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Dermoid cyst, case 2

CLINICAL HISTORY:
This 70-year old man is admitted to the emergency ward in coma after a grand mal seizure. A few hours later he is awake and well, but with retrograde amnesia.

NEUROLOGICAL EXAMINATION is normal.

CT:
a) NON-CONTRAST SCAN (IMAGE 1): In the left frontal lobe a rounded lesion (arrow) is seen with focally calcified wall. The bulk of the lesion has attenuation values of -80 Hounsfield Units, pointing to a high fatty content. Superficially a second lesion (arrowhead) is seen. Some edema is noted.

MRI:
a) TRANSAXIAL T2-WEIGHTED (5400/119/1) SPIN-ECHO SEQUENCE (IMAGES 2 AND 3): The mass displays mixed intensity, overall similar to the intensity of subcutaneous fat.

b) TRANSAXIAL (IMAGES 4 AND 5), CORONAL (IMAGE 6) AND SAGITTAL (IMAGE 7) T1-WEIGHTED SPIN-ECHO SEQUENCES: Again mixed intensity is seen, but part of the mass is very hypointense, again similar to the subcutaneous fat. Several similar foci (arrowhead) are seen near the primary lesion.

RADIOLOGICAL DIAGNOSIS: is dermoid cyst, based on the negative density on CT, the short T1 and T2 and the inhomogeneous appearance of the lesions.

SURGICAL FINDINGS: In the left superior frontal gyrus a well-defined thin-walled mass was found, containing a white amorphous, waxy substance. Identical lesions were found in the vicinity. More medially, similar extraaxial lesions were found. Total resection was performed.

ANATOMOPATHOLOGY: Pathologically only signs of old hemorrhage were found. The gross impression of the neurosurgeon was dermoid cyst.

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Fig. 1

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