Medcyclopaedia Home E-learningLibraryLexical IndexLexical TopicsGlossaryFace-a-CaseSpinal CordCerebral TumorsCystic TumorsEmbryonal TumorsLocal Extension From Regional TumorsLymphomas And Hematopoetic NeoplasmsMeningeal And Mesenchymal TumorsMetastatic TumorsNeural And Mixed Neural Glial TumorsPineal Region TumorsPseudotumoral LesionsTumors Of Neuroepithelial TissueMR Neuro AngiographyTextbook of RadiologyTextbook of Radiology (e-paper)Medical Imaging Made EasyDownloadsMedcyclOasisAbout MedcyclopaediaContact Us
MedcycloPoll
Did you get the help you required from Medcyclopaedia™ during today's visit?
Yes
 
 (84.6%)
No
 
 (10.9%)
Undecided
 
 (4.5%)
You must be logged on to vote.
Please log in or register.
 
 
 

Epidermoid cyst, giant

CLINICAL HISTORY:
This 65-year old man complains of memory and concentration disturbances, gait apraxia and urge incontinence. The diagnosis of normal pressure hydrocephalus is suspected.

NEUROLOGICAL EXAMINATION shows a demented patient, with gait apraxia and problems with coordination.

NON-CONTRAST CT (IMAGES 1 AND 2) shows a diffuse infiltrating hypodense mass in the basal cisterns with displacement of brainstem (arrow) and uncus (arrowhead) of the temporal lobe and surrounding the vascular and nervous structures of the suprasellar cistern.

MRI:
a) TRANSAXIAL (IMAGES 3 AND 4) AND SAGITTAL (IMAGE 5) T2-WEIGHTED (3380/90/1) SPIN-ECHO SEQUENCE: A diffuse, well-circumscribed mass is seen in the basal cisterns, with compression and displacement of the brainstem and the temporal lobe bilaterally. The mass is markedly hyperintense and clearly stands out against the flow void of the circle of Willis. The mass obliterates the anterior third ventricle and shows retroclival extension (arrow images 5 and 6).

b) TRANSAXIAL T1-WEIGHTED (560/15/1) SPIN-ECHO SEQUENCE (IMAGES 6 AND 7): The mass is hypointense.

c) TRANSAXIAL (IMAGE 8), CORONAL (IMAGES 9 AND 10) AND SAGITTAL (IMAGE 11) GADOLINIUM-ENHANCED SPIN-ECHO SEQUENCES: No enhancement is identified within the mass. Note is again made of the position of the optic chiasm (arrow) within the tumor and the displacement of brainstem, third ventricle and frontal and temporal lobes.

RADIOLOGICAL DIAGNOSIS is epidermoid cyst, based on the long T1 and T2, the extraaxial location, the insinuating aspect along the basal CSF cisterns and engulfing of vessels and nerves.

SURGICAL FINDINGS: At surgery, the tumor had a typical glassy, mother-of-pearl appearance. The lesion diffusely infiltrated around the optic chiasm, the infundibulum, the carotid bifurcation, the basilar tip and the oculomotor nerves bilaterally. Partial resection was performed. The very thin cyst wall was tightly adherent to the large vessels and the nerves.

ANATOMOPATHOLOGY was consistent with epidermoid cyst.
Postoperatively, aseptic meningitis developed, and after a period of external drainage, a ventriculoperitoneal shunt had to be inserted. The cognitive disturbances remain unchanged.

Search also:
Epidermoid cysts

 

The ESNR CD-Rom Series

To view high resolution images,
please register first.

Click  here to register.

Already registered? Enter your e-mail in the window below.
Re-register

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