Suprasellar keratinous cyst: A case report and review on its radiological features and treatment outcome

Abstract

Background:Keratinous or epidermoid cysts (ECs) are encapsulated lesions lined by squamous cell epithelium. They comprise approximately 1% of intracranial lesions. Contrary to dermoid cysts, they lack dermal elements such as sebaceous or apocrine glands and hair follicles. The sellar region is the second most common intracranial site following the cerebellopontine angle. Here, we report a case of EC in a patient who complained of endocrine disturbances. We also performed a systematic review on previously published cases to analyze clinical and radiological characteristics and report the treatment outcomes of suprasellar ECs.Case Description:A 42-year-old woman presented with a one-year history of amenorrhea, weight gain, severe headache, and visual disturbances for 6 months. Work-up identified an elevated prolactin level and a temporal field defect of the right eye. Magnetic resonance imaging (MRI) showed a cystic suprasellar lesion pushing on the optic chiasm. She underwent endoscopic trans-sphenoidal surgery, which confirmed a keratinous cyst on histology. Postoperatively, complete resection was confirmed on imaging. She did well although her hospital stay was prolonged due to diabetes insipidus and hypocortisolism.Conclusion:Chronic endocrine disturbances can be the presenting complaints of a suprasellar EC, whose T1-weighted MRI appearance can be non-specific, mimicking other differential diagnoses, such as a Rathke's cleft cyst. However, the T2-weighted MRI appearances of ECs are generally hyper-intense and lesions show diffusion restriction. Treatment is surgical and yields good outcomes in most cases reported.

Suprasellar epidermoid cyst in an adult female, presenting as amnesia and somnolence: A rare case report

“…Despite better outcome has been reported by C.W. Huo et al [ 7 ] in patients underwent endoscopic intervention, however, due to its rare occurrence and the overall low number of published studies, caution is required when drawing any definitive conclusion.…”

“…The most specific MR sequence appears to be diffusion-weighted imaging where ECs show a restricted pattern. This allows differentiating these lesions from other cystic pathologies, including arachnoid cysts, which show isointensity to CSF on all MR sequences without diffusion restriction [ 7 ].…”

Physiopathological Aspects of Sellar Epidermoid Cyst Determining Endocrine Disturbances: A Case Report

“…Unlike dermoid cysts, ECs often occur laterally, without a preference for midline sites. 3,4,[12][13][14][15][16][17][18] Intracranial ECs account for only 1% of all intracranial tumors, if suprasellar examples are excluded. The cerebellopontine angle and parapontine regions are the most common intracranial site for ECs.…”

“…Rarely, ECs are located in the cranial diploe of the middle ear region or frontal bone, where they present as a lytic defect. 2,3,7,8,11,[15][16][17][18] The authors reported a female patient with clinical complaint of amenorrhea due to a sellar EC. Symptoms associated to sellar EC can be related to a slow growing mass effect, and include focal neurologic deficits or nonlocalizing signs such as headache, visual alterations, and pituitary dysfunction.…”

“…Symptoms associated to sellar EC can be related to a slow growing mass effect, and include focal neurologic deficits or nonlocalizing signs such as headache, visual alterations, and pituitary dysfunction. 15,[18][19][20][21][22] Epidermoid cysts tend to surround adjacent structures, and its rupture can produces chronic inflammation of the leptomeninges or ependyma. 15,[18][19][20][21] Sellar/suprasellar ECs can determine disturbances in the release and/or production of hormones, because the compressive effect of the process may affect the physiology of the pituitary gland or even determine hypothalamic disorders.…”