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Alhammad O, Joueidi F, Aljohani HN, Basurrah AA, Ansary M. The Endoscopic Resection of Sellar and Suprasellar Epidermoid Cyst in a Pediatric Patient: A Case Report and Review of the Literature. Cureus 2023; 15:e50084. [PMID: 38186446 PMCID: PMC10770576 DOI: 10.7759/cureus.50084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/06/2023] [Indexed: 01/09/2024] Open
Abstract
Epidermoid cysts are benign congenital tumors that originate from the ectodermal tissue. The sellar/suprasellar region is an infrequent location for epidermoid cysts and such cases are rarely reported in pediatric patients, as these become symptomatic only when they reach 30 years of age. Surgical intervention is considered the ideal treatment option in patients with suprasellar epidermoid cysts, either via open or endonasal approach. We discuss a case of a 12-year-old male who presented with left visual impairment and was treated with successful resection through an endoscopic endonasal approach (EEA). We also engage in a literature review of the use of EEA in the management of sellar/suprasellar epidermoid cysts in the pediatric age group.
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Affiliation(s)
- Othman Alhammad
- Neurosurgery, King Faisal Specialist Hospital and Research Centre, Riyadh, SAU
| | | | - Hanan N Aljohani
- Neurosurgery, King Faisal Specialist Hospital and Research Centre, Riyadh, SAU
| | | | - Muhammad Ansary
- Neuroscience Centre, King Faisal Specialist Hospital and Research Centre, Riyadh, SAU
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Devathasan D, Murakami M, Miller MA, Thomovsky SA, Lewis MJ. Case Report: Recurrence of an Extradural Spinal Epidermoid Cyst Following Surgical Excision in a Dog. Front Vet Sci 2022; 9:871023. [PMID: 35498737 PMCID: PMC9051319 DOI: 10.3389/fvets.2022.871023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 03/23/2022] [Indexed: 11/13/2022] Open
Abstract
Congenital epidermoid cysts are slow-growing, mass lesions caused by the abnormal inclusion of neuroectodermal tissue within the developing central nervous system. Subtotal excision of epidermoid cysts increases the risk of early recurrence of clinical signs. A 4-year-old female spayed boxer was presented with a 4-month history of ambulatory paraparesis and proprioceptive ataxia. Neurological examination localized a T3-L3 myelopathy. MRI revealed a T1 iso- to hypointense, T2 and FLAIR hyperintense, rim-enhancing mass at the level of the T9-T10 vertebrae resulting in extradural compression of the spinal cord. This was histopathologically confirmed as an extradural epidermoid cyst following subtotal excision. MRI performed 2 months post-operatively revealed a significant decrease of the lesion volume. The dog was neurologically normal following the surgery however re-presented 28 months later with recurrence of clinical signs. A 28-month post-operative MRI revealed substantial enlargement of the epidermoid cyst. The dog was subsequently taken for repeat decompressive surgery. At 6 months from the repeat surgery, the dog was neurologically static with mild proprioceptive deficits. The case report highlights the clinical and MRI features of a recurrent extradural spinal epidermoid cyst treated by subtotal excision.
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Affiliation(s)
- Dillon Devathasan
- Department of Clinical Sciences, College of Veterinary Medicine, Auburn University, Auburn, AL, United States
- *Correspondence: Dillon Devathasan
| | - Masahiro Murakami
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Purdue University, West Lafayette, IN, United States
| | - Margaret A. Miller
- Department of Comparative Pathobiology, College of Veterinary Medicine, Purdue University, West Lafayette, IN, United States
| | - Stephanie A. Thomovsky
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Purdue University, West Lafayette, IN, United States
| | - Melissa J. Lewis
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Purdue University, West Lafayette, IN, United States
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Correlation of radiological features of white epidermoid cysts with histopathological findings. Sci Rep 2022; 12:2314. [PMID: 35145173 PMCID: PMC8831518 DOI: 10.1038/s41598-022-06167-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Accepted: 01/25/2022] [Indexed: 11/16/2022] Open
Abstract
Epidermoid cysts are benign congenital extra-axial lesions commonly found in the posterior fossa. These lesions have a characteristic imaging appearance on computed tomography (CT) scan and magnetic resonance imaging (MRI), but occasionally they may exhibit atypical radiological features, showing unusual hyperintensity on T1-weighted images (T1WI). Currently, such atypical appearance is referred to as white epidermoid. We present the imaging features of 5 cases of white epidermoid cyst and discuss the possible underlying etiology of this unusual radiological appearance. We retrospectively searched our electronic radiology database from January 2005 to December 2015 for all intracranial epidermoid cysts, which were confirmed either by typical MRI appearance or histopathological examination. All white epidermoid cases were evaluated with non-enhanced CT scan and multisequential MRI. Histopathological correlation was carried out in four white epidermoid cases. A total of 61 patients with epidermoid cyst were found, of those 5 (8%) were considered white epidermoids. These consisted of 3 females and 2 males, ranging in age between 31–63 years (average age was 51.8 years). Three patients had lesions located in the posterior fossa. The 2 other patients had lesions in the suprasellar region, with extension to the right middle cranial fossa in one. All 5 lesions were hyperdense on CT scan and hyperintense on T1WI. One patient demonstrated evidence of transformation of a classic epidermoid to a white epidermoid after partial resection. Histopathologically, cholesterol clefts were seen in 3 epidermoid cysts, each which also showed microcalcifications, proteinaceous material or melanin. Hemorrhage was demonstrated in one additional lesion. White epidermoid cyst is an unusual intracranial lesion that should be considered when encountered with an extra-axial T1 hyperintense lesion. The cause of this hyperintensity is not clearly understood, but the presence of cholesterol, microcalcifications, proteinaceous content and rarely hemorrhage or melanin may be contributing factors.
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Mageed M, Elfadl A. Computed Tomography and Magnetic Resonance Imaging of an Epidermoid Cyst in a Foot of a Horse. J Equine Vet Sci 2020; 94:103223. [PMID: 33077085 DOI: 10.1016/j.jevs.2020.103223] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Revised: 07/16/2020] [Accepted: 08/10/2020] [Indexed: 10/23/2022]
Abstract
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.
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Affiliation(s)
| | - Ahmed Elfadl
- Department of Pathology, Faculty of Veterinary Medicine, University of Khartoum, Khartoum, Sudan
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Kondo T, Kawahara T, Matsumoto T, Yamamoto Y, Tsutsui M, Ohtani M, Ohtaka M, Kumano Y, Maeda Y, Mochizuki T, Mori K, Asai T, Kuroda S, Takeshima T, Hattori Y, Teranishi JI, Miyoshi Y, Yumura Y, Yao M, Inayama Y, Uemura H. Epidermal Cyst in the Scrotum Successfully Treated while Preserving the Testis: A Case Report. Case Rep Oncol 2016; 9:235-40. [PMID: 27194984 PMCID: PMC4868926 DOI: 10.1159/000445826] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
A 66-year-old male was referred to our hospital for further examination of a scrotal mass. Because of the risk of testicular cancer, we first clamped the vessels as a course of higher orchiectomy. Then, we approached the tumor through the scrotum and successfully resected it while preserving the testis. A histopathological diagnosis revealed an epidermal cyst. We herein report a rare case of an intrascrotal epidermal cyst successfully treated while preserving the testis.
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Affiliation(s)
- Takuya Kondo
- Department of Urology and Renal Transplantation, Yokohama City University Medical Center, Yokohama, Japan
| | - Takashi Kawahara
- Department of Urology and Renal Transplantation, Yokohama City University Medical Center, Yokohama, Japan
- Department of Urology, Yokohama City University Graduate School of Medicine, Yokohama, Japan
- *Takashi Kawahara, MD, Department of Urology and Renal Transplantation, Yokohama City University Medical Center, 4-57, Urafune-cho, Minami-ku Yokohama (Japan), E-Mail
| | - Taro Matsumoto
- Department of Pathological Diagnosis, Yokohama City University Medical Center, Yokohama, Japan
| | - Yuko Yamamoto
- Department of Urology and Renal Transplantation, Yokohama City University Medical Center, Yokohama, Japan
| | - Miho Tsutsui
- Department of Urology, Yokohama Toho Hospital, Yokohama, Japan
| | - Masako Ohtani
- Department of Urology, Yokohama Toho Hospital, Yokohama, Japan
| | - Mari Ohtaka
- Department of Urology and Renal Transplantation, Yokohama City University Medical Center, Yokohama, Japan
| | - Yohei Kumano
- Department of Urology and Renal Transplantation, Yokohama City University Medical Center, Yokohama, Japan
| | - Yoko Maeda
- Department of Urology and Renal Transplantation, Yokohama City University Medical Center, Yokohama, Japan
| | - Taku Mochizuki
- Department of Urology and Renal Transplantation, Yokohama City University Medical Center, Yokohama, Japan
| | - Kohei Mori
- Department of Urology and Renal Transplantation, Yokohama City University Medical Center, Yokohama, Japan
| | - Takuo Asai
- Department of Urology and Renal Transplantation, Yokohama City University Medical Center, Yokohama, Japan
| | - Shinnosuke Kuroda
- Department of Urology and Renal Transplantation, Yokohama City University Medical Center, Yokohama, Japan
| | - Teppei Takeshima
- Department of Urology and Renal Transplantation, Yokohama City University Medical Center, Yokohama, Japan
| | - Yusuke Hattori
- Department of Urology and Renal Transplantation, Yokohama City University Medical Center, Yokohama, Japan
| | - Jun-ichi Teranishi
- Department of Urology and Renal Transplantation, Yokohama City University Medical Center, Yokohama, Japan
| | - Yasuhide Miyoshi
- Department of Urology and Renal Transplantation, Yokohama City University Medical Center, Yokohama, Japan
| | - Yasushi Yumura
- Department of Urology and Renal Transplantation, Yokohama City University Medical Center, Yokohama, Japan
| | - Masahiro Yao
- Department of Urology, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Yoshiaki Inayama
- Department of Pathological Diagnosis, Yokohama City University Medical Center, Yokohama, Japan
| | - Hiroji Uemura
- Department of Urology and Renal Transplantation, Yokohama City University Medical Center, Yokohama, Japan
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