Minicraniotomy treatment of an intracerebral epidermoid cyst.

Intracerebral epidermoid cysts are extremely rare. We report the case of a 16-year-old girl with an intracerebral epidermoid cyst in the left temporal lobe. The lesion was totally removed through a minimally invasive minicraniotomy by which we could obtain satisfactory intraoperative disclosure and manipulation. The incidence, clinical course, radiological features, surgical treatment, and complications of such a rare lesion are discussed.     

Intramedullary epidermoid cyst: preoperative diagnosis and surgical management after MRI introduction. Case report and updating of the literature

Many patients with spinal tumours of developmental origin do not receive preoperative diagnosis and the surgical management, especially as for capsule resection, is often unplanned. Like other uncommon tumours, the intramedullary epidermoid cyst is often an operative or histological finding. Since magnetic resonance imaging (MRI) introduction, evidence has accumulated that they may be preoperatively suspected. In reporting the case of a young patient with a T3-T4 intramedullary epidermoid cyst, the authors present an overview of the clinical, radiological and surgical aspects of such tumors and review the latest literature in which MRI and microsurgical excision were performed. Despite the introduction of new diagnostic and surgical instrumentation, the preoperative diagnosis and surgical management of such tumours need further discussion.     

Subarachnoid fat dissemination after resection of a cerebellopontine angle dysontogenic cyst: case report and review of the literature

OBJECTIVE AND IMPORTANCE: This case report illustrates the clinical and radiological relevance of extensive intracranial subarachnoid and ventricular dissemination in dysontogenic (dermoid) tumors. CLINICAL PRESENTATION: We describe a patient with a cerebellopontine angle dysontogenic tumor. Postoperatively, the cyst disseminated fat particles extensively into the subarachnoid space. Magnetic resonance imaging (MRI) studies revealed continuous dispersion of the fat particles into the cerebral cisterns, subarachnoid space, and ventricles. INTERVENTION: Eight years of clinical and MRI follow-up demonstrated neither neurological deterioration in the patient nor growth of the multiple lesions. CONCLUSION: Intracranial subarachnoid dissemination of fat material may occur during the preoperative or postoperative course of dermoid and epidermoid cysts. Aseptic meningitis or other complications such as hydrocephalus, seizures, or cranial nerve deficits also may occur owing to spillage of intracranial cyst contents into the subarachnoid space. MRI can detect the presence of fat drops that may adhere to the surrounding structures or migrate with the cerebrospinal fluid flow. Intracranial disseminated fat particles can remain silent without radiological or neurological change, justifying a wait-and-see approach. During long-term postoperative follow-up, however, regular MRI studies and clinical examinations are necessary to avoid potential complications.     

Paraesophageal bronchogenic cyst associated with multiple epithelial splenic cysts

BACKGROUND: Bronchogenic cysts are rare congenital cystic lesions of foregut origin. They are the result of abnormal budding of the primitive tracheobronchial tube. Nonparasitic, true splenic cysts are another rare entity that might occur as incidental findings but may lead to deleterious courses in case of ruptures. CASE REPORT: We report here the first case of the uncommon association of a paraesophageal bronchogenic cyst and multiple primary splenic cysts in a 23-year-old woman suffering from dysphagia and chest pain. Successful complete resection of the paraesophageal cyst was performed using an abdominal, transhiatal approach and splenic cysts were subjected to organ-preserving TA stapler resection. CONCLUSION: Thus far there is no proof or genetic indication for a direct association of bronchogenic cysts and multiple splenic cysts, however, the uncommon coincidence of both lesions in our patient might suggest a common origin. Difficulties in preoperative diagnosis, histopathological characteristics and surgical treatment modalities are presented.     

Differentiating imaging findings in primary and secondary tumors of the jugular foramen

The preoperative diagnosis of a jugular foramen tumor may be challenging, since a large variety of unusual lesions may be located in this region. These tumors may be classified as primary lesions (which are located in the jugular foramen or extend from the jugular foramen into the surrounding structures) and as secondary lesions (that extend from the surrounding structures into the jugular foramen). Primary tumors include glomus jugulare tumors, schwannomas, meningiomas and peripheral primitive neuroectodermal tumors, while secondary tumors comprise chordomas, chondrosarcomas, chondroblastomas, giant-cell tumors, cholesterol granulomas, giant cholesterol cyst, endolymphatic sac tumors, reactive myofibroblastic tumors, temporal bone carcinomas and metastases. Accurate preoperative radiological suspicion is of great value for preoperative patient counseling and has a direct impact on the surgical planning in these cases. The present study describes and discusses the main differentiating imaging features of lesions involving the jugular foramen, whose accurate preoperative radiological evaluation is essential for proper surgical planning.Commentaries on this paper are available at and     

Epidermoid cysts of the cavernous sinus

BACKGROUND: Epidermoid cysts involving the cavernous sinus are rare lesions. They can be divided into 3 different categories: extracavernous, interdural, and true intracavernous. METHODS: This classification of cavernous epidermoid cysts is correlated with the extent of tumor resection and the clinical outcome in reported cases here and elsewhere. RESULTS: Patients with cysts invading or compressing the cavernous sinus present with an excellent functional recovery after surgery independent of the extent of tumor resection. In cases of interdural cysts, there is often an adherence of the tumor capsule to the third and fourth cranial nerves. Therefore, in this group, subtotal resection is a safe strategy to prevent surgical morbidity. However, this policy may lead to a higher incidence of tumor recurrence in these cases. In true intracavernous lesions, a higher rate of total removal is possible despite the increased occurrence of internal carotid artery encasement and cranial nerve displacement. CONCLUSION: Postoperative outcome with preservation of neural and vascular structures in cavernous epidermoid cysts is more likely related to surgical strategy than to tumor localization. Independent of the different tumor origins in these cases, a subtotal resection is usually sufficient to achieve postoperative improvement of the symptoms without additional morbidity.     

Pathogenesis of intraparenchymal epidermoid cyst in the brain: a case report and review of the literature

BACKGROUND: Intracranial epidermoid cysts are relatively common; however, epidermoid cysts in the brain parenchyma are rare. In addition, the etiology of intraparenchymal epidermoid cysts is not clear. CASE DESCRIPTION: A 61-year-old woman presented with convulsive seizures. CT and MRI revealed a mass lesion in the right parietal lobe. With low-grade glioma as a preoperative diagnosis, the tumor was totally excised, but the subsequent pathologic diagnosis was epidermoid cyst. CONCLUSION: Exact preoperative diagnosis of this disease would be helpful in preventing chemical meningitis. The etiology is likely related to the time and locus of sequestration of ectodermal tissue during fetal development. Clarifying the pathogenesis will lead to effective preventive measures.     

睾丸良性占位病变18例报告

目的　提高睾丸良性占位病变的诊疗水平。　方法　对过去 2 0年间临床诊断睾丸肿瘤而行睾丸探查术的 77例资料进行总结。　结果　 77例中良性占位病变 18例 (2 3% ) ,其中 13例行睾丸肿物切除术 ,5例行睾丸切除术 ,术后随访未发现复发或转移。　结论　睾丸良性占位的发生率可能远高于一般报道。在认识到良性病变高发率的基础上对可疑病人进行积极的探查可以减少不必要的睾丸切除。病史 ,体检 ,B超等对良性占位病变的术前诊断有较大意义。     

Dysembryogenetic spinal tumours in adults without dysraphism

The authors report 15 patients with spinal intradural dysembryogenetic tumours with clinical onset in adult age in the absence of clinical and radiological signs of dysraphism. The series includes seven lipomas, four epidermoid cysts, three dermoid cysts and one teratoma. The tumour site was the thoracic region in three cases, the lumbar cord and conus in six, the cauda equina in four and the filum terminale in two. Among 14 patients operated upon, the surgical removal was complete in eight cases, subtotal in two and partial in four. Recurrence was noticed only in one subtotally resected thoracic epidermoid cyst. Magnetic resonance imaging allows a precise diagnosis of these lesions, mainly of small lipomas and dermoids of the conus and filum, where a tethered conus is responsible for clinical symptoms. Dysembryogenetic spinal rumours that become symptomatic in adult age may require surgical treatment. Reduction of the mass and release of any associated tethered neural elements are the goal of surgery for spinal lipomas, whereas epidermoid and dermoid cysts require a more radical treatment. However, even partial resections to avoid neural damage result in a good clinical outcome and very low risk of recurrence.     

Tumors of the third ventricle: review of the literature

In this chapter, the authors compared the results of the national series (262 patients) with the relevant data from the literature, in order to establish the optimal therapeutic management. Colloid cysts represent the main tumor encountered within the third ventricle (145 cases). Sudden death from colloid cysts is documented in this series, but neurosurgeons should also be aware of the increasing number of fortuitous diagnosis of such lesions. The liquid consistency of the content of the cyst is the major argument to choose the surgical procedure. Liquid colloid cysts usually associate isodense appearance on CT Scan, hypo-intensity on T1 weighted MRI images, and hyperintensity on T2-weighted MRI images. Endoscopy now appears as an accurate surgical procedure. A surgical strategy is proposed. Among glial tumors, pilocytic astrocytomas are poorly documented in the literature. Low grade astrocytomas, ependymomas, subependymomas and giant cell subependymal astrocytomas, gangliogliomas, and oligodendrogliomas were reviewed with the relevant literature. Other tumors are rare in the third ventricle, except for choroid plexus papilloma and craniopharyngioma. The reality of purely intraventricular craniopharyngioma is confirmed by the experience of this series. Other lesions such as meningioma, cavernoma, germ-cell tumors, lymphomas, metastasis, epidermoid cysts, and exceptionnal lesions were also reviewed.     

Sellar-Parasellar Brown Tumor: Case Report and Review of Literature

Brown tumors are the end stage of primary or secondary hyperparathyroidism. Such lesions are rare because hyperparathyroidism is now usually diagnosed and treated before they develop. Skeletal bone is most frequently involved, whereas sellar-parasellar involvement is extremely rare. We report a patient with a brown tumor involving the sellar-parasellar region associated with primary hyperparathyroidism. The patient's clinical history and biochemical and radiological tests were used for the diagnosis. Excision of the sellar-parasellar mass enabled histopathological confirmation and surgical decompression of neural structures. After the transsphenoidal surgery, excision of a parathyroid adenoma normalized the patient's metabolic status. Brown tumors are rarely associated with complications but occasionally may compress neural structures such as the optic nerve as they enlarge.     

Endodermal and coelomic mediastinal cysts

Eight cases of mediastinal cysts of endodermic and celomatic origin were operated on at Istituto di Chirurgia Generale e Cardiovascolare, University of Milano: two were bronchogenic cysts, two enteric and four pericardial. Embryology, morphologic presentation, clinical feature and diagnostic aspects are discussed for each group of cysts. The most modern techniques, radiological or not, available for the preoperative diagnosis are illustrated and the indication to surgical treatment of these benign mediastinal lesions is discussed.     

Intramedullary epidermoid cysts of the spinal cord. Case report.

Epidermoid cysts are tumors familiar to neurosurgeons, but intramedullary epidermoid cysts are rare. The authors report the case of a 6-year-old girl presenting with progressive paraparesis. A midthoracic intramedullary mass was revealed on myelography and magnetic resonance (MR) imaging and confirmed as an intramedullary epidermoid cyst at surgery, at which time the cyst was removed. This is the fourth report documenting a purely intramedullary epidermoid cyst occurring in a child. The pathology and etiology, epidemiology, clinical features, radiology (including MR image characteristics), and surgical treatment of such rare intramedullary benign tumors are discussed. Magnetic resonance imaging reduces the delay in diagnosis of spinal cord tumors but should be guided by clinical judgment.     

Traumatic mesenteric cyst after blunt abdominal trauma

Mesenteric cysts are rare abdominal tumors of unclear histologic origin, usually asymptomatic. Post-traumatic mesenteric cyst usually results as a consequence of a mesenteric lymphangitic rupture or a hematoma followed by absorption and cystic degeneration. The preoperative histological and radiological diagnosis is difficult. We present the case of a 45-year-old male patient with sizable, palpable abdominal tumor, the gradual swelling of which the patient himself combined with the blunt abdominal trauma he acquired from an opponent's knee in a football game 5 months ago.     

The synchronous appearance of multiple testicular epidermoid cysts and of a malignant mixed germinal tumor in the contralateral testis]

We describe the simultaneous appearance of multiple epidermoid cysts in the right and an adult teratoma containing embryonal carcinoma and choriocarcinoma in the left testis. No similar case has previously been described. Epidermoid cysts of the testis are rare, accounting for about 1% of all testicular tumors. Epidermoid cysts are now regarded as monoepidermally developed teratomas of germ cell origin. Testicular teratomas in adults, however, are always malignant. Because epidermoid cysts are rare tumors, primary therapy often consists in ablation of the testis. In the case described, excision of the epidermoid cyst protected the patient from complete castration. This case demonstrates the simultaneous appearance of a malignant and a benign testicular germ cell tumor.     

Splenic cysts and tumors: diagnosis and management

Cysts and tumors of the spleen are rare and are often discovered fortuitously. They are most often asymptomatic but may present with abdominal pain in the left upper quadrant. Splenic cysts are far more common than solid lesions; true cysts must be differentiated from pseudocysts of the pancreas and from cystic degeneration following splenic contusion or infarction. Cysts may be congenital (epidermoid cysts), infectious (abscess or hydatid cyst), or neoplastic (lymphangioma or angioma with tumor necrosis). Diagnosis can usually be established with the clinical context and imagery (ultrasound, CT, MRI). Surgery should be avoided for angiomas and pseudocysts. Spleen-conserving surgery is indicated for large symptomatic epidermoid cysts. Splenectomy is often required for hydatid cysts and tumors. Of the solid tumors, hemangiomas and lymphangiomas often have a characteristic fleshy appearance. For other solid tumors, whether benign or malignant, imaging may give some clues to the diagnosis, but diagnostic certitude often requires pathologic examination of the piece. Needle biopsy is contraindicated because of the risk of bleeding. Resection should be as limited as possible in order to avoid the risks of total splenectomy (overwhelming sepsis, thrombosis).     

Posterior fossa epidermoid cysts presenting with unusual radiological appearances--two case reports

Intracranial epidermoid cysts generally appear as hypodense on computed tomography (CT), hypointense on T(1)-weighted magnetic resonance (MR) imaging, and hyperintense on diffusion-weighted MR imaging. We report two cases of posterior fossa epidermoid cysts with unusual radiological features. A 49-year-old male presented with facial dysesthesia and a 12-year-old male presented with diplopia and internuclear ophthalmoplegia. CT of both cases revealed hyperdense lesions. MR imaging showed the first case as hypointense in the posterior part and hyperintense in the anterior part of the tumor on diffusion-weighted imaging, and the second case as hyperintense on diffusion-weighted and T(1)-weighted MR imaging. Surgical exploration revealed that the tumors consisted of creamy materials, instead of the usual semi-solid or flaky texture in epidermoid cysts. Xanthochromic serous fluid was also contained in the superoposterior half of the cyst of the first case. These unusual contents of the cyst may be responsible for the unusual neuroimaging findings. Histological examination showed both cysts were lined with stratified squamous epithelium and contained keratinaceous materials. Therefore, epidermoid cysts can occasionally present with unusual radiological characteristics giving rise to a diagnostic pitfall.     

Benigne zystische Knochenläsionen

Background

Bone cysts are benign tumor-like lesions which often present as a fluid-containing cavity in the bone. They can occur in the skeletal bone as solitary or sometimes multiple bone lesions.

Objectives

This review discusses the diagnostics, radiological appearance and therapeutic strategies of the most important benign cystic bone lesions, such as simple bone cysts, aneurysmal bone cysts, intraosseous ganglia, epidermoid cysts and subchondral cysts. The differential diagnoses with respect to cystoid formations and tumors with cystic components are discussed.

Method

A selective literature search was performed taking own experiences into consideration.

Results

These tumor-like lesions can have the radiological appearance of bone tumors but show no autonomic, stimulus-independent growth and can resolve spontaneously. In the majority of cases open biopsy is necessary to confirm the diagnosis. In some cases no surgical intervention is necessary (e.g. do not touch and leave me alone lesions), whereas in other cases the focus of treatment is on the prevention and therapy of pathological fractures as well as prevention of recurrence.

Conclusion

Cystic bone formations are among the most commonly occurring non-traumatic bone lesions. To eliminate differential diagnostic unclarity, histological investigation of biopsy material is essential. In terms of surgical intervention there exists a trend towards multimodal therapy mostly based on a meticulous curretage.