Intraparenchymal epidermoid cyst: proper surgical management may lead to satisfactory outcome

Diagnosis and therapy of giant epidermoid double cysts with infection on the buttock: A case report and literature review

RATIONALE

Epidermoid cyst (EC) is a common clinical condition and it can be filled with keratinized material. EC often represents painless, slow progressive growth, and single cyst. The cyst is usually 1 to 5 cm in size. Giant epidermoid cysts on the buttock area are extremely rare, and reports of giant epidermoid double cysts on the buttock are even rarer.

PATIENT CONCERNS

This paper reports a patient with a painless mass was on the left buttock.

DIAGNOSIS

A giant epidermoid double cysts with infection in a left buttock paranal location.

INTERVENTIONS

The mass was surgically removed.

OUTCOMES

The patient recovered well after surgical treatment and currently has no recurrence.

CONCLUSION

For patients with EC, MRI is recommended as a routine examination before surgery in order to detect the variation and extent of the cyst early. This lays a foundation for the complete resection of the lesion during the operation. The review of relevant literature will hopefully be helpful to clinicians.

Intrinsic epidermoid cyst of the brainstem in children-review and case report

PURPOSE

The study aimed to summarize all published cases of intrinsic brainstem epidermoid cysts in a timeline to highlight the specific characteristics and individualize the disease, in addition to discussing the best treatment used.

METHODS

The scientific literature on pediatric cases of intrinsic epidermoid cysts of the brainstem was analyzed. We present the case of a 1.5-year-old male with incidental presentation, who was treated with gross total resection. We summarize all previously published cases to individualize the disease.

RESULTS

We identified 21 patients, including 10 boys and 11 girls, with a mean age of 4.85 (1-15) years at the time of surgery. The most frequent symptoms were cranial nerve palsy (71.4%), pyramidal tract deficit (57.14%), and headache (52.38%). Among the affected cranial nerves, VII was the most frequently reported in 10 patients.

CONCLUSION

Brainstem epidermoid cysts are extremely rare pathologies with relevant age involvement in young children. The treatment objective should be the maximum resection of the lesion through a careful approach and with the appropriate tools for the functional preservation of the patient.

Incidental findings on brain magnetic resonance imaging (MRI) in adults: a review of imaging spectrum, clinical significance, and management

Utilization of brain MRI has dramatically increased in recent decades due to rapid advancement in imaging technology and improving accessibility. As a result, radiologists increasingly encounter findings incidentally discovered on brain MRIs which are performed for unrelated indications. Some of these findings are clinically significant, necessitating further investigation or treatment and resulting in increased costs to healthcare systems as well as increased patient anxiety. Moreover, management of these incidental findings poses a significant challenge for referring physicians. Therefore, it is important for interpreting radiologists to know the prevalence, clinical consequences, and appropriate management of these findings. There is a wide spectrum of incidental findings on brain MRI such as asymptomatic brain infarct, age-related white matter changes, microhemorrhages, intracranial tumors, intracranial cystic lesions, and anatomic variants. This article provides a narrative review of important incidental findings encountered on brain MRI in adults with a focus on prevalence, clinical implications, and recommendations on management of these findings based on current available data.

Establishment and Verification of a Prediction Model for Identifying Pathologic Infections Based on the Clinical Characteristics of Epidermoid Cysts

Background: To construct a prediction model based on the clinical characteristics of epidermoid cysts to identify pathologic infections, evaluate the diagnostic accuracy of the model, and conduct preliminary verification. Patients and Methods: We conducted a retrospective analysis of 314 patients diagnosed with epidermoid cysts that had been removed surgically. The clinical and pathologic data of all patients were collected. The patients were divided randomly into modeling group and verification group in a 75:25 ratio. In the modeling group, the multifactor logistic regression method was used to construct a prediction model for identifying epidermoid cyst pathologic infection, and the receiver operating characteristic (ROC) curve was used to evaluate the diagnostic accuracy of the model, which was then validated in the verification group. Results: All 314 patients with epidermoid cysts were divided into non-infected group (183 cases) and infected group (131 cases) according to the pathologic results. Logistic regression analysis showed that the disease course, growth trend, redness, and texture of epidermoid cysts were independent factors affecting pathologic infection. The above four indicators were selected to construct the prediction model of epidermoid cyst pathologic infection. In the modeling group, the prediction model showed an area under the curve (AUC) of 0.898, with the sensitivity of 0.830, specificity of 0.890, positive likelihood ratio of 7.523, and negative likelihood ratio of 0.191. The AUC of the prediction model in the verification group was 0.919, which was not significantly different from that of the modeling group (p = 0.886). Conclusions: The prediction model based on the clinical characteristics of epidermoid cysts had good diagnostic accuracy and high specificity; it can be used to identify pathologic infections of epidermoid cysts.

Clinicoradiological Features and Treatment Outcome of Supratentorial Intraparenchymal Epidermoid Cyst: A Report of Five Cases and Literature Review

Objectives  Intraparenchymal epidermoid cysts (IECs) are rare lesions. They represent less than 1% of the intracranial epidermoid cysts. The supratentorial IEC is a clinically and prognostically distinct subset. Given the rarity, most of the articles are case reports. We present a series of five cases of supratentorial IEC to characterize their clinical presentation and outcome, with emphasis on the surgical features.

Materials and Methods  We searched our database for all cases of intracranial epidermoid cysts operated between January 2005 and January 2020. Five patients were identified having IEC from the hospital information system and the neurosurgical operation record book. Standard craniotomy and decompression of the lesion were performed in all these patients. Standard postoperative care includes computed tomography scan of head on the day of surgery and magnetic resonance imaging of brain after 6 weeks to look for the residual lesion, if any. Subsequent follow-up visits in outpatient department to look for resolution of the presurgical symptoms.

Results  The mean age of the patients in our series was 28.8 years (range: 28–40 years.). All the five patients were male. Four patients had IEC involving frontal lobe and one in parietal lobe with a small occipital lobe extension. Seizure was the most common presenting complaint followed by headache. Complete excision was achieved in all the cases. All the three patients with seizure attained seizure freedom postlesionectomy. Focal neurological deficits resolved gradually in postoperative period. There was no recurrence of lesion during follow-up.

Conclusion  Supratentorial IEC most commonly affects young males, involve frontal lobe and present clinically with seizure. Complete surgical excision offers best outcome in the form of remission of seizure disorder.

Intradiploic Epidermoid Cyst Causing Otitis Media with Effusion: Case Report and Review of the Literature

BACKGROUND

Epidermoid cysts are rare, slow-growing, benign tumors. They commonly occur at the cerebellopontine angle or the suprasellar region, and they can also occur in the skull. Intradiploic epidermoid cysts are often detected incidentally, but their progression can cause various symptoms.

CASE DESCRIPTION

The patient was a 49-year-old woman who was diagnosed with otitis media with effusion based on a reported sensation of left ear blockage. Thorough examination revealed a mass lesion in the left occipital bone. Computed tomography depicted a mass lesion on the left occipital bone, part of which reached the inner table of the skull and eroded the mastoid air cell. On magnetic resonance imaging, T1-weighted signal was low but T2-weighted signal and diffusion-weighted signal were high. An intradiploic epidermoid cyst was suspected on the basis of imaging results, and it was surmised that mastoid cellulitis by the mass lesion accompanied by bone destruction had progressed to otitis media with effusion. The pathologic diagnosis was epidermoid cysts. Six months after the operation the otitis media with effusion had improved, and there had been no recurrence of epidermoid cysts.

CONCLUSIONS

We experienced a case of occipital bone intradiploic epidermoid cysts diagnosed in conjunction with otitis media with effusion.

Intraparenchymal Epidermoid Cyst Close to Broca Area-Awake Craniotomy and Gross Total Resection

BACKGROUND

Epidermoid tumors, or epidermoid cysts (ECs), are benign, slow-growing, congenital, and rare lesions that represent approximately 0.2%-1.8% of all intracranial tumors. Intraparenchymal ECs are very rare lesions that may account for 1.5% of all intracranial epidermoid tumors; frontal lobe involvement is found in 39.2% of intraparenchymal ECs. We present a case using awake craniotomy to achieve maximal safe gross total resection of a rare intraparenchymal EC close to Broca area in a bilingual patient.

CASE DESCRIPTION

A 45-year-old man presented with a generalized seizure episode. He was initially treated with levetiracetam, which led to renal failure. Imaging findings demonstrated an intraparenchymal left frontal EC with peripheral coarse calcifications at Broca area. As the patient was bilingual and had a normal neurologic examination, we performed a left frontal awake craniotomy under local anesthesia so as to map both languages, using the motor task and a test for language monitoring, alternating a naming task in Portuguese and English and a semantic task in Portuguese. A gross total resection was achieved with no neurologic deficits. Histopathologic examination confirmed the diagnosis of an epidermoid cyst. After 1 year, the patient is still seizure-free.

CONCLUSIONS

Awake surgery proved to be a useful tool for complete resection of the capsule even in a very eloquent language area. In multilingual patients with benign intra-axial lesions, intraoperative mapping should be performed for all the languages in which the patient is fluent to avoid postoperative neurologic deficits.