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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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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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Mascarenhas A, Parsons A, Smith C, Molloy C, Jukes A. Malignant squamous cell carcinoma arising in a previously resected cerebellopontine angle epidermoid. Surg Neurol Int 2017; 8:186. [PMID: 28868198 PMCID: PMC5569395 DOI: 10.4103/sni.sni_99_17] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2017] [Accepted: 06/28/2017] [Indexed: 11/04/2022] Open
Abstract
Background: Malignant squamous cell differentiation of an epidermoid cyst can carry a significantly poor prognosis and very little is known about this entity. Case Description: We present the case of a 35-year-old lady, with primary malignant squamous cell carcinoma (SCC) arising from a previously partially resected cerebellopontine angle epidermoid cyst almost 5 years after initial resection. We also review the relevant literature. Conclusion: The imaging findings, histopathology, and management of a malignant SCC arising from a benign epidermoid cyst are discussed with recommendation for increased surveillance and follow-up, even for classically accepted benign lesions.
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Affiliation(s)
- Annika Mascarenhas
- Department of Neurosurgery, Women's and Children's Hospital, North Adelaide, Australia
| | - Alyssa Parsons
- Department of Neurosurgery, Women's and Children's Hospital, North Adelaide, Australia
| | - Caroline Smith
- Department of Anatomical Pathology, SA Pathology, Adelaide, Australia
| | - Cindy Molloy
- Department of Neurosurgery, Women's and Children's Hospital, North Adelaide, Australia
| | - Alistair Jukes
- Department of Neurosurgery, Royal Adelaide Hospital, Adelaide, Australia
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DNA methylation analysis by bisulfite next-generation sequencing for early detection of oral squamous cell carcinoma and high-grade squamous intraepithelial lesion from oral brushing. J Craniomaxillofac Surg 2015; 43:1494-500. [DOI: 10.1016/j.jcms.2015.07.028] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2015] [Revised: 06/19/2015] [Accepted: 07/27/2015] [Indexed: 12/28/2022] Open
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Velamati R, Hageman JR, Bartlett A. Meningitis secondary to ruptured epidermoid cyst: case-based review. Pediatr Ann 2013; 42:248-51. [PMID: 23718247 DOI: 10.3928/00904481-20130522-12] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- Rukmini Velamati
- Department of Pediatrics, Comer Children’s Hospital, Pritzker School of Medicine, University of Chicago, 60637, USA. Rukmini.velamati@ uchospitals.edu
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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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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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Kim DR, Kang HI, Kim JH, Kim JS. Epidermoid Cyst Arising from the Corpus Callosum. J Korean Neurosurg Soc 2007. [DOI: 10.3340/jkns.2007.41.3.177] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Affiliation(s)
- Dok Ryong Kim
- Department of Neurosurgery, Eulji University School of Medicine, Seoul, Korea
| | - Hee In Kang
- Department of Neurosurgery, Eulji University School of Medicine, Seoul, Korea
| | - Jae Hoon Kim
- Department of Neurosurgery, Eulji University School of Medicine, Seoul, Korea
| | - Joo Seung Kim
- Department of Neurosurgery, Eulji University School of Medicine, Seoul, 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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Michael LM, Moss T, Madhu T, Coakham HB. Malignant transformation of posterior fossa epidermoid cyst. Br J Neurosurg 2006; 19:505-10. [PMID: 16574566 DOI: 10.1080/02688690500495356] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
The authors report the case of a 45-year-old man who presented with a short duration of a painful ophthalmoparesis. Initial magnetic resonance imaging revealed an extraaxial petroclival mass characteristic of an epidermoid cyst, with the exception of a contiguous contrast-enhancing lobule. A subtotal resection was performed with the histopathological diagnosis revealing malignant transformation of an epidermoid cyst. Despite aggressive postoperative adjuvant therapy, the patient developed leptomeningeal metastasis and died shortly thereafter. The presence of contrast enhancement at the site of an epidermoid cyst combined with an acute, progressive neurological deficit should alert the treating physician to the possibility of a malignant transformation. When transformation does occur, the clinical and radiological course is quite aggressive as compared with the indolent growth of epidermoid cysts. Treatment options include surgery with adjuvant chemotherapy or radiotherapy. We review the pertinent features of this case along with the relevant literature regarding primary intracranial squamous cell carcinomas.
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Affiliation(s)
- L M Michael
- Department of Neurosurgery, University of Tennessee at Memphis, Memphis, Tennessee 38120, USA.
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Tamura K, Aoyagi M, Wakimoto H, Tamaki M, Yamamoto K, Yamamoto M, Ohno K. Malignant transformation eight years after removal of a benign epidermoid cyst: a case report. J Neurooncol 2006; 79:67-72. [PMID: 16583265 DOI: 10.1007/s11060-005-9117-6] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2005] [Accepted: 12/30/2005] [Indexed: 11/24/2022]
Abstract
Malignant transformation of benign epidermoid cysts is rare and their prognosis remains poor. A 56-year-old woman presented with left facial hypoesthesia and photophobia in the left eye. She had undergone removal of a benign epidermoid cyst in the cerebellopontine angle 8 years previously. Magnetic resonance imaging of the brain revealed a cystic lesion in the left cerebellopontine angle. The cyst wall was enhanced by gadolinium-DTPA. She underwent removal again and the histopathologic diagnosis was squamous cell carcinoma. Gamma knife radiosurgery was performed on the remnant lesion with a marginal dose of 15 Gy. The tumor shrank rapidly for 2 months after radiosurgery, but recurred 9 months later. She underwent radiosurgery again with a marginal dose of 12 Gy. A gradual increase in the size of the enhanced lesion was seen during the 4-month follow-up period subsequent to the second radiosurgery. Careful observation, employing serial magnetic resonance images, is necessary for incompletely resected epidermoid cysts because intervals before malignant transformation reportedly range from 3 months to 33 years. Newly identified contrast enhancement strongly indicates malignant change in epidermoid cysts. Gamma knife radiosurgery may be useful for short-term control of intracranial squamous cell carcinomas, but long-term effects are presently unknown.
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Affiliation(s)
- Kaoru Tamura
- Department of Neurosurgery, Graduate School, Tokyo Medical and Dental University, Bunkyo-ku, Tokyo, 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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Ciurea AV, Coman T, Tascu A, Ionescu V. Intradural dermoid tumor of the posterior fossa in a child with diastematobulbia. ACTA ACUST UNITED AC 2005; 63:571-5; discussion 575. [PMID: 15936393 DOI: 10.1016/j.surneu.2004.06.024] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2004] [Accepted: 06/28/2004] [Indexed: 11/23/2022]
Abstract
Dermoid tumors (DTs) are rare lesions and represent 0.3% of all intracranial tumors. More than 50% of these tumors are diagnosed in childhood or early adolescence. Authors report an intradural DT of the posterior fossa in a child aged 4 years, possibly originating in the brainstem in which the diastematobulbia was detected postoperatively. Magnetic resonance imaging investigations are mandatory to diagnose these cases. The only curative treatment in DT is the total removal of the lesion. The reported case presents good recovery in the follow-up period of 3 years. The surgical intervention is particularly related to the DT type. Diastematobulbia associated with DT and the origin of the DT in the brainstem is discussed based on the literature.
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Link MJ, Cohen PL, Breneman JC, Tew JM. Malignant squamous degeneration of a cerebellopontine angle epidermoid tumor. Case report. J Neurosurg 2002; 97:1237-43. [PMID: 12450053 DOI: 10.3171/jns.2002.97.5.1237] [Citation(s) in RCA: 59] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The authors present the case of a woman with a cerebellopontine angle (CPA) epidermoid cyst that degenerated into a squamous cell carcinoma. Malignant degeneration of an epidermoid cyst is an extremely rare occurrence. Malignant transformation must be considered in the differential diagnosis when new contrast enhancement on imaging studies and progressive neurological deficit are seen in a patient harboring an epidermoid cyst. The patient initially presented with a 10-year history of left trigeminal neuralgia, subacute left-sided hearing loss, and with facial weakness of 3 weeks' duration. Initial magnetic resonance (MR) imaging revealed a left CPA mass, consistent with an epidermoid. There was faint contrast enhancement where the tumor was in contact with the lateral brainstem. A subtotal resection was performed. Histopathological findings were consistent with an epidermoid tumor. One year after initial presentation, the patient's neurological deficit had increased, and follow-up MR imaging demonstrated a large contrast-enhancing tumor filling the left CPA and compressing the brainstem. At repeated surgery a squamous cell carcinoma arising from the previous epidermoid was found. The patient was subsequently treated with external-beam radiotherapy and stereotactic radiosurgery. Her tumor stabilized. Three years and 8 months after the patient's initial presentation, a new area of tumor developed at the torcular Herophili. The patient died shortly thereafter. Malignant squamous degeneration is a rare cause of enhancement on MR images, as is progressive neurological deficit in a patient with an epidermoid. The combination of subtotal resection, external-beam radiotherapy, and stereotactic radiosurgery may be useful for local tumor control but the long-term prognosis is guarded.
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Affiliation(s)
- Michael J Link
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota 55905, USA
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Tsugu H, Fukushima T, Hayashi S, Iwaasa M, Matsuda T. Squamous cell carcinoma arising in an intracranial dermoid cyst--case report. Neurol Med Chir (Tokyo) 2001; 41:213-6. [PMID: 11381682 DOI: 10.2176/nmc.41.213] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
A 47-year-old male presented with headache. Magnetic resonance imaging revealed an enhanced mass lesion in the cerebellar vermis and left cerebellar hemisphere and in the cisterna magna. Gross total removal of the tumor was performed. Histological examination demonstrated squamous cell carcinoma in the dermoid cyst. The patient subsequently received localized radiation therapy of total 55 Gy. He has been without tumor recurrence for 6 years since the surgery. We recommend local radiation therapy over 50 Gy following surgery.
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Affiliation(s)
- H Tsugu
- Department of Neurosurgery, School of Medicine, Fukuoka University, Fukuoka
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Bayindir C, Balak N, Karasu A. Micro-invasive squamous cell carcinoma arising in a pre-existing intraventricular epidermoid cyst. Case report and literature review. Acta Neurochir (Wien) 1996; 138:1008-12. [PMID: 8891000 DOI: 10.1007/bf01411292] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
The authors report the case of a 67-year-old woman with primary micro-invasive squamous cell carcinoma located in the lateral ventricle and originating from an epidermoid cyst. Radiological and histological features of the neoplasm are described and the relevant literature is studied briefly. Two consecutive surgical specimens were studied by light microscopy. In the histological sections of the subtotally removed material of the first operation, the cyst wall was layered by epithelium-the same as expected in an epidermoid cyst- and showed foci with mild to moderate dysplastic changes. Theses changes did not reach up to the degree of a carcinoma. However, because the cyst could not be resected totally, the possibility of a squamous cell carcinoma was considered in the differential diagnosis. In the present case, the diagnosis was firmly established in a second surgical specimen obtained ten months after the first operation. Now, the tumour proved to be a primary squamous cell carcinoma, which exhibited severe dysplastic changes. Primary squamous cell carcinoma of brain is extremely rare. To our knowledge, only 20 such tumours with pre-existing epidermoid cyst have been reported in the central nervous system. The intriguing observation in this case is a three year recurrence free survival following the subtotal removal of the malignant neoplasm at the second surgery, without postoperative radiotherapy.
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Affiliation(s)
- C Bayindir
- Division of Neuropathology, University of Istanbul, Istanbul Faculty of Medicine, Turkey
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