Unusual CT-dense transtentorial epidermoid cyst

Lunardi, Pierpaolo; Rizzo, A; Guidetti, G

doi:10.1055/s-2008-1053941

Cited by 6 publications

(2 citation statements)

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“…10) However, they occasionally present as hyperdense lesions on CT, making the diagnosis more difficult. 4,6,[8][9][10][11][12][13][15][16][17][18][19]22) The pathophysiology remains unclear, but many contributing factors have been suggested. Hypodense epidermoids have pearly appearance with white waxy material rich in cholesterol whereas hyperdense epidermoids are grossly cystic and contain fluids of various colors.…”

Section: Discussionmentioning

confidence: 99%

Posterior Fossa Epidermoid Cysts Presenting With Unusual Radiological Appearances -Two Case Reports-

Bohara

Yonezawa

Hanaya

et al. 2011

Neurol. Med. Chir.(Tokyo)

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Intracranial epidermoid cysts generally appear as hypodense on computed tomography (CT), hypointense on T(1)-weighted magnetic resonance (MR) imaging, and hyperintense on diffusion-weighted MR imaging. We report two cases of posterior fossa epidermoid cysts with unusual radiological features. A 49-year-old male presented with facial dysesthesia and a 12-year-old male presented with diplopia and internuclear ophthalmoplegia. CT of both cases revealed hyperdense lesions. MR imaging showed the first case as hypointense in the posterior part and hyperintense in the anterior part of the tumor on diffusion-weighted imaging, and the second case as hyperintense on diffusion-weighted and T(1)-weighted MR imaging. Surgical exploration revealed that the tumors consisted of creamy materials, instead of the usual semi-solid or flaky texture in epidermoid cysts. Xanthochromic serous fluid was also contained in the superoposterior half of the cyst of the first case. These unusual contents of the cyst may be responsible for the unusual neuroimaging findings. Histological examination showed both cysts were lined with stratified squamous epithelium and contained keratinaceous materials. Therefore, epidermoid cysts can occasionally present with unusual radiological characteristics giving rise to a diagnostic pitfall.

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Section: Discussionmentioning

confidence: 99%

Posterior Fossa Epidermoid Cysts Presenting With Unusual Radiological Appearances -Two Case Reports-

Bohara

Yonezawa

Hanaya

et al. 2011

Neurol. Med. Chir.(Tokyo)

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“… 11 , 12) The low-density region is reported to be due to fat and hair components, and the high-density regions are due to calcification, hemorrhagic changes, presence of protein-rich substances and liquefied cholesterol, and calcium deposition due to saponification of fat and keratin components. 14 – 16) The low- and high-density regions appear mixed as a result of the mixture of these contents. MRI shows high signal intensity on T1 and mixed signal intensity on T2 and FLAIR.…”

Section: Discussionmentioning

confidence: 99%

A Case of Dermoid Cyst Arising in the Temporal Lobe

Onoda

Kawaguchi

Takaya

et al. 2021

NMC Case Report Journal

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Intracranial dermoid cysts are rare congenital lesions that result from abnormal sequestration of ectodermal cells during neural tube formation. These tumors are especially rare in lateral areas such as in the temporal lobe. In this study, we report a case of dermoid cyst located in the right temporal lobe. A 50-year-old man was referred for further treatment of a tumor. CT revealed a low-density mass lesion in the right temporal lobe, with calcification. MRI showed the lesion with high signal intensity on diffusion-weighted imaging, high-low mixed signal intensity on T1-weighted imaging, and iso-high signal mixed intensity on T2-weighted imaging; the capsule was enhanced with gadolinium. Differential diagnosis included dermoid cyst, epidermoid cyst, teratoma, and neurenteric cyst. We decided to perform surgery for the improvement of his symptom, histopathological diagnosis, and radical cure. A right temporal craniotomy was performed, and the tumor was found adherent to the surrounding brain tissue. The tumor was completely removed under subpial dissection. Hair was confirmed in the tumor content. On histopathology, the cyst wall was lined with stratified squamous epithelium, sebaceous glands, small vessel aggregates, and inflammatory infiltrate. Keratinized material and hair were found in the lumen. The patient was discharged 7 days after surgery with no new neurologic deficits. This case was unusual in terms of the effect of gadolinium enhancement on MRI, and the presence of adipose tissue and calcification were useful for diagnosis. It is vital to consider prevention of chemical meningitis due to intrathecal dissemination of the tumor content intraoperatively.

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