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CP angle epidermoid

Case contributed by: Dr Gagandeep Choudhary

Presentation:

Young female presented with tinnitus and headache

From the case: CP angle epidermoid

Modality: MRI

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T1

Hypointense mass seen in right CP angle insunating along cisterns

Case Discussion:

An epidermoid cyst is an inclusion cyst. They are benign congenital lesions of ectodermal origin. They account for approximately 1% of all intracranial tumors. Although these lesions are congenital, patients are usually not symptomatic until they are aged 20-40 years. The most common locations are around the brainstem, pituitary gland and in the posterior fossa along the cerebellum and brainstem. Some epidermoid cysts can rupture and result in a meningitis type reaction from inflammation. It insunates along the cisterns. No malignant degeneration seen.

Cauliflower like surface with mother of peal appearance on gross examination.

Imaging:

Attenuation similar to CSF, calcification seen on 10-25% of cases. No contrast enhancement seen.

MRI

Typically have intensity similar to CSF on T1 and T2.
Not supreses on FLAIR and shows no contrast enhancement.
On ADC intensity similar to brain parenchyma. and shows restricted diffusion on DWI.