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Epidermoid cyst, giant

 

CLINICAL HISTORY:
This 42-year old woman complains of 3 years of intermittent tinnitus of the left ear and oscillopsia. Over the past year she notes parestesias of the right corner of the mouth and a sensation of cold in the right side of her face and body.

NEUROLOGICAL EXAMINATION is entirely normal.

CT:
a) NON-CONTRAST SCAN (IMAGE 1): In the left cerebellopontine angle an inhomogeneously hypodense lesion (arrowheads) is seen, with marked brainstem compression and displacement of the fourth ventricle (arrow) to the right.

b) CONTRAST-ENHANCED SCAN (IMAGE 2): The lesion is again seen and does not enhance.

MRI:
a) TRANSAXIAL T2-WEIGHTED (2500/90/1) SPIN-ECHO SEQUENCE (IMAGE 3): The lesion (arrowheads) is seen in the left cerebellopontine angle, with marked hyperintensity.

b) CORONAL T1-WEIGHTED (480/20/1) SPIN-ECHO SEQUENCE (IMAGES 4 - 5 - 6): On this sequence the mass (arrowheads) is seen within the left cerebellopontine angle, with extension from the tentorium to the jugular foramen. The lesion does not enter the left internal auditory canal (arrow image 6). The overall intensity of the lesion is hypointense, but with a very inhomogeneous character. Some septa can be suspected within the tumor.

c) CORONAL (IMAGES 7 AND 8) AND SAGITTAL (IMAGE 9) GADOLINIUM-ENHANCED SPIN-ECHO SEQUENCES: There is no definite contrast enhancement of the lesion. The inhomogeneous character of the lesion is somewhat accentuated. Again noted is absence of extension into the internal auditory canal.

RADIOLOGICAL DIAGNOSIS is epidermoid cyst, based on the extraaxial location, the long T1 and T2, the multilobulated appearance, the intratumoral strands and the absence of contrast enhancement.

SURGICAL FINDINGS: At surgery, a typical epidermoid cyst was found with a bright white-grey pearly content. The lesion was avascular and considerably displaced the pons and the mesencephalon to the right. Cranial nerves V to XI were adherent to the capsule of the tumor, but could easily be dissected free.

ANATOMOPATHOLOGY (IMAGE 10) was consistent with epidermoid cyst.

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Epidermoid cysts

 

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Fig. 1

Epidermoid cyst, giant, Fig. 1
Epidermoid cyst, giant, Fig. 2
Epidermoid cyst, giant, Fig. 3
Epidermoid cyst, giant, Fig. 4
Epidermoid cyst, giant, Fig. 5
Epidermoid cyst, giant, Fig. 6
Epidermoid cyst, giant, Fig. 7
Epidermoid cyst, giant, Fig. 8
Epidermoid cyst, giant, Fig. 9
Epidermoid cyst, giant, Fig. 10