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Sakamoto H, Akimoto J, Tsutsumi M, ken KM, Ichimasu N, Kohno M. Radio-pathological characteristics of malignant transformation of an epidermoid cyst in the cerebellopontine angle: A case report. Surg Neurol Int 2022; 13:135. [PMID: 35509542 PMCID: PMC9062930 DOI: 10.25259/sni_1226_2021] [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: 12/10/2021] [Accepted: 03/10/2022] [Indexed: 11/25/2022] Open
Abstract
Background Intracranial epidermoid cysts are rare congenital neoplasms that are clinically indolent and histologically benign. They rarely show malignant transformation, and several such cases have been reported. Some radiological features that suggest malignant transformation have been reported. However, histopathological features that indicate a high risk of malignant transformation have not been reported to date. Case Description We report a 59-year-old woman with a benign epidermoid cyst in the cerebellopontine angle that showed malignant transformation after 6 years. Magnetic resonance imaging (MRI) at the time of initial onset displayed a high-intensity signal on diffusion-weighted imaging (DWI), no peritumoral edema, and no enhancement on contrast-enhanced T1-weighted imaging. On the other hand, MRI at the time of malignant transformation showed a low-intensity signal on DWI, peritumoral edema, and enhancement of the tumor capsule on contrast-enhanced T1-weighted imaging. Pathological findings at the time of the first surgery differed from normal benign epidermoid cysts, in that stratified squamous epithelial metaplasia was observed, and immunohistochemical (IHC) analysis showed positive p53 staining. In addition, IHC analysis at the time of malignant transformation demonstrated positive p16 staining. Conclusion In benign epidermoid cysts, it is considered to cause malignant transformation when squamous metaplasia or p53 mutation is observed. Therefore, strict follow-up is required while paying attention to the characteristic changes in MRI for early detection and timely treatment of malignant transformation.
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Affiliation(s)
| | | | | | | | | | - Michihiro Kohno
- Department of Neurosurgery, Tokyo Medical University, Tokyo, Japan
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Cuoco JA, Rogers CM, Busch CM, Apfel LS, Entwistle JJ, Marvin EA. Intracranial Squamous Cell Carcinoma Arising From a Cerebellopontine Angle Epidermoid Cyst Remnant Four Decades After Partial Resection. Front Oncol 2019; 9:694. [PMID: 31428577 PMCID: PMC6689955 DOI: 10.3389/fonc.2019.00694] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Accepted: 07/15/2019] [Indexed: 11/13/2022] Open
Abstract
Intracranial epidermoid cysts are benign lesions that typically remain asymptomatic; however, although histopathologically benign, these cysts can rarely undergo malignant transformation into squamous cell carcinoma. Primary intracranial squamous cell carcinoma carries a poor prognosis as optimal treatment modalities remain unclear due to their low incidence. Here, we present a case of a cerebellopontine angle epidermoid cyst remnant that underwent malignant transformation into squamous cell carcinoma 40 years after partial resection. To our knowledge, this case establishes the longest time interval to date for an intracranial epidermoid cyst to undergo malignant transformation. We also review the relevant literature and discuss recent retrospective clinical studies that have analyzed the effect of multimodal treatment approaches on survival outcomes in patients with these lesions.
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Affiliation(s)
- Joshua A Cuoco
- Section of Neurosurgery, Carilion Clinic, Roanoke, VA, United States.,Virginia Tech Carilion School of Medicine, Roanoke, VA, United States.,Virginia Tech School of Neuroscience, Blacksburg, VA, United States.,Edward Via College of Osteopathic Medicine, Blacksburg, VA, United States
| | - Cara M Rogers
- Section of Neurosurgery, Carilion Clinic, Roanoke, VA, United States.,Virginia Tech Carilion School of Medicine, Roanoke, VA, United States.,Virginia Tech School of Neuroscience, Blacksburg, VA, United States.,Edward Via College of Osteopathic Medicine, Blacksburg, VA, United States
| | - Christopher M Busch
- Section of Neurosurgery, Carilion Clinic, Roanoke, VA, United States.,Virginia Tech Carilion School of Medicine, Roanoke, VA, United States.,Virginia Tech School of Neuroscience, Blacksburg, VA, United States.,Edward Via College of Osteopathic Medicine, Blacksburg, VA, United States
| | - Lisa S Apfel
- Section of Neurosurgery, Carilion Clinic, Roanoke, VA, United States.,Virginia Tech Carilion School of Medicine, Roanoke, VA, United States.,Virginia Tech School of Neuroscience, Blacksburg, VA, United States.,Edward Via College of Osteopathic Medicine, Blacksburg, VA, United States
| | - John J Entwistle
- Section of Neurosurgery, Carilion Clinic, Roanoke, VA, United States.,Virginia Tech Carilion School of Medicine, Roanoke, VA, United States.,Virginia Tech School of Neuroscience, Blacksburg, VA, United States.,Edward Via College of Osteopathic Medicine, Blacksburg, VA, United States
| | - Eric A Marvin
- Section of Neurosurgery, Carilion Clinic, Roanoke, VA, United States.,Virginia Tech Carilion School of Medicine, Roanoke, VA, United States.,Virginia Tech School of Neuroscience, Blacksburg, VA, United States.,Edward Via College of Osteopathic Medicine, Blacksburg, VA, United States
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Okada T, Fujitsu K, Ichikawa T, Miyahara K, Tanino S, Uriu Y, Hataoka S, Tanaka Y, Suzuki K, Niino H, Yagishita S, Kato I. Intracranial epidermoid cyst with proliferative folliculosebaceous epithelium: Report of a rare case and discussion on pathogenesis. Neuropathology 2018; 38:510-515. [PMID: 29876981 DOI: 10.1111/neup.12481] [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: 03/29/2018] [Revised: 05/13/2018] [Accepted: 05/14/2018] [Indexed: 11/29/2022]
Abstract
Intracranial epidermoid cysts are rarely known to increase in size over a brief period. While malignant transformations of epidermoid cyst have been previously described, no reports to date have described rapid proliferation accompanied by mature hair follicles and sebaceous glands without malignant transformations. The present case involved a 71-year-old man who visited a local physician with disturbance of equilibrium. A mass lesion was detected at the left cerebellopontine angle and was subsequently removed. Histopathological diagnosis of this lesion was as an epidermoid cyst. Seventeen years after this initial surgery, worsened left hypoacusis, disorientation, eating disorder and gait disturbance appeared, and the patient visited the physician again. Local recurrence of the lesion was observed, and the patient was referred to our hospital for its removal. Intraoperative findings revealed a pearly white tumor, histopathologically diagnosed as an epidermoid cyst. Three years later, local recurrence was observed, and the cyst was again removed. Intraoperative findings revealed a partially pearly white tumor similar to the tumor observed during the second surgery, but the majority of the tumor was non-shiny, ochre-colored and suckable. Histopathological diagnosis was an epidermoid cyst with an epidermis-like structure. Postoperative activities of daily living were independent thereafter, but from March of the following year, he began to experience increasing difficulty in walking and subsequently visited our hospital again. Tumor recurrence was observed and was removed again in November of the same year. Intraoperative findings revealed a tumor that was primarily ochre-colored, non-shiny, brittle and suckable. The histopathological diagnosis was folliculosebaceous epithelial proliferative lesion accompanied by an epidermis-like epithelium and a differentiation into hair follicles and sebaceous gland,s and the tumor was determined to be an epidermoid cyst with proliferative folliculosebaceous epithelium.
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Affiliation(s)
- Tomu Okada
- Department of Neurosurgery, National Hospital Organization, Yokohama Medical Center, Yokohama, Japan
| | - Kazuhiko Fujitsu
- Department of Neurosurgery, National Hospital Organization, Yokohama Medical Center, Yokohama, Japan
| | - Teruo Ichikawa
- Department of Neurosurgery, National Hospital Organization, Yokohama Medical Center, Yokohama, Japan
| | - Kousuke Miyahara
- Department of Neurosurgery, National Hospital Organization, Yokohama Medical Center, Yokohama, Japan
| | - Shin Tanino
- Department of Neurosurgery, National Hospital Organization, Yokohama Medical Center, Yokohama, Japan
| | - Yasuhiro Uriu
- Department of Neurosurgery, National Hospital Organization, Yokohama Medical Center, Yokohama, Japan
| | - Synsuke Hataoka
- Department of Neurosurgery, National Hospital Organization, Yokohama Medical Center, Yokohama, Japan
| | - Yuusuke Tanaka
- Department of Neurosurgery, National Hospital Organization, Yokohama Medical Center, Yokohama, Japan
| | - Kouji Suzuki
- Department of Neurosurgery, National Hospital Organization, Yokohama Medical Center, Yokohama, Japan
| | - Hitosi Niino
- Department of Pathology, National Hospital Organization, Yokohama Medical Center, Yokohama, Japan
| | - Saburou Yagishita
- Department of Pathology, National Hospital Organization, Yokohama Medical Center, Yokohama, Japan
| | - Ikuma Kato
- Department of Pathology, Yokohama City University, Yokohama, Japan
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