Cranial computed tomography of epidermoid and congenital fatty tumors of maldevelopmental origin

Ossified spinal epidermoid cyst: A systematic review and case report

Background

Epidermoid cysts (ECs) are rare, benign lesions which comprise less than 1 % of all spinal tumors. Calcification of spinal ECs is rare, and EC ossification within the lumbar spine has never been documented. We report the only known congenital lumbar epidermoid tumor with ossification and a literature review of intradural lumbar ECs.

Methods

Studies meeting the following criteria were included: 1) EC as the primary tumor type, 2) intradural location, 3) involvement of the lumbar spinal level, and 4) primary presentation. Studies lacking individual patient data or published in a non-English language were excluded.

Results

A total of 172 studies were reviewed and 43 were included in analysis. Of the 83 total patients, 37 (45.1 %) were male and 45 (54.9 %) female, at an average age of 26 years. The L3 and L4 spinal levels were most frequently involved. Acquired etiology was reported in 49 (59.0 %) patients, and 24 (28.9 %) cases were congenital. Multivariate analyses demonstrated trends between decreased age and improved outcome, decreased delay in diagnosis and improved outcome, and increased extent of resection with reduced recurrence. Nine calcified spinal ECs were identified, with no previous report of EC ossification in the lumbar spine.

Conclusion

We present a case report of the only known ossified epidermoid tumor of the lumbar spine and a comprehensive literature review of 83 patients with intradural lumbar ECs. This review demonstrated trends between reduced age and improved outcome, reduced delay in diagnosis and improved outcome, and increased extent of resection with reduced recurrence.

Multidetector computed tomography in the diagnosis and management of renal trauma

Renal injuries fall within the broad and complex subject of retroperitoneal trauma. Although their computed tomography (CT) features have been known for a while, the timing, diagnostic approach and management are still debated. In addition, some areas of uncertainty remain regarding timing, indications and imaging modalities to be used in the follow-up of these patients. The purpose of this paper is to review the impact of CT on the management of renal trauma, stressing the importance of this technique and the role of the radiologist in the timing of decisions. Finally, we discuss the diagnostic approach to the follow-up of renal trauma.

Intradiploic epidermoid causing spontaneous extradural hematoma: case report

OBJECTIVE

A case of an intradiploic epidermoid tumor leading to spontaneous extradural hematoma is reported. Intradiploic epidermoids are not common intracranial tumors. This is the first reported case of intradiploic epidermoid presenting as a spontaneous extradural hematoma.

CLINICAL PRESENTATION

The patient presented with sudden onset of headache and deterioration in the sensorium. A computed tomographic scan revealed a lesion causing erosion of both tables of the calvarium and a mixed intensity extradural hematoma.

INTERVENTION

The patient underwent immediate operation, and evacuation of the hematoma and excision of the tumor were performed.

CONCLUSION

Intradiploic epidermoid tumors so rarely present with extradural hemorrhage that prophylactic removal cannot be recommended in all such cases. However, in view of the seriousness of the hemorrhage, prophylactic removal may be recommended, especially if the patient, such as a sportsman, child, or elderly person, is prone to injuries.

Imaging of the temporal bone

Classical descriptions of the temporal bone are based on its five embryologically distinct osseous components: the petrous, tympanic, mastoid, squamous, and styloid portions.

Imaging of the temporal bone

Classical descriptions of the temporal bone are based on its five embryologically distinct osseous components: the petrous, tympanic, mastoid, squamous, and styloid portions.

[Cerebellopontine angle lipoma: clinical case]

Lipomas of the cerebellopontine angle are extremely rare. These tumors are probably maldevelopment lesions which can cause slowly progressive neurological symptoms. Including the present case, 90 lipomas in this localization have been described in the literature. The authors report a case of cerebellopontine angle lipoma in a 44-year-old male patient who suffered right hearing loss and tinnitus during seven months. The literature concerning this rare cerebellopontine angle tumor is review. The symptoms, radiological features and surgical management are discussed.

[Lipoma of the cerebellopontine angle: case report]

Lipoma of the cerebellopontine angle is a very rare tumor. We report the case of a 14-years-old female, with left side deafness during three years, associated with headache. CT scan showed an hypodense mass, without enhancement at the cerebellopontine angle. The patient was treated surgically by left retrosigmoid approach. The lesion involved the eighth and seventh cranial nerves and only a partial removal was performed. The postoperative course was uneventful. She had no more headache; the deafness of the left side remained unchanged. Asymptomatic lipoma of the cerebellopontine angle can be treated conservatively, although those with progressive symptoms should be treated surgically, with total or partial remove based on their neurovascular involvement.

Lipoma of the interpeduncular fossa: demonstration by CT and MRI

A case of intracranial lipoma located in the interpeduncular fossa of a young woman is presented. Since the patient suffers only nonspecific headache, no treatment was performed. To our knowledge this is the only which was demonstrated by magnetic resonance images (MRI) in the English language literature.

Lipomas of the frontal lobe

An extremely rare case of lipomas on the cerebral surface in a 65-year-old female is reported. The tumors were located both in an unusual fissure of the right frontal convexity and under the right frontal lobe associated with and surrounded by areas of focal cortical dysplasia. Angiograms revealed dilated branches of the right anterior cerebral artery associated with angiomatous tumor blushes. The etiology of the combination of the lipomas and the anomalies, and the angiographic features, are briefly discussed.

Traumatic brain injury associated with an intradiploic epidermoid cyst: case report

We present a case of an intradiploic epidermoid cyst with an unusual complication. After a minor fall, a patient with a large right parietal epidermoid suffered a traumatic brain injury caused by the transfer of the force of the fall through the cyst contents to the brain and by transdural herniation of the cyst contents into brain parenchyma. Elective resection of intradiploic epidermoids associated with large bony defects is recommended to avoid this apparently rare but potentially dangerous complication of an otherwise benign condition.

Lipoma of the cerebellopontine angle. Case reports and literature review

Two patients with cerebellopontine angle (CPA) lipoma were studied. They were submitted to surgical treatment. Available literature was reviewed and 29 cases with same lesion were identified which had been treated by surgery. Clinical manifestations, possibility of diagnostic methods, surgical indications and treatment strategies are discussed. Attention is called to the peculiarities of CPA lipomas and the doubtful validity of attempting complete excision in all cases.

CT and MRI features of intracranial germ cell tumors

The computed tomographic (CT) and magnetic resonance imaging (MRI) features of 73 histologically proven primary intracranial germ cell tumors were analysed. CT images were available for all 73 patients, and 22 of them were also examined by MRI. The tumors were classified as germinoma, mature teratoma, immature or malignant teratoma, yolk sac tumor, choriocarcinoma, embryonal carcinoma and mixed type. Germinoma was revealed as a high- or slightly high-density area on plain CT scan, and was enhanced homogeneously. MRI revealed iso- or slightly low signal intensity on T1-weighted images, and iso- or high intensity on T2-weighted images. Mature teratoma, which had a clear margin on neuroradiological images, was characterized by mixed density on CT scans, often showing large cysts and area of calcification. Immature or malignant teratoma had a similar pattern to that of mature teratoma, but the cystic components and area of calcification tended to be less and smaller respectively. The tumor margin was obscure in malignant teratoma, and perifocal edema was observed in some cases. The shape of yolk sac tumors was irregular. Plain CT scan revealed an iso- or low-density mass with good heterogeneous enhancement. Perifocal edema was observed in some cases. In mixed germ cell tumors, MRI imaging was useful for detecting teratomatous components, particularly fatty components. Although definite histological diagnosis cannot be achieved by CT and/or MRI alone, detailed analysis of neuroradiological images are useful for predicting the histological diagnosis.

Magnetic resonance of intracranial epidermoids

The magnetic resonance images of seven patients with biopsy-proven epidermoids were evaluated. The epidermoids were hypointense on T1-weighted images. Intermediate density images revealed the tumors to be heterogeneous in signal intensity consisting of areas of hypo- and isointensity. Signal intensity on T2-weighted images was hyperintense and inhomogeneous in all but one case. CT performed in five patients demonstrated the tumors to be well-defined hypodense lesions without contrast enhancement.

Pediatric supratentorial tumors

There is a multitude of variables that must be taken into account when interpreting an imaging study and deriving a differential diagnosis. These include the clinical as well as the imaging findings. An intelligent analysis of the imaging findings, whether CT or MR, and whether enhanced or not, will, in most cases, narrow the differential diagnosis. The imaging information, when taken along with the clinical information, should provide guidelines as to the next step, diagnostic or therapeutic. Ultimately, there is no substitute for histologic characterization when the diagnosis remains unresolved and there is a need to institute treatment.

Cerebellopontine angle lipoma in a teenager

Lipomas of the cerebellopontine angle are very rare lesions. To date, 18 patients have been reported, 17 of whom were adults. A second child is described with cerebellopontine angle lipoma.

Imaging of intrasellar, suprasellar, and parasellar tumors

The complex anatomy and multiple functions of the structures involved in the sella, suprasellar, and parasellar spaces present a challenge for the imager in identifying an etiology when symptoms are present. Computed tomography, magnetic resonance imaging, and arteriography all play roles depending upon the localization of the process. In this area, as in others, care must be exercised, as nonneoplastic masses may mimic those that are neoplasms. Studies must be tailored to answering questions posed by the differential diagnosis.

Adult infratentorial tumors

In adults, the combination of clinical presentation and imaging results permit prediction of the histology of a posterior fossa tumor. MR imaging, which uses various pulse sequences and contrast material is the most sensitive and precise technique for the evaluation of patients who have symptoms referrable to the posterior fossa.

Lipoma of the sylvian region

An exceptional case of lipoma of the sylvian region is described and the other seven reported cases are reviewed. The sylvian fissure is the most rare site of intracranial lipomas. Sylvian lipomas may be asymptomatic or present with epileptic seizures due to irritation of the cortex of the sylvian fissure. Only two previous cases have been diagnosed during life by computerized tomography and operated on; the deep location of these lipomas and their adherences to the sylvian cortex and the branches of the middle cerebral artery make radical removal impossible and dangerous.

Lipoma in the cerebellopontine angle

A case of lipoma in the cerebellopontine angle is reported. Intracranial lipomas are very rare, especially in the cerebellopontine angle. To our knowledge, only four cases, including our own, have been operated upon. Until now, total extirpation has not been possible. The singular appearance on computed tomography scanning of this dysembryoplasia is presented together with a bibliography of this subject.

Cerebellopontine angle lipoma

Lipomas rarely occur intracranially. Moreover, the cerebellopontine angle is one of the more unusual sites of such hamartomas. Of the 11 reported cases, all but three caused symptoms related to compression of the cranial nerves in the cerebellopontine angle. Only three separate cases have been studied by computed tomography, and in one the fat density was not recognized. This report deals with the clinical presentations, surgical management, and radiologic assessment of these lesions.

Dense suprasellar epidermoid cyst. A case report

A case of a dense epidermoid cyst of the suprasellar cistern is presented. The clinical symptoms were headache radiating to the left eye and a quadrant anopsia on the left eye. The density of the epidermoid was 62 HU and no significant contrast enhancement occurred after contrast application. The main feature which allows differentiation from other hyperdense suprasellar lesions seems to be the lack of contrast enhancement.

Epidermoid tumor of the fourth ventricle: use of metrizamide-computed tomography

This report describes two cases of epidermoid tumor of the fourth ventricle diagnosed with metrizamide computed tomography. They both presented as a low-density lesion in the region of the fourth ventricle on computed tomography. They did not show any enhancement after intravenous injection of contrast medium and had no hydrocephalus. Metrizamide-enhanced computed tomography demonstrated the irregular fourth-ventricular filling defect characteristic of epidermoid tumors.