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Dermoid cyst, multiple suprasellar

CLINICAL HISTORY:
This 38-year old man complains of one year of worsening vision. Bilateral gynecomastia is developing.

CLINICAL NEUROLOGICAL EXAMINATION is normal.

CT (IMAGES 1 AND 2): Presence within the suprasellar region of multiple hypointense lesions (arrowheads) with negative attenuation values of -70 Hounsfield Units.

MRI:
a) TRANSAXIAL T2-WEIGHTED (2500/90/1) SPIN-ECHO SEQUENCE (IMAGES 3 AND 4): The tumor is identified within the suprasellar cistern and is composed of several small nodules (arrowheads) with an intensity similar to subcutaneous fat.

b) TRANSAXIAL (IMAGES 5 AND 6) AND SAGITTAL (IMAGE 7) T1-WEIGHTED (600/20/1) SPIN-ECHO SEQUENCE: The different nodular components of the lesion are markedly hyperintense (arrowheads), similar to subcutaneous fat. The optic chiasm is displaced upward. Dorsal to the lesion a more cystic component is found (arrow).

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

SURGICAL FINDINGS: At surgery, the tumor appeared solitary and well-defined. The lesion was surrounded by a very thin transparent wall with a whitish content. The tumor extended up to the optic chiasm which was displaced in an upward and posterior direction. Both optic nerves were stretched. After opening of the capsule the content appeared to be sebum-like and avascular. More posteriorly the cyst was seen containing a yellowish fluid. Resection was total.

ANATOMOPATHOLOGY (IMAGE 8) was consistent with dermoid cyst.

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Fig. 1

Dermoid cyst, multiple suprasellar, Fig. 1
Dermoid cyst, multiple suprasellar, Fig. 2
Dermoid cyst, multiple suprasellar, Fig. 3
Dermoid cyst, multiple suprasellar, Fig. 4
Dermoid cyst, multiple suprasellar, Fig. 5