurologic outcomes (P = .002) and has become less common in recent decades. Although growth is unlikely, it has been demonstrated in patients into their 30s. Conclusions Accurate radiographic diagnosis is imperative for appropriate patient management, as CPA/IAC lipomas should typically be managed through observation and serial imaging whereas vestibular schwannomas and other CPA/IAC lesions may require microsurgical or radiosurgical intervention depending on growth and symptomatology. Laryngoscope, 131:2081–2087, 2021

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Section: Discussionmentioning

confidence: 99%

Cerebellopontine Angle and Internal Auditory Canal Lipomas: Case Series and Systematic Review

et al. 2021

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“… 27 The most common signs of CPA lipomas are hearing loss, tinnitus, vertigo, facial symptoms (facial and trigeminal nerve signs), and headaches. 28 When lipomas are viewed using CT, they appear as hypodense masses (−40 to −100 Hounsfield units [HU]) and do not enhance with contrast administration. 29 On a T1-weighted MRI, lipomas are hyperintense, whereas on T2-weighted sequences, the appearance of a lipoma can vary from hypointense to hyperintense.…”

Section: Discussionmentioning

confidence: 99%

Primary Lymphoma of Internal Acoustic Meatus Mimicking Vestibular Schwannoma—A Rare Diagnostic Dilemma

et al. 2021

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Background/Setting A subject presenting with a unilateral sensorineural hearing loss and with vertigo/imbalance and a lesion of internal acoustic meatus (IAM) most often represents a vestibular schwannoma. Several alternative pathologies involving the region, with clinical and neuroradiological similarities, could lead to an error in judgement and management. Rare tumors of the IAM pose unique diagnostic difficulty. A rare case that we present here had a typical history and imaging findings suggestive of vestibular schwannoma. A primary central nervous system (CNS) lymphoma was diagnosed in later stages of brain involvement warranting a retrospective analysis of the entity. Case Summary An 80-year-old male presented with unilateral sensorineural hearing loss, vertigo, and imbalance. On imaging, he was found to have a lesion in the left internal auditory meatus, reported as a vestibular schwannoma and operated upon. Subject's condition worsened with time and a repeat imaging was suggestive of a CNS lymphoma with lesions involving bilateral cerebellum and subcortical white matrix. Conclusion To conclude, primary CNS lymphoma presenting an isolated lesion in the IAM with no other parenchymal lesions at presentation is a rare incidence; to our knowledge this is the first case of such unique presentation.

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“…Dermoid cysts can remain stable or become symptomatic by enlargement or rupture [4 , 8] . Malignant transformation to squamous cell carcinoma is a rare but a possible complication [9] . The dermoid cyst and epidermoid cyst are different entities, although the term “dermoid” has been used broadly to describe both entities [2] .…”

Section: Discussionmentioning

confidence: 99%

“…Based on such literature, we suspected a lipoma variant or well-differentiated liposarcoma and/or atypical lipomatous tumor preoperatively. Differentiating lipomatous tumors from dermoid cysts is also difficult in the head and neck or in the intracranial location, which are relatively common locations for dermoid cysts [9 , 18] . Bertot et al reported a lipoma at the cerebellopontine angle and indicated that the loss of signal on fat saturation sequences could suggest a lipoma than a dermoid cyst [9] .…”

Section: Discussionmentioning

confidence: 99%

Dermoid cyst in the subcutaneous tissues of the back: A rare case with multimodal imaging and pathologic correlation

Chung

Kim

Park

et al. 2021

Radiology Case Reports

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Dermoid cysts are lined by keratinizing squamous epithelium and consist of skin appendages such as hair follicles, apocrine glands, and sebaceous glands. They are usually diagnosed during infancy or early childhood, commonly reported in the head and neck region. A dermoid cyst on the back is extremely rare, with only three cases in the pediatric and adult populations. We report a rare case of a dermoid cyst in the subcutaneous layer of the back in an adult. A 75-year-old man presented with a soft, painless mass on his left upper back. Computed tomography revealed a low-density mass nearly identical to the subcutaneous fat in the subcutaneous layer with nodular soft-tissue density components. It was a heterogeneously hyperechoic mass without internal vascularity on ultrasonography. On magnetic resonance imaging, the lesion showed nearly identical signal intensity (SI) to subcutaneous fat on T1 and T2-weighted images. The soft tissue component was intermediately hyperintense on T1- and T2- weighted images with enhancement. This lesion was pre-operatively suspected as a lipoma variant or a well-differentiated liposarcoma/atypical lipomatous tumor because of the fat density or SI and enhancing portion. We demonstrated and reviewed the multimodality imaging features of dermoid cysts at an unusual location and suggested imaging features that could help readers differentiate dermoid cysts from lipomatous tumors. When a mass shows fat density or SI with or without enhancing soft tissue components at the trunk or extremity, dermoid cysts as well as lipomatous tumors could be considered in the differential diagnosis.

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Diagnostic Dilemma: Cerebellopontine Angle Lipoma Versus Dermoid Cyst

Cited by 7 publications

References 27 publications

Cerebellopontine Angle and Internal Auditory Canal Lipomas: Case Series and Systematic Review

Cerebellopontine Angle and Internal Auditory Canal Lipomas: Case Series and Systematic Review

Primary Lymphoma of Internal Acoustic Meatus Mimicking Vestibular Schwannoma—A Rare Diagnostic Dilemma

Dermoid cyst in the subcutaneous tissues of the back: A rare case with multimodal imaging and pathologic correlation

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