Dermoid cyst, case 1

CLINICAL HISTORY:
This 20-year old male patient complains of one month of left frontal headaches, resistant to medication. He furthermore notes loss of appetite and weight.

NEUROLOGICAL EXAMINATION is normal.

CT (IMAGE 1) shows a rounded mass (arrow) in the left intra- and suprasellar region, with negative attenuation values of -80 Hounsfield Units.

MRI:
a) TRANSAXIAL T2-WEIGHTED (2500/90/1) SPIN-ECHO SEQUENCE (IMAGE 2): The mass (arrow) is seen within the left suprasellar region. The lesion is markedly hypointense, similar to the subcutaneous fat.

b) CORONAL (IMAGES 3 - 4 AND 5) AND SAGITTAL (IMAGE 6) T1-WEIGHTED (400/15/1) SPIN-ECHO SEQUENCE: The lesion (arrow) is homogeneously hyperintense, again similar to subcutaneous fat. The mass is located in the left suprasellar cistern, and shows slight compression of the optic chiasm (arrowhead). The infundibulum is displaced to the right.

RADIOLOGICAL DIFFERENTIAL DIAGNOSIS is lipoma or dermoid cyst, based on the negative density on CT, the short T1 and T2 of the lesion and its typical location.

SURGICAL FINDINGS: At surgery, a supra- and parasellar tumor was found with an appearance consistent with dermoid cyst. The content was semi-liquid and was removed by suction. The anterior part of the cyst wall was removed. The posterior wall shows tight adhesion to the chiasm.

ANATOMOPATHOLOGY: There was an insufficient amount of tissue to allow reliable anatomopathological diagnosis. Based on the impression of the neurosurgeon the final diagnosis is dermoid cyst.

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Dermoid cysts

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