1
|
Ahuja S, Mankotia DS, Zaheer S. Enigmatic echoes: Exploring brainstem neurenteric cysts - A case series and literature review. Int J Surg Case Rep 2024; 117:109573. [PMID: 38531289 PMCID: PMC10979191 DOI: 10.1016/j.ijscr.2024.109573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Revised: 03/16/2024] [Accepted: 03/19/2024] [Indexed: 03/28/2024] Open
Abstract
INTRODUCTION AND IMPORTANCE Neurenteric cysts (NCs) are rare congenital anomalies within the central nervous system, originating from the endodermal layer due to inappropriate embryonic notochordal plate and endoderm separation. Despite constituting a minute fraction of CNS tumors, their diverse clinical presentations and brainstem occurrence pose diagnostic challenges. CASE PRESENTATION This study presents a series of three brainstem NCs, detailing demographics, clinical presentations, radiological features, and operative findings. Patients aged 2-40 years exhibited varied symptoms including headaches, vomiting, cranial nerve deficits, and motor/sensory deficits. Literature review of 27 cases showed a mean age of 26.8 years, predominantly in females, with diverse cystic characteristics on MRI. Surgical intervention achieved mostly complete resection, with varying outcomes including recurrence and malignant transformation. CLINICAL DISCUSSION This study sheds light on the rare entity of brainstem NCs, emphasizing their diagnostic complexity. NCs, though constituting a minute fraction of CNS tumors, present a diagnostic challenge due to their diverse clinical presentations and rarity in the brainstem. CONCLUSION This study provides insights into brainstem NCs, emphasizing diagnostic complexity and the importance of MRI in accurate diagnosis and surgical intervention. Enhanced collaboration is needed to refine management strategies for these intriguing lesions.
Collapse
Affiliation(s)
- Sana Ahuja
- Department of Pathology, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Dipanker Singh Mankotia
- Department of Neurosurgery, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Sufian Zaheer
- Department of Pathology, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India.
| |
Collapse
|
2
|
Elshamy W, Ozaydin B, Sayyahmelli S, Salamat MS, Baskaya MK. A Neuroenteric Cyst of the Cavernous Sinus: A Case Report. J Neurol Surg Rep 2023; 84:e80-e84. [PMID: 37583572 PMCID: PMC10425234 DOI: 10.1055/s-0043-1772157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Accepted: 06/13/2023] [Indexed: 08/17/2023] Open
Abstract
Background Neuroenteric cysts (NECs) are benign lesions mostly found as intradural extramedullary lesions in the cervicothoracic spinal cord. NECs in the cavernous sinus are very rare. To the best of our knowledge, this is only the second reported case and the first in an adult. Presentation We present a left cavernous sinus NEC in a 75-year-old female with gradually worsening headache and facial pain unresponsive to medical treatment. Imaging revealed a cystic mass lesion in the left cavernous sinus encasing the distal petrosal and cavernous segment of the internal carotid artery. Initial differential diagnoses included more common pathologies located near the cavernous sinus, including cystic schwannoma, craniopharyngioma, and dermoid and epidermoid tumors. The patient underwent a left pterional craniotomy with an extradural transcavernous approach for surgical exploration and possible resection of this mass lesion. Histopathology revealed an NEC lined with benign respiratory-type epithelium. Postoperative imaging revealed gross total tumor resection. The patient remained neurologically intact with complete resolution of facial pain. Conclusion We present a rare pathology that can easily be misinterpreted as other types of lesions. NECs should be kept in mind for differential diagnosis of cavernous sinus cystic lesions. The surgical aim should be maximal safe excision.
Collapse
Affiliation(s)
- Walid Elshamy
- Department of Neurological Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, United States
- Department of Neurological Surgery, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Burak Ozaydin
- Department of Neurological Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, United States
| | - Sima Sayyahmelli
- Department of Neurological Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, United States
| | - M. Shahriar Salamat
- Department of Neurological Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, United States
- Department of Pathology and Laboratory Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, United States
| | - Mustafa K. Baskaya
- Department of Neurological Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, United States
| |
Collapse
|
3
|
Saito S, Natsumeda M, Sainouchi M, Takino T, Shibuya K, On J, Kanemaru Y, Ogura R, Okada M, Oishi M, Shimada Y, Wakai T, Okuda S, Ajioka Y, Kakita A, Fujii Y. Elucidating the multiple genetic alterations involved in the malignant transformation of a KRAS mutant neurenteric cyst. A case report. Neuropathology 2022; 42:519-525. [PMID: 36146951 DOI: 10.1111/neup.12822] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Revised: 04/06/2022] [Accepted: 05/06/2022] [Indexed: 12/15/2022]
Abstract
Neurenteric cyst (NC) shows benign histopathology and rarely demonstrate malignant transformation. We herein describe a case of NC that exhibited malignant transformation. A 65-year-old female presented with gait disturbance due to compression by a cystic mass on the dorsal surface of the medulla oblongata. Partial resection was performed twice, leading to improvement of her symptoms. Two years after the second surgery, gadolinium-perfused T1-weighted magnetic resonance imaging revealed an invasive lesion with contrast enhancement at the trigone of the left lateral ventricle for which partial resection followed by radiotherapy was performed. However, mass regrowth was observed, with the patient eventually succumbing to her disease 11 months after her third surgery. Histopathological analyses of the first and second surgical specimens identified pseudostratified cuboidal epithelial cells, with no nuclear or cellular atypia resembling gastrointestinal mucosa, lining the inner surface of the cystic wall. Based on these findings the lesion was diagnosed as NC. The third surgical specimen exhibited apparent malignant features of the epithelial cells with elongated and hyperchromatic nuclei, several mitotic figures, small necrotic foci, and a patternless or sheet-like arrangement. Based on these findings, the lesion was diagnosed as NC with malignant transformation. Next-generation sequencing revealed KRAS p.G12D mutation in all specimens. Additionally, the third surgical specimen harbored the following 12 de novo gene alterations: ARID1A loss, BAP1 p.F170L, CDKN1B loss, CDKN2A loss, CDKN2B loss, FLCN loss, PTCH1 loss, PTEN loss, PTPRD loss, SUFU loss, TP53 loss, and TSC1 loss. The aforementioned results suggest that KRAS mutation is associated with the development of the NC, and that the additional gene alterations contribute to malignant transformation of the NC.
Collapse
Affiliation(s)
- Shoji Saito
- Department of Neurosurgery, Niigata University Brain Research Institute, Niigata, Japan.,Department of Pathology, Niigata University Brain Research Institute, Niigata, Japan
| | - Manabu Natsumeda
- Department of Neurosurgery, Niigata University Brain Research Institute, Niigata, Japan
| | - Makoto Sainouchi
- Department of Pathology, Niigata University Brain Research Institute, Niigata, Japan
| | - Toru Takino
- Department of Neurosurgery, Niigata University Brain Research Institute, Niigata, Japan
| | - Kohei Shibuya
- Department of Neurosurgery, Niigata University Brain Research Institute, Niigata, Japan
| | - Jotaro On
- Department of Neurosurgery, Niigata University Brain Research Institute, Niigata, Japan.,Department of Pathology, Niigata University Brain Research Institute, Niigata, Japan
| | - Yu Kanemaru
- Department of Neurosurgery, Niigata University Brain Research Institute, Niigata, Japan
| | - Ryosuke Ogura
- Department of Neurosurgery, Niigata University Brain Research Institute, Niigata, Japan
| | - Masayasu Okada
- Department of Neurosurgery, Niigata University Brain Research Institute, Niigata, Japan
| | - Makoto Oishi
- Department of Neurosurgery, Niigata University Brain Research Institute, Niigata, Japan
| | - Yoshifumi Shimada
- Division of Digestive and General Surgery, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Toshifumi Wakai
- Division of Digestive and General Surgery, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Shujiro Okuda
- Division of Bioinformatics, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan.,Medical AI Center, Niigata University School of Medicine, Niigata, Japan
| | - Yoichi Ajioka
- Molecular and Diagnostic Pathology, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Akiyoshi Kakita
- Department of Pathology, Niigata University Brain Research Institute, Niigata, Japan
| | - Yukihiko Fujii
- Department of Neurosurgery, Niigata University Brain Research Institute, Niigata, Japan
| |
Collapse
|
4
|
Chu M, Wang L, Ye H, Li J, Lu D, Piao Y, Wu L. Meningeal carcinomatosis secondary to neurenteric cysts with malignant transformation: a case report. BMC Neurol 2022; 22:433. [PMCID: PMC9667666 DOI: 10.1186/s12883-022-02978-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Accepted: 11/10/2022] [Indexed: 11/17/2022] Open
Abstract
Abstract
Background
Meningeal carcinomatosis is mainly associated with breast cancer, lung cancer, and melanoma. However, meningeal carcinomatosis secondary to a neurenteric cyst with malignant features is extremely rare.
Case presentation
We report the case of a 35-year-old woman who was admitted to the hospital with a 10-month history of headache, 6-month history of diplopia, 4-month history of hearing loss, and 1-month history of back pain, suggesting a diagnosis of chronic meningitis. Notably, enhanced brain and spinal cord magnetic resonance imaging (MRI) revealed extensive lesions with enhancement signals in the pia mater of the pons and cervical, thoracic, and lumbar spinal cord. The cerebral spinal fluid profile showed that pressure was significantly elevated, with a slight increase in leukocytes that mostly comprised mononuclear cells and decreased glucose concentration. Cytology evaluation showed a small cluster of atypical nuclei, which were suspected to be tumor cells arising from the epithelium. However, no primary tumor was found through comprehensive body and skin screening. After a histopathological biopsy of subarachnoid meninx of the thoracic spinal canal, the cause of meningeal carcinomatosis of this patient was determined as neurenteric cysts with malignant features, which is extremely rare.
Conclusion
This is the first case to ever report neurenteric cysts as a cause of leptomeningeal carcinomatosis and the first ever report of neurenteric cysts presenting as leptomeningeal carcinomatosis without typical cyst visible on brain MRI. This extremely rare case provided a novel view on the pathogenesis of meningeal carcinomatosis and clinical presentation of neurenteric cysts, highlighting the value of meningeal biopsy in chronic meningitis of unknown causes.
Collapse
|
5
|
Pediatric intracranial neurenteric cyst of the oculomotor nerve: a case-based review. Childs Nerv Syst 2021; 37:3681-3693. [PMID: 34401938 DOI: 10.1007/s00381-021-05308-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Accepted: 07/24/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Neurenteric cysts (NECs) of the central nervous system (CNS) are uncommon congenital entities arising from embryonal elements. Intracranial NECs in the pediatric population are rare. METHODS The authors describe the presentation, radiographic imaging, and pathologic findings of an 11-year-old boy with a right oculomotor nerve NEC. A literature review was performed to identify additional cases of pediatric intracranial NECs published in the English language, over the past 30 years (1990-2020). The authors discuss the presentation, investigations, management, and prognosis of this interesting entity. RESULTS We describe an 11-year-old boy who presented to neurosurgical attention with disconjugate gaze, anisocoria, and ptosis. Magnetic resonance imaging (MRI) demonstrated a lobulated, cystic, and peripherally enhancing mass involving the right oculomotor nerve. The patient underwent pterional craniotomy for drainage of the cyst and subtotal resection of the cyst wall. The tan-colored mass was displacing the basilar artery, compressing the cerebral peduncle, and adherent to the inferior surface of the tentorium. The lesion was within the oculomotor nerve and splitting the fibers, and the cystic contents were thick and mucinous. Histopathological examination of the specimen demonstrated a thin fibrous cyst wall with scattered inflammatory cells and lined by simple columnar epithelium containing mucin. The lining cells were immunoreactive with epithelial membrane antigen (EMA) and pan-keratin AE1/AE3. The diagnosis of a NEC was rendered. A comprehensive literature review of pediatric intracranial NECs yielded 46 additional lesions published in the literature, involving the skull base, posterior fossa, cerebral convexity, and cranial nerves. NECs present with local mass effect and less commonly, with aseptic meningitis or intracystic hemorrhage. Maximal safe GTR remains the mainstay management, although cyst drainage and marsupialization, cyst shunting, and fenestration of cystic contents into the ventricle or basal cisterns have been reported with variable success. CONCLUSION CNS NECs are rare congenital entities; although they occur less frequently in the intracranial components compared to the spine, their diagnosis and management should be considered for intracranial cystic lesions. Maximal safe GTR is the mainstay treatment and frequently yields favorable outcomes.
Collapse
|
6
|
Krivoshapkin A, Sergeev G, Gaytan A, Salim N, Krotenkova I, Savitskiy I, Bulanov D, Yasieva M, Abdullaev O. A case report: Malignant transformation of a neurenteric cyst with intracranial metastases mimicking neurocysticercosis. INTERDISCIPLINARY NEUROSURGERY 2021. [DOI: 10.1016/j.inat.2021.101193] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
|
7
|
Kalfas F, Scudieri C. Endodermal Cysts of the Central Nervous System: Review of the Literature and a Case Report. Asian J Neurosurg 2020; 15:989-996. [PMID: 33708675 PMCID: PMC7869303 DOI: 10.4103/ajns.ajns_322_19] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Revised: 03/30/2020] [Accepted: 08/13/2020] [Indexed: 11/04/2022] Open
Abstract
Context Endodermal cysts are rare benign developmental cysts lined by mucin-secreting and/or ciliated, cuboidal, or columnar epithelium of probably endodermal origin. Aims Endodermal cysts are rarely intracranial, frequently located in the posterior fossa. Supratentorial location is the most infrequent and only few cases are reported in the literature, included our case. Settings and Design The authors report a case of intracranial supratentorial endodermal cyst with a review of the literature. Subjects and Methods A 40-year-old woman was admitted to our department because of progressive gait disorder for 3 months due to right brachial and crural motor deficit associated to right crural sensory disorder (tactile hypesthesia) and right Babinski response at neurological examination due to an endodermal cyst located in the left frontoparietal convexity. Discussion Total resection of endodermal cysts is recommended, despite their location and adhesion to the surrounding structures, due to its high risk of recurrence. Fenestration of the cystic content into the subarachnoid cistern may cause obstructive hydrocephalus or chemical meningism. Results Although rare, surgeons should be aware that these lesions must be differentiated clinically, radiologically, and histologically from other supratentorial cystic lesions.
Collapse
Affiliation(s)
- Fotios Kalfas
- Department of Neurosurgery Padua University Hospital, Padua, Italy
| | - Claudia Scudieri
- Department of Neurosurgery and Gamma Knife Radiosurgery, IRCCS San Raffaele Scientific Institute, Vita-Salute University, Milan, Italy.,Department of Neurological Surgery, Galliera Hospitals, Genova, Italy
| |
Collapse
|
8
|
Neurenteric cysts at foramen magnum in children: presentation, imaging characteristics, and surgical management-case series and literature review. Childs Nerv Syst 2020; 36:1379-1384. [PMID: 32322975 DOI: 10.1007/s00381-020-04604-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Accepted: 03/30/2020] [Indexed: 10/24/2022]
Abstract
INTRODUCTION Neurenteric cysts (NEC) are rare benign tumors of the central nervous system. Even more rare are the NEC at the ventral foramen magnum in children that are misdiagnosed. They cause distortion of the vertebrobasilar vascular system and cervicomedullary neural structures and are adherent to the latter. The inferior portion lies ventral to the upper most dentate ligament. This has implications in the surgical approach for complete excision. METHODS AND CASE SERIES We reviewed our series of five children with ventral foramen magnum NEC in the MRI era and analyzed presentation, radiological findings and surgical management. A literature review is also presented. RESULTS There were two females and five males. Headache and neurological deficit was present in all five; one child presented with recurrent meningitis. The NEC was present ventral to the cervicomedullary junction in all cases. The posterolateral transcondylar approach was used for complete excision with no recurrences. CONCLUSIONS Neurenteric cysts at the ventral foramen magnum can be confused with other cystic lesions. Headaches are the most common presentation. The posterolateral transcondylar approach to the ventral cervicomedullary junction provides the most reliable avenue for entire resection.
Collapse
|
9
|
Tsutsumi S, Izumi H, Nonaka S, Okura H, Suzuki T, Ito M, Yasumoto Y, Ishii H. Spinal endodermal cyst undergoing malignant transformation and marked elevation of serum carbohydrate 19-9 level. Br J Neurosurg 2020:1-3. [PMID: 32347122 DOI: 10.1080/02688697.2020.1759780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Endodermal cyst (EC) is a benign tumor that can arise along the craniospinal axis. Infrequently, ECs undergo malignant transformation. A 43-year-old man presented with numbness in the right arm, leg and occipitalgia. MRI revealed a multicystic, intradural extramedullary tumor at C2 with enhancement along the ventral surface of the spinal cord. Blood test showed an abnormal increase in serum carbohydrate antigen 19-9 (CA 19-9) level. Systemic positron emission tomography-computed tomography was normal. He underwent total tumor resection and was diagnosed with EC. He developed double vision, hearing loss, and swallowing difficulty on postoperative day 70. Cerebral MRI revealed marked extensions of leptomeningeal dissemination. The serum CA 19-9 level increased continuously and finally reached 1515.0 U/ml. He died of respiratory failure on day 108. An autopsy did not reveal abnormalities in the abdominal and chest organs. On microscopic examination, the post-mortem specimen revealed adenocarcinoma. Immunohistochemically, both the surgical and autopsy specimens were positive for CA 19-9. Spinal ECs may lead to malignant transformation with leptomeningeal dissemination that causes abnormal elevation of serum CA 19-9 levels.
Collapse
Affiliation(s)
- Satoshi Tsutsumi
- Department of Neurological Surgery, Juntendo University Urayasu Hospital, Urayasu, Chiba, Japan
| | - Hiroshi Izumi
- Department of Pathology, Juntendo University Urayasu Hospital, Urayasu, Chiba, Japan
| | - Senshu Nonaka
- Department of Neurological Surgery, Juntendo University Urayasu Hospital, Urayasu, Chiba, Japan
| | - Hidehiro Okura
- Department of Neurological Surgery, Juntendo University Urayasu Hospital, Urayasu, Chiba, Japan
| | - Takamoto Suzuki
- Department of Neurological Surgery, Juntendo University Urayasu Hospital, Urayasu, Chiba, Japan
| | - Masanori Ito
- Department of Neurological Surgery, Juntendo University Urayasu Hospital, Urayasu, Chiba, Japan
| | - Yukimasa Yasumoto
- Department of Neurological Surgery, Juntendo University Urayasu Hospital, Urayasu, Chiba, Japan
| | - Hisato Ishii
- Department of Neurological Surgery, Juntendo University Urayasu Hospital, Urayasu, Chiba, Japan
| |
Collapse
|
10
|
Singhal A, Hackney JR, Chapman PR. Rare cause of cystic cerebellopontine angle lesion: Answer. J Clin Neurosci 2020. [DOI: 10.1016/j.jocn.2019.12.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
11
|
Nunes Dias L, Puerta Roldán P, Guillén Quesada A, Suñol Capella M, Hinojosa J. Supratentorial neuroenteric cyst in children: a case report and brief literature review. Childs Nerv Syst 2019; 35:2227-2231. [PMID: 31079180 DOI: 10.1007/s00381-019-04190-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Accepted: 04/30/2019] [Indexed: 11/30/2022]
Abstract
Neurenteric cysts are rare developmental lesions typically found outside the central nervous system but when they do, we most likely find them in a spinal (cervical or dorsal) intradural extramedular location, often associated with dysraphism. The more unusual intracranial cases have been published because of its rarity, occurring mostly as a posterior fossa extra-axial cyst, in adults. Supratentorial cases are distinctly infrequent, especially in children, resulting in few case reports and even fewer case reviews. We describe a case of a child with a supratentorial neurenteric cyst and present a brief review of the literature about these cysts in children, a noticeable gap in the literature.
Collapse
Affiliation(s)
- Lídia Nunes Dias
- Department of Neurosurgery, Hospital Egas Moniz - Centro Hospitalar Lisboa Ocidental EPE, Rua da Junqueira 126, 1349-019, Lisbon, Portugal.
| | | | | | | | - José Hinojosa
- Department of Neurosurgery, Hospital Sant Joan de Déu, Barcelona, Spain
| |
Collapse
|
12
|
Agrawal M, Dharanipathy S, Nakra T, Garg K, Gurjar H, Mishra S, Singh M, Chandra PS. Supratentorial Neurenteric Cyst: A Rare Differential for a Frontal Cyst. World Neurosurg 2019; 129:140-142. [PMID: 31426248 DOI: 10.1016/j.wneu.2019.05.246] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2019] [Revised: 05/28/2019] [Accepted: 05/29/2019] [Indexed: 11/30/2022]
Abstract
Supratentorial neurenteric cyst is a rare entity. They are usually isointense to slightly hyperintense on T1W images and hyperintense on T2-weighted/fluid attenuated inversion recovery images. There was a diagnostic dilemma in this case due to the cerebrospinal fluid intensity of the cyst on magnetic resonance imaging. Postoperative residual lesion predisposes to hemorrhage and seizures.
Collapse
Affiliation(s)
- Mohit Agrawal
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | | | - Tripti Nakra
- Department of Neuropathology, All India Institute of Medical Sciences, New Delhi, India
| | - Kanwaljeet Garg
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India.
| | - Hitesh Gurjar
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | - Shashwat Mishra
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | - Manmohan Singh
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | - P Sarat Chandra
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| |
Collapse
|
13
|
Nelson SM, Mathis DA, Hobbs JK, Timpone VM. Intracranial neurenteric cyst mimicking an ependymoma: imaging features, pathologic correlation and review of literature. Clin Imaging 2017; 44:117-120. [PMID: 28505503 DOI: 10.1016/j.clinimag.2017.04.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2016] [Revised: 04/22/2017] [Accepted: 04/25/2017] [Indexed: 10/19/2022]
Abstract
We present a case of a 57-year-old female with four-months of diplopia and vertigo. MRI revealed a mixed cystic and solid partially enhancing lesion of the 4th ventricle, foramen of Luschka and cerebellopontine angle. Preoperative differential diagnosis favored ependymoma. Biopsy revealed a neurenteric cyst, a benign developmental lesion that rarely occurs intracranially. This case highlights several atypical manifestations of intracranial neurenteric cyst, with regions of histologically benign solid enhancement, multicompartmental extra-axial location mimicking an ependymoma, and rapid recurrence without evidence of underlying malignancy.
Collapse
Affiliation(s)
- Steve M Nelson
- Department of Radiology, San Antonio Military Medical Center, United States
| | - Derek A Mathis
- Department of Pathology, San Antonio Military Medical Center, United States
| | - Joseph K Hobbs
- Department of Neurosurgery, San Antonio Military Medical Center, United States
| | - Vincent M Timpone
- Department of Radiology, San Antonio Military Medical Center, United States.
| |
Collapse
|
14
|
Rim HT, Song JH, Kim ES, Kwon MJ. Mucinous adenocarcinoma arising from a residual supratentorial neurenteric cyst and expressing mutated KRAS: a case report. Hum Pathol 2016; 58:146-151. [PMID: 27569299 DOI: 10.1016/j.humpath.2016.05.027] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2016] [Revised: 05/03/2016] [Accepted: 05/12/2016] [Indexed: 11/16/2022]
Abstract
Malignant transformation of intracranial neurenteric cysts (NCs) has been reported in only 7 cases, but the molecular characteristics leading to malignant transformation remain unclear. A 61-year-old woman presented with headache and dizziness. Imaging revealed a 10-cm, extra-axial cystic mass in both middle fossae. A partial resection was performed, and the residual mass size gradually decreased. She had repeated ventriculoperitoneal shunts to relieve symptoms of hydrocephalus. Eight years later, follow-up images revealed marked enlargement of the mass and a newly developed lesion. After a second partial resection, a mucinous adenocarcinoma infiltrating the brain was identified. Transitions from benign-looking cuboidal cells to dysplastic cells were observed. A KRAS mutation, which might be associated with malignant NC transformation and was not present in the initial specimen, was identified in the adenocarcinoma. In conclusion, KRAS-mutant mucinous adenocarcinoma may arise in a longstanding residual NC after partial resection.
Collapse
Affiliation(s)
- Hyun Taek Rim
- Department of Neurosurgery, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang 431-070, Republic of Korea
| | - Joon Ho Song
- Department of Neurosurgery, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang 431-070, Republic of Korea
| | - Eun Soo Kim
- Department of Radiology, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang 431-070, Republic of Korea.
| | - Mi Jung Kwon
- Department of Pathology, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang 431-070, Republic of Korea.
| |
Collapse
|
15
|
Yang Y, Fang J, Li DA, Wang L, Ji N, Zhang J. Recurrent intracranial neurenteric cyst with malignant transformation: A case report and literature review. Oncol Lett 2016; 11:3395-3402. [PMID: 27123123 DOI: 10.3892/ol.2016.4386] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2015] [Accepted: 01/06/2016] [Indexed: 11/06/2022] Open
Abstract
Neurenteric cysts (NCs) are uncommon congenital cystic lesions. Malignantly transformed NCs are extremely rare. The present study reports the case of a recurrent foramen magnum NC with a malignant transformation and reviews 8 previously reported cases. A 58-year-old woman with a 5-month history of occasional headaches, dizziness and vomiting presented to the Beijing Tiantan Hospital (Beijing, China) with palsy of the left cranial IX and X nerves, decreased sensation in the limbs on the right side and an ataxic gait. Magnetic resonance imaging (MRI) scans revealed a cystic mass in the left side of the foramen magnum, positioned anteriolaterally to the medulla oblongata. Surgery using a left suboccipital retrosigmoid approach was performed. The lesion was partially resected and was histopathologically diagnosed as an NC with focal hyperplasia of the epithelial cells. Additional MRI scans that were performed 25 months later revealed a solid lesion posterior to the medullar oblongata. Therefore, surgery using a suboccipital midline approach was performed. The solid lesion was sub-totally removed and was histopathologically diagnosed as a well-differentiated papillary adenocarcinoma. At 1 month post-surgery, the patient's condition worsened, eventually resulting in mortality due to respiratory failure. Based on the findings of the present case and previous literature, strict criteria for malignant-transformed NCs were created. The location distribution of malignant-transformed NCs does not coincide with the location distribution of all NCs, and malignantly transformed NCs usually occur in adult patients and present as atypical radiological features. Surgery is the optimal treatment for malignantly transformed NCs, and the effectiveness of adjuvant therapy requires additional studies.
Collapse
Affiliation(s)
- Yang Yang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing 100050, P.R. China
| | - Jingyi Fang
- Department of Neuropathology, Beijing Neurosurgical Institute, Capital Medical University, Beijing 100050, P.R. China
| | - D A Li
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing 100050, P.R. China
| | - Liang Wang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing 100050, P.R. China
| | - Nan Ji
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing 100050, P.R. China
| | - Junting Zhang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing 100050, P.R. China
| |
Collapse
|
16
|
Fujisawa N, Oya S, Higashi M, Matsui T. Malignant Transformation of a Neurenteric Cyst in the Posterior Fossa Presenting with Intracranial Metastasis: A Case Report and Literature Review. NMC Case Rep J 2015; 2:123-127. [PMID: 28663981 PMCID: PMC5364880 DOI: 10.2176/nmccrj.2014-0416] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2014] [Accepted: 03/24/2015] [Indexed: 11/29/2022] Open
Abstract
Intracranial neurenteric cysts are relatively rare and almost exclusively benign. Here we present a case of an intracranial neurenteric cyst that was histologically benign in the first surgery and later demonstrated significant growth and intracranial metastasis with malignant transformation. A 47-year-old woman presented with a headache, which had gradually worsened over 1 year. Initial magnetic resonance (MR) images revealed a solitary cystic lesion in the left cerebellopontine angle with significant mass effect. Subtotal resection leaving a small mass strongly adhered to the brainstem was achieved. Histopathological diagnosis was neurenteric cyst with no malignant features. This lesion recurred 4 years after the first surgery in the form of a cystic mass adjacent to the brainstem. In addition, histopathological examination of a specimen from the second surgery revealed malignant transformation. The patient declined to undergo radiation therapy and was conservatively managed. Three years after the second surgery, MR imaging showed recurrence of the solid mass. Although the patient had been treated with subtotal resection and radiation therapy, she died with metastatic masses in the right frontal lobe and cervical cord. A specimen from the third surgery revealed diffuse malignant features similar to mucinous adenocarcinoma. Our case and literature review indicate that, although rare, malignant transformation can occur particularly among intracranial neurentreric cysts. This finding suggests the importance of long-term follow-up for subtotally or partially resected intracranial neurenteric cysts.
Collapse
Affiliation(s)
- Naoaki Fujisawa
- Department of Neurosurgery, Saitama Medical Center/University, Saitama
| | - Soichi Oya
- Department of Neurosurgery, Saitama Medical Center/University, Saitama
| | - Morihiro Higashi
- Department of Pathology, Saitama Medical Center/University, Saitama
| | - Toru Matsui
- Department of Neurosurgery, Saitama Medical Center/University, Saitama
| |
Collapse
|
17
|
Chakraborty S, Priamo F, Loven T, Li J, Insinga S, Schulder M. Supratentorial Neurenteric Cysts: Case Series and Review of Pathology, Imaging, and Clinical Management. World Neurosurg 2015; 85:143-52. [PMID: 26341448 DOI: 10.1016/j.wneu.2015.08.057] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2015] [Revised: 08/14/2015] [Accepted: 08/18/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND Neurenteric cysts are rare congenital lesions along the neuroaxis, typically found in the spine, and rarely intracranially. Here, we present 3 patients who presented to our institution during a 6-year period with supratentorial intracranial neurenteric cysts and conduct a comprehensive review of the literature to describe the salient pathology, radiologic features, and clinical issues regarding these lesions. CASE REPORTS Three patients were treated surgically for supratentorial neurenteric cysts. One patient presented in extremis, whereas the others were treated electively. Each patient presented with significantly different signs and symptoms and unique radiologic findings. All patients were neurologically intact after surgery. CONCLUSIONS Neurenteric cysts present with a variety of signs and symptoms. Given the increased use of neuroimaging, supratentorial neurenteric cysts may be encountered more frequently and are important to include on the differential diagnosis and managed accordingly. Postoperative seizures occur in more than 20%, even in patients who had no preoperative seizures. Surgery can be performed safely with good neurologic outcomes.
Collapse
Affiliation(s)
- Shamik Chakraborty
- Department of Neurosurgery, Hofstra-Northwell School of Medicine, Manhasset, New York, USA.
| | - Francesco Priamo
- Department of Radiology, Mount Sinai Beth Israel Hospital, Icahn School of Medicine, New York, New York, USA
| | - Tina Loven
- Department of Neurosurgery, Hofstra-Northwell School of Medicine, Manhasset, New York, USA
| | - Jianyi Li
- Division of Neuropathology, Department of Pathology, Hofstra-Northwell School of Medicine, Lake Success, New York, USA
| | - Salvatore Insinga
- Department of Neurosurgery, Hofstra-Northwell School of Medicine, Manhasset, New York, USA
| | - Michael Schulder
- Department of Neurosurgery, Hofstra-Northwell School of Medicine, Manhasset, New York, USA
| |
Collapse
|
18
|
Fujisawa N, Oya S, Higashi M, Matsui T. Malignant Transformation of a Neurenteric Cyst in the Posterior Fossa Presenting with Intracranial Metastasis: A Case Report and Literature Review. NMC Case Rep J 2015. [DOI: 10.2176/nmccrj.cr.2014-0416] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Naoaki Fujisawa
- Department of Neurosurgery, Saitama Medical Center/University
| | - Soichi Oya
- Department of Neurosurgery, Saitama Medical Center/University
| | | | - Toru Matsui
- Department of Neurosurgery, Saitama Medical Center/University
| |
Collapse
|
19
|
Janczar K, Tybor K, Papierz W. Supratentorial neurenteric cyst—A case report. Neurol Neurochir Pol 2014; 48:219-22. [DOI: 10.1016/j.pjnns.2014.04.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2014] [Accepted: 04/04/2014] [Indexed: 10/25/2022]
|
20
|
Okabe H, Katsura K, Yamano T, Tenjin H, Nakahara Y, Ishida M, Kato T. Mucinous adenocarcinoma arising from supratentorial intramedullary neuroenteric cyst with broncho-pulmonary differentiation. Neuropathology 2014; 34:420-4. [PMID: 24673460 DOI: 10.1111/neup.12118] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2013] [Revised: 02/20/2014] [Accepted: 02/21/2014] [Indexed: 11/29/2022]
Abstract
Neuroenteric cysts are benign intradural endoderm cysts lined by gastrointestinal (GI) or tracheobronchial epithelial cells. Their malignant transformation is extremely rare and only six cases have been reported. In these cases, tissue lineage of the cystic endoderm cells giving rise to carcinoma was not clearly identified either as respiratory or as GI type. Herein, we report a case of mucinous adenocarcinoma arising from the neuroenteric cyst with broncho-pulmonary differentiation in the right cerebral hemisphere of a Japanese woman in her late 50s. The cyst wall was entirely lined by the following respiratory epithelial components: stratified bronchial ciliated columnar epithelium with basal cells positive for CK5 and p63, terminal bronchiolar Clara cells positive for thyroid transcription factor (TTF)-1, surfactant B and negative for surfactant C, type I pneumocytes positive for TTF-1, negative for surfactant B and C, and type II pneumocytes positive for TTF-1 and surfactant B and C. In addition, nests of hyperplastic single layered mucinous epithelial cells with bronchial goblet cell phenotype were also demonstrated, and histologic features were almost the same as the pulmonary type I congenital adenomatoid malformation (CCAM) with mucinous epithelial proliferation. The mucinous epithelial nests of type I CCAM are liable to develop mucinous adenocarcinoma and frequently accompany K-ras mutation and expression of p16. However, K-ras mutation and p-16 expression were not detected in this case.
Collapse
Affiliation(s)
- Hidetoshi Okabe
- Division of Diagnostic Pathology, Department of Laboratory Medicine, Shiga University of Medical Science, Otsu, Japan; Department of Pathology, Japanese Red Cross Kyoto Daini Hospital, Kyoto, Japan
| | | | | | | | | | | | | |
Collapse
|
21
|
Al-Ahmed IH, Boughamoura M, Dirks P, Kulkarni AV, Rutka JT, Drake JM. Neurosurgical management of neurenteric cysts in children. J Neurosurg Pediatr 2013; 11:511-7. [PMID: 23452031 DOI: 10.3171/2013.1.peds1290] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT Neurenteric cysts (NCs) are endothelium-lined structures of presumed endodermal origin. There have been few pediatric series of intracranial NCs reported previously. The authors present their experience in the management of these lesions. METHODS A retrospective chart review of all cases of NCs identified between 1977 and 2007 was carried out. Demographics, details of clinical presentation, surgical therapy, and outcome data were extracted. RESULTS Eleven cases were identified, involving 6 girls and 5 boys. The patients' average age was 4.6 years (range 1 day-14 years). Limb weakness was the most common presenting symptom. The location of the cysts was cervical in 2 cases, cervicothoracic in 4 cases, and thoracic in 3 cases. One cyst was anterior to the pons with extension to the left cerebellopontine angle and 1 cyst was at the craniocervical junction. Five patients had an apparently complete initial excision, with 1 recurrence. Four patients were initially treated with incomplete excision and/or cyst drainage, usually into an Ommaya reservoir. A neonate with a large cervicothoracic cyst died of multiple congenital anomalies without any intervention. All other patients were alive at last follow-up. One patient with a radiologically identified presumed cyst, which remained stable, was simply followed up. Several patients required multiple procedures and 1 patient developed hydrocephalus after aseptic meningitis and was treated with CSF shunting. CONCLUSIONS Neurenteric cysts are rare in the pediatric population. Total resection, if possible, provides the best long-term outcome. Incomplete excision may lead to multiple procedures, including cyst drainage, but can lead to long-term stability.
Collapse
Affiliation(s)
- Ibrahim H Al-Ahmed
- Division of Neurosurgery, The Hospital for Sick Children, The University of Toronto, Ontario, Canada.
| | | | | | | | | | | |
Collapse
|
22
|
Gauden AJ, Khurana VG, Tsui AE, Kaye AH. Intracranial neuroenteric cysts: A concise review including an illustrative patient. J Clin Neurosci 2012; 19:352-9. [DOI: 10.1016/j.jocn.2011.10.005] [Citation(s) in RCA: 66] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2011] [Accepted: 10/09/2011] [Indexed: 10/14/2022]
|