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Zuo P, Sun T, Wang Y, Geng Y, Zhang P, Wu Z, Zhang J, Zhang L. Primary Squamous Cell Carcinomas Arising in Intracranial Epidermoid Cysts: A Series of Nine Cases and Systematic Review. Front Oncol 2021; 11:750899. [PMID: 34765553 PMCID: PMC8576414 DOI: 10.3389/fonc.2021.750899] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Accepted: 09/30/2021] [Indexed: 11/26/2022] Open
Abstract
Objective Primary squamous cell carcinomas (PSCCs) arising in intracranial epidermoid cysts (IECs) are very rare, and their management and prognostic factors remain unclear. This study aimed to enunciate the clinical features and suggest a treatment protocol based on cases from the literature and the cases from our institution. Methods The clinicoradiological data were obtained from nine patients with PSCCs arising in IECs, who underwent surgical treatment at Beijing Tiantan Hospital between July 2012 and June 2018. We also searched the PubMed database using the keywords “epidermoid cyst(s)” or “epidermoid tumor(s)” combined with “malignant” or “malignancy” or “intracranial” or “brain” or “squamous cell carcinoma” between 1960 and 2020. Risk factors for overall survival (OS) were evaluated in the pooled cohort. Results The mean age of our cohort was 51.2 ± 8.3 years (range: 39–61 years), which included eight males and one female. Gross total resection (GTR) was achieved in three patients, while non-GTR was achieved in six patients. Radiotherapy was administered to five patients. After a median follow-up of 16.7 ± 21.6 months (range: 3–72 months), eight patients died with a mean OS time of 9.75 ± 6.6 months (range: 3–23 months). In the literature between 1965 and 2020, 45 cases of PSCCs arising in IECs were identified in 23 males and 22 females with a mean age of 55.2 ± 12.4 years. GTR, non-GTR, and biopsy were achieved in six (13.3%), 36 (80%), and three (6.7%) cases, respectively. After a mean follow-up of 12.7 ± 13.4 months (range: 0.33–60 months), 54.1% (20/37) patients died, and recurrence occurred in 53.6% (15/28) patients. A multivariate analysis demonstrated that postoperative radiotherapy (p = 0.002) was the only factor that favored OS. The Kaplan–Meier analysis showed that, compared with no radiotherapy (median survival time: 4 months), radiotherapy (median survival time: 24 months) had significantly prolonged OS (p = 0.0011), and GTR could not improve OS (p = 0.5826), compared with non-GTR. The 1-year OS of patients with or without radiotherapy was 72.5% or 18.2%, respectively. Conclusion Malignant transformation of IEC into PSCC was prevalent in elderly patients, with slight male predominance. GTR of previous benign IECs is recommended. For remnant benign IECs, close follow-up should be performed. Postoperative radiotherapy for PSCCs could bring survival benefit. GTR of these malignant intracranial tumors is difficult when they involve important brain structures. Future studies with larger cohorts are necessary to verify our findings.
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Affiliation(s)
- Pengcheng Zuo
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Tao Sun
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yi Wang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yibo Geng
- Department of Neurosurgery, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Peng Zhang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Zhen Wu
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Junting Zhang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Liwei Zhang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China.,Beijing Key Laboratory of Brain Tumor, Beijing, China
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Kaneko T, Fujinaga Y, Ichinohe F, Ogiwara T, Horiuchi T. Spontaneous Regression of Radiologically Diagnosed Epidermoid Cyst Originating from the Cerebellopontine Angle. World Neurosurg 2020; 144:238-243. [PMID: 32971281 DOI: 10.1016/j.wneu.2020.09.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 09/01/2020] [Accepted: 09/02/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND Generally, asymptomatic epidermoid cysts (ECs) or ECs with minor symptoms controlled by medication are not treated further. Although epidermoid carcinomas are only sporadically reported, the possibility of malignant transformation of ECs is of concern. CASE DESCRIPTION A 77-year-old man under observation for a left cerebellopontine angle tumor presented with no symptoms, including headache, dizziness, or other cranial nerve abnormalities typical of cerebellopontine angle tumors. The tumor manifested as an extra-axial mass in the left cerebellopontine angle and measured 24 × 16 mm (length × width) on magnetic resonance imaging (MRI). As he was asymptomatic, his primary physician did not pursue invasive treatment but ordered follow-up MRI every 2 years. The tumor decreased in size 2 years after the initial MRI, and no tumor fragmentation was observed on the patient's spinal MRI. Ultimately, the tumor shrank to 19 × 11 mm over 22 years. CONCLUSIONS The reduction of an EC is extremely rare. We report a case of spontaneous regression of an EC and consider similar previous cases.
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Affiliation(s)
- Tomoki Kaneko
- Department of Radiology, Shinshu University School of Medicine, Matsumoto, Japan.
| | - Yasunari Fujinaga
- Department of Radiology, Shinshu University School of Medicine, Matsumoto, Japan
| | - Fumihito Ichinohe
- Department of Radiology, Shinshu University School of Medicine, Matsumoto, Japan
| | - Toshihiro Ogiwara
- Department of Neurosurgery, Shinshu University School of Medicine, Matsumoto, Japan
| | - Tetsuyoshi Horiuchi
- Department of Neurosurgery, Shinshu University School of Medicine, Matsumoto, Japan
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Chen Z, Araya M, Onishi H. Proton beam therapy for malignant transformation of intracranial epidermoid cyst. BMJ Case Rep 2019; 12:12/7/e229388. [PMID: 31320371 DOI: 10.1136/bcr-2019-229388] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
We report the first clinical case on the successful use of proton beam therapy in the management of malignant transformation of intracranial epidermoid cyst. A 43-year-old man was initially diagnosed as this disease with left facial paresis, hypesthesia and hypoalgesia in the territories of the trigeminal nerve. After failure of surgical interventions, he was referred to our radiation centre. We performed a postoperative proton beam therapy for treatment. We delivered a total dose of 57 GyE in 31 fractions. He tolerated the treatment well with mild acute toxicities and remained healthy and functional by 2-year follow-up postradiotherapy. No evidence of delayed radiation-induced neurotoxicity was observed.
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Affiliation(s)
- Zhe Chen
- Radiology, University of Yamanashi Faculty of Medicine, Chuo, Yamanashi, Japan
| | - Masayuki Araya
- Proton Therapy Centre, Aizawa Hospital, Matsumoto, Nagano, Japan
| | - Hiroshi Onishi
- Radiology, University of Yamanashi Faculty of Medicine, Chuo, Yamanashi, Japan
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Treatment and Survival Outcomes of Primary Intracranial Squamous Cell Carcinoma. World Neurosurg 2019; 125:e1-e9. [DOI: 10.1016/j.wneu.2018.11.252] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Revised: 11/28/2018] [Accepted: 11/30/2018] [Indexed: 11/20/2022]
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Liu X, Chen Z, Dong Y, He X, Pan X, Tong D. Primary Intracranial Squamous Cell Carcinoma Arising De Novo: A Case Report and Review of the Literature. World Neurosurg 2018; 120:372-381. [DOI: 10.1016/j.wneu.2018.08.067] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Revised: 08/10/2018] [Accepted: 08/11/2018] [Indexed: 11/26/2022]
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Roh TH, Park YS, Park YG, Kim SH, Chang JH. Intracranial squamous cell carcinoma arising in a cerebellopontine angle epidermoid cyst: A case report and literature review. Medicine (Baltimore) 2017; 96:e9423. [PMID: 29390569 PMCID: PMC5758271 DOI: 10.1097/md.0000000000009423] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
RATIONALE Most of the intracranial epidermoid cysts are benign, but malignant lesions are occasionally reported. These lesions appear as squamous cell carcinoma and carry a dismal prognosis. Here, we report a case of a primary intracranial squamous cell carcinoma arising in a cerebellopontine epidermoid cyst. The relevant literatures were also reviewed. PATIENT CONCERNS A 53-year-old woman presented with dizziness and diplopia 9 months in duration. Magnetic resonance imaging revealed an epidermoid cyst in the left cerebellopontine angle and prepontine region with a focal enhancing lesion on T1-weighted gadolinium-enhanced images. DIAGNOSES Histopathologic diagnosis revealed squamous cell carcinoma on a background of epidermoid cyst. Imaging studies excluded metastases. INTERVENTIONS The tumor was removed subtotally through a lateral suboccipital approach. The patient received intensity modulated radiation therapy (6720 cGy total) postoperatively. OUTCOMES The patient was free from recurrence of the tumor until 3 years after surgery, at which point she was lost to follow-up. The patient died 4 years after the surgery. LESSONS The epidermoid cyst may occasionally become malignant. Finding an area of enhancement through preoperative magnetic resonance imaging can help to make a correct diagnosis. Based on the review of previous reports, surgical removal followed by radiotherapy shows the best result to treat malignant epidermoid cysts.
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Affiliation(s)
- Tae Hoon Roh
- Yonsei University Graduate School
- Department of Neurosurgery, Ajou University Hospital, Suwon
| | - Yong Sook Park
- Department of Neurological Surgery, Chung-Ang University Yongsan Hospital
| | | | - Se Hoon Kim
- Department of Pathology, Brain Tumor Center, Brain Research Institute, Yonsei University Health System, Seoul, Republic of Korea
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Nagasawa DT, Choy W, Spasic M, Yew A, Trang A, Garcia HM, Yang I. An analysis of intracranial epidermoid tumors with malignant transformation: treatment and outcomes. Clin Neurol Neurosurg 2012; 115:1071-8. [PMID: 23219403 DOI: 10.1016/j.clineuro.2012.10.026] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2012] [Accepted: 10/29/2012] [Indexed: 11/26/2022]
Abstract
OBJECTIVE While typically benign, epidermoid tumors upon rare occasion can undergo malignant transformation, which carries a poor prognosis. Here, we reviewed treatment strategies and analyzed outcomes for every case of malignant epidermoid tumor reported since its original description in 1912. METHODS A comprehensive literature review identified all reported cases of malignant transformation of intracranial epidermoid tumor. Treatments were categorized as follows: palliative management, stereotactic radiosurgery (SRS), chemotherapy, and surgery plus multiple (2+) adjuvant therapies. Survival data of these groups were compared to treatment outcomes for patients receiving only surgical resection, as reported in our previous study. RESULTS We identified 58 cases of intracranial epidermoid tumor with malignant degeneration. Average survival regardless of therapy was 11.8 months. Mean survival outcomes for groups treated with palliative management, chemotherapy, SRS, and multiple postoperative adjuvant therapies were 5.3 months, 25.7 months, 29.2 months, and 36.3 months, respectively. Outcomes for the groups including SRS, chemotherapy, and multiple post-operative adjuvant therapies were statistically significant compared to surgical resection alone. CONCLUSION While there remains a lack of consensus regarding the best approach to the management of patients with malignant epidermoid tumors, our systematic analysis characterizes and confirms the added benefit of SRS, chemotherapy, and multimodal adjuvant therapies.
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Affiliation(s)
- Daniel T Nagasawa
- UCLA Department of Neurological Surgery, University of California Los Angeles, Los Angeles, CA 90095-1761, USA
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Survival outcomes for radiotherapy treatment of epidermoid tumors with malignant transformation. J Clin Neurosci 2011; 19:21-6. [PMID: 22024232 DOI: 10.1016/j.jocn.2011.06.002] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2011] [Revised: 06/09/2011] [Accepted: 06/11/2011] [Indexed: 11/21/2022]
Abstract
Epidermoid tumors are intracranial lesions that may occasionally undergo malignant transformation. Although surgical resection is the first-line treatment for malignant epidermoids, postoperative radiotherapy has been intermittently reported with favorable findings. Our analysis identified all previously reported patients with malignant epidermoids treated with surgical resection alone or surgery plus radiotherapy to examine the potential role for this adjuvant therapy. Whereas patients treated with surgery only had an overall survival of 6.6 months, those treated with postoperative radiotherapy demonstrated a statistically significant increase in survival to 12.7 months (log-rank test, p<0.003). Furthermore, the mean dosage of radiation given to this patient population was 52.2 Gy, with no appreciable survival benefit for the utilization of levels of radiation greater than 50 Gy. When determining the management for malignant transformation of epidermoid tumors, the combination of surgical resection and radiotherapy may be associated with improved short-term survival.
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Nagasawa D, Yew A, Safaee M, Fong B, Gopen Q, Parsa AT, Yang I. Clinical characteristics and diagnostic imaging of epidermoid tumors. J Clin Neurosci 2011; 18:1158-62. [PMID: 21742503 DOI: 10.1016/j.jocn.2011.02.008] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2011] [Revised: 02/16/2011] [Accepted: 02/22/2011] [Indexed: 11/20/2022]
Abstract
Epidermoid tumors are rare, benign congenital lesions which typically present between the third and fifth decades of life. They are thought to originate from ectodermal cells misplaced during neural tube formation and separation. While epidermoids may present anywhere in the cranial vault, they are characteristically located intradurally and in a paramedian position within the cerebellopontine angle and parasellar regions. Although imaging results may vary depending upon cystic content, CT scanning generally reveals a well-circumscribed, nonenhancing, lobulated, hypodense mass. They are hypointense on T1-weighted MRI, and hyperintense on T2-weighted MRI, diffusion-weighted imaging and fluid-attenuated inversion recovery sequences. The use of appropriate neuroimaging should be utilized to differentiate epidermoids from other intracranial lesions. While gross total resection of these tumors is the definitive treatment to prevent recurrence and aseptic meningitis, a subtotal resection may be necessary to preserve neurological function.
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Affiliation(s)
- Daniel Nagasawa
- Department of Neurological Surgery, University of California Los Angeles, 695 Charles E. Young Drive South, Gonda 3357, Los Angeles, CA 90095-1761, USA
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KANO T, IKOTA H, KOBAYASHI S, IWASA S, KUROSAKI S, WADA H. Malignant Transformation of an Intracranial Large Epidermoid Cyst With Leptomeningeal Carcinomatosis -Case Report-. Neurol Med Chir (Tokyo) 2010; 50:349-53. [DOI: 10.2176/nmc.50.349] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Tomoaki KANO
- Department of Neurosurgery, Fukaya Red Cross Hospital
| | - Hayato IKOTA
- Department of Pathology, Fukaya Red Cross Hospital
| | | | - Susumu IWASA
- Department of Neurosurgery, Fukaya Red Cross Hospital
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Kim MS, Kim OL. Primary intracranial squamous cell carcinoma in the brain stem with a cerebellopontine angle epidermoid cyst. J Korean Neurosurg Soc 2008; 44:401-4. [PMID: 19137089 DOI: 10.3340/jkns.2008.44.6.401] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2008] [Accepted: 11/24/2008] [Indexed: 11/27/2022] Open
Abstract
Primary intracranial squamous cell carcinoma is extremely rare, with most cases arising from a preexisting benign epidermoid cyst. We report a rare case of primary intracranial squamous cell carcinoma in the brain stem with a cerebellopontine angle (CPA) epidermoid cyst. A 72-year-old female suffered from progressive left hemiparesis, difficulty in swallowing, and right hemifacial numbness. Diffusion-weighted magnetic resonance imaging revealed a high signal intensity (SI) lesion in the CPA region and an intra-axially ring-enhanced cystic mass in the right brain stem with low SI. Whole-body positron emission tomography showed no evidence of metastatic disease. The histological findings revealed a typical epidermoid cyst in the CPA region and a squamous cell carcinoma in the brain stem. We speculate that the squamous cell carcinoma may have been developed due to a chronic inflammatory response by the adjacent epidermoid cyst. The patient underwent a surgical resection and radiotherapy. After 12 months, she had no evidence of recurrence.
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Affiliation(s)
- Min-Su Kim
- Department of Neurosurgery, Yeungnam University College of Medicine, Daegu, Korea
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Kodama H, Maeda M, Hirokawa Y, Suzuki H, Hori K, Taki W, Takeda K. MRI findings of malignant transformation of epidermoid cyst: case report. J Neurooncol 2006; 82:171-4. [PMID: 17004101 DOI: 10.1007/s11060-006-9255-5] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2006] [Accepted: 08/23/2006] [Indexed: 10/24/2022]
Abstract
Malignant transformation of epidermoid cysts into squamous cell carcinoma (SCC) rarely occurs. A 67-year-old man initially presented with an 8-year history of right trigeminal neuralgia. His symptoms had changed into right facial anesthesia with right-ear hearing impairment 8 months before first consulting a neurosurgeon at our hospital. Results obtained using MRI suggested an epidermoid cyst in the right cerebellopontine angle, but showed atypical findings of a small enhancing nodule in the periphery and surrounding edema in the cerebellum and pons. Surgery was performed to remove the mass, but a small nodule was not reached. Despite stereotactic radiosurgery, the patient's clinical course deteriorated; he died 13 months after the first MRI examination. Autopsy revealed SCC originating from the epidermoid cyst. We present serial MRI and pathologic findings in the early and terminal phases of this patient.
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Affiliation(s)
- Hiroshi Kodama
- Department of Radiology, Mie University School of Medicine, 2-174 Edobashi, Tsu, Mie, 514-8507, Japan
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Nambu A, Imanishi Y, Iwasaki Y, Fujikawa M, Hayashi T, Shinagawa T, Araki T. Intradiploic epidermoid cyst with focal internal enhancement. ACTA ACUST UNITED AC 2006; 24:224-7. [PMID: 16875312 DOI: 10.1007/s11604-005-1545-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
We report a case of intradiploic epidermoid cyst with focal internal enhancement. The patient was a 55-year-old woman presenting with right temporal head protrusion and head heaviness. Skull radiography and computed tomography demonstrated an expansile mass in the right diploic space. On magnetic resonance imaging, the mass showed makedly high signal T2-weighted images (T2WI) and intermediate to low signal on T1WI. On contrast-enhanced T1WI, there was nodular internal enhancement, which corresponded to neovascularity on pathology, as well as rim-like enhancement. It should be noted that internal enhancement, an indicator of malignant transformation, may be seen even in a benign epidermoid cyst.
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Affiliation(s)
- Atsushi Nambu
- Department of Radiology, St. Marianna University Toyoko Hospital, Kosugi-cho, Nakahara-ku, Kawasaki 211-0063, Japan.
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Hamlat A, Hua ZF, Saikali S, Laurent JF, Gedouin D, Ben-Hassel M, Guegan Y. Malignant transformation of intra-cranial epithelial cysts: systematic article review. J Neurooncol 2005; 74:187-94. [PMID: 16193391 DOI: 10.1007/s11060-004-5175-4] [Citation(s) in RCA: 70] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
INTRODUCTION Epidermoid and dermoid cysts are among the most benign intra cranial tumors. Their malignant transformation into squamous cell carcinoma is rare. The authors reviewed the literature. MATERIALS AND METHODS MEDLINE and SCIENCE DIRECT searches, and examination of the references in the selected articles yielded 74 patients, 52 of whom fulfilled Garcia's criteria and were selected for the study. Survival analyses were performed to determine whether survival differences were of statistical significance, and P < 0.05 was considered as significant. RESULTS Malignant transformation is characterized by a rapid onset of symptoms, recurrence, leptomeningeal carcinomatosis (LC), and tumor enhancement at Computed Tomography Scan or Magnetic Resonance Imaging (87.8 showed this radiological feature). In this review, the SCCs were classified in five groups: (1) Initial malignant transformation of a benign cyst; (2) malignant transformation from a remnant cyst; (3) malignant transformation of a dermoid and epithelial cyst; (4) malignant transformation with leptomeningeal carcinomatosis; (5) other malignancies arising from benign cysts. The median survival was 9 months. Statistics show that LC was of poor prognosis and radiotherapy, although not statistically significant, seems effective against such lesions, with a median survival of 26 months as opposed to 3 months (P=0.077). CONCLUSION Although rare, malignant transformation of intracranial epithelial cysts has a poor prognosis and surgery followed by radiotherapy seems to be the best therapeutic modality.
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Affiliation(s)
- Abderrahmane Hamlat
- Department of Neurosurgery, Service de Neurochirurgie, CHRU Pontchaillou, Rue Henry Le Guilloux, 35000 Rennes Cedex 2, France.
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Iaconetta G, Carvalho GA, Vorkapic P, Samii M. Intracerebral epidermoid tumor: a case report and review of the literature. ACTA ACUST UNITED AC 2001; 55:218-22. [PMID: 11358593 DOI: 10.1016/s0090-3019(01)00346-9] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND Intracerebral epidermoid cysts are rare lesions and may account for only 1.5% of intracranial epidermoid tumors. Cell entrapment from the mesectodermal origin of the neural crest within the primitive cerebral hemisphere may lead to the formation of such rare intracerebral lesions. METHODS An intracerebral epidermoid cyst located in the right temporal lobe that was surgically treated is presented. The origin, clinical course, radiological features, and surgical treatment of such uncommon lesions are discussed based on a review of the literature. RESULTS Intraoperative findings revealed an epidermoid tumor. The postoperative course was uneventful and the patient was discharged with no neurological deficits. On long-term follow-up (2 years), there were no signs of recurrence. CONCLUSIONS Truly intracerebral epidermoid tumors are rarely found. Cells originating from mesectodermal lines may migrate and remain trapped within the primitive cerebral hemisphere while the neural tube is closing, leading to the formation of such intraparenchymal epidermoid tumors. Accurate preoperative diagnosis can be very difficult due to the radiological similarities to other common intracerebral cysts (e.g., astrocytomas or gliomas). Magnetic resonance imaging (MRI) studies, especially with diffusion-weighted images, allow greater accuracy in the preoperative differential diagnosis. Radical surgical removal should be attempted, but a less aggressive surgical strategy should be considered if there is strong adherence between the tumor capsule and the brain tissue, particularly in eloquent areas.
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Affiliation(s)
- G Iaconetta
- Department of Neurosurgery, School of Medicine "Federico II", Naples, Italy
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