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Dermoid cyst, atypical

CLINICAL HISTORY:
a 58-year old woman with a long history of depression now complains of gait instability and nausea.

NEUROLOGICAL EXAMINATION reveals an apathetic patient. Her gait is ataxic with loss of coordination.

CT (not illustrated): Presence of ovoid calcification in the roof of the fourth ventricle.

MRI:
a) TRANSAXIAL T2-WEIGHTED (2500/90/1) SPIN-ECHO SEQUENCE (IMAGE 1): Presence in the posterior fossa of a rounded cystic mass with predominantly hyperintense content. At the ventral aspect of the lesion a small rounded markedly hypointense component is present (arrowhead). This lesion caused supratentorial hydrocephalus (not illustrated).

b) TRANSAXIAL (IMAGES 2 AND 3) AND SAGITTAL (IMAGES 4 AND 5) T1-WEIGHTED (680/20/1) SPIN-ECHO SEQUENCE: Without administration of IV contrast medium the lesion is homogeneously hyperintense, except for the small ventral nodule (arrowhead) that remains hypointense.

RADIOLOGICAL DIFFERENTIAL DIAGNOSIS is cyst with hemorrhagic or colloidal content.

SURGICAL FINDINGS: At surgery a large cystic mass was found together with a more solid component. Puncture of the cyst was performed with partial resection of the tumor mass. Part of the tumor wall in the vicinity of the brainstem was left in place.

ANATOMOPATHOLOGY was consistent with dermoid cyst.

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Fig. 1

Dermoid cyst, atypical, Fig. 1
Dermoid cyst, atypical, Fig. 2
Dermoid cyst, atypical, Fig. 3
Dermoid cyst, atypical, Fig. 4
Dermoid cyst, atypical, Fig. 5