Intracranial epidermoid cyst in a horse

Computed Tomography and Magnetic Resonance Imaging of an Epidermoid Cyst in a Foot of a Horse

An 18-year-old Quarter Horse mare was evaluated because of moderate left forelimb lameness of 4 weeks' duration. The clinical evaluation and diagnostic perineural analgesia localized the lameness to the distal portion of the left forelimb. There was swelling on the dorsal and lateral aspect of the coronary band. Radiography, ultrasound, magnetic resonance imaging, and computed tomography of the foot revealed circumscribed well-capsulated soft tissue mass causing a focal deformation of the dorsolateral border of the middle phalanx. The treatment aimed to remove the mass surgically and stabilized the interphalangeal joint, but the owner elected human euthanasia before treatment attempt. Histopathology diagnosis was an epidermoid cyst, which was characterized by multilayers of keratin surrounded by stratified squamous epithelium. Although rare, an epidermoid cyst should be considered as a differential diagnosis for space-occupying mass in horses' foot that develops chronic lameness after trauma. This report describes the multimodality appearance of the epidermoid cyst.

Epidermoid cysts of the rumen in a Holstein-Friesian steer

Epidermoid cysts were identified in the rumen of a 2-year-old Holstein-Friesian steer. Small nodules (<4 mm diameter) filled with paste-like, friable, white material were scattered in the rumen wall. Microscopically, the nodules were located in the submucosal connective tissue and comprised of cysts lined by stratified squamous epithelium surrounding keratin debris, exhibiting features identical to those of epidermoid cysts. The cysts were surrounded by chronic inflammation. The ruminal mucosa contained vesicles or cystic cavities filled by inflammatory exudate, in addition to empty cystic spaces lined by flattened endothelial cells, which were possibly of lymphatic origin. The development of these epidermoid cysts might have resulted from implantation of exfoliated squamous epithelial cells from damaged ruminal epithelium into the submucosal connective tissue, although the precise aetiology of this anomaly remains to be defined.

IMAGING DIAGNOSIS - INTRACRANIAL EPIDERMOID CYST IN A DOBERMAN PINSCHER

A 4-year-old Doberman Pinscher was evaluated for chronic progressive central vestibular disease and aggressiveness. A cyst-like lesion was identified in the region of the left cerebellopontine angle. The lesion was hypointense on T1-weighted and hyperintense on T2-weighted images. Differentials included an epidermoid or dermoid cyst, cystic neoplasm, and brain abscess. Hyperintensity on subsequent fluid-attenuated inversion recovery images excluded an arachnoid cyst. The histopathologic diagnosis was epidermoid cyst within the fourth ventricle.

INTRACRANIAL EPIDERMOID CYST AND SYRINGOHYDROMYELIA IN A DOG

A 5-year-old female Cocker Spaniel dog had a sudden onset of vestibular disease that localized to the caudal fossa. Upon computed tomography of the brain, a large, hypoattenuating mass with a slight peripheral ring enhancement pattern was detected ventral to the cerebellum. A hypoattenuating region was also identified in the center of the C2 spinal cord segment, consistent with syringohydromyelia. Postmortem examination of the brain revealed a fluid filled, cystic mass located dorsal to medulla oblongata that caused severe compression of the overlying cerebellum. The histopathologic diagnosis was an epidermoid cyst. Extensive syringohydromyelia and obstructive hydrocephalus were identified, both thought to be secondary to overcrowding of the caudal fossa.

Detection of an epidermoid cyst in the foot of a horse by use of magnetic resonance imaging

CASE DESCRIPTION-A 4-year-old Quarter Horse stallion was evaluated because of a 10-month history of moderate (grade 3/5) left forelimb lameness (detectable during trotting over a smooth, hard surface). CLINICAL FINDINGS-No abnormalities were detected in either forelimb via palpation or application of hoof testers; however, lameness was eliminated after administration of a palmar digital nerve block in the left forelimb. Whereas radiography and ultrasonography did not identify any left forelimb foot abnormalities, magnetic resonance (MR) imaging revealed a circumscribed soft tissue mass in the distal aspect of the digital flexor tendon sheath (DFTS) dorsal to the lateral aspect of the deep digital flexor tendon. Subsequently, the left forelimb DFTS was injected with local anesthetic, which resulted in 90% improvement of the horse's lameness. TREATMENT AND OUTCOME-The distal aspect of the left forelimb DFTS was evaluated tenoscopically. The mass was removed under tenoscopic guidance, after which the distal digital annular ligament was transected. The horse received phenylbutazone orally for 10 days, and the left forelimb DFTS was injected with hyaluronic acid and methylprednisolone acetate 7 days after the surgery. Following a rehabilitation program, the horse was returned to full training at 6 months after surgery and competed successfully during a 2-year follow-up period. CLINICAL RELEVANCE-Use of MR imaging should be considered in all lame horses for which a definitive diagnosis cannot be made via radiography, ultrasonography, or other imaging techniques, especially when the lameness has been localized to a specific anatomic region by use of diagnostic anesthesia.