Extradural epidermoid cyst

Case contributed by A.Prof Frank Gaillard

Presentation

Headache.

Patient Data

Age: 75 years
Gender: Male
CT

An ovoid well circumscribed right-sided posterior fossa mass with bony remodelling is noted. It is hypodense with only peripheral enhancement. 

MRI

There is an extradural mass in the right posterior fossa. The lesion is T2 hyperintense with multiple internal septations. It demonstrates diffusion restriction with no appreciable contrast enhancement. It causes moderate mass effect, displacing the right cerebellum. It effaces, but does not compress the right transverse and sigmoid sinuses. There is no surrounding edema. The fourth ventricle is patent and there is no hydrocephalus. A 5mm high T2 / low T1 focus in the left post-central gyrus demonstrates susceptibility artefact consistent with calcification on phase and CT suggests an old granuloma or burnt out cysticercosis. There are no other foci of susceptibility artefact. Parenchymal signal is otherwise normal throughout.

Conclusion: Extradural cystic mass in the right posterior fossa is almost certainly a "white" epidermoid.

Pathology

Histology post resection

Sections show a cyst wall lining with a thin layer of stratified squamous epithelium including a granular cell layer, with bland nuclear features and surface keratinization. There is abundant Iamellated keratin debris. The wall is fibrous with areas of infiltration by mononuclear chronic inflammatory cells, foreign body type multinucleate giant cells, in association with cholesterol clefts. The inflammatory process focally extends into bone. There is no brain tissue identified. There are no adnexal skin structures or immature elements. There is no evidence of malignancy. 

FINAL DIAGNOSIS: epidermoid cyst.

Case Discussion

This is a case of extradural epidermoid cyst rather than the more commonly encountered cerebellopontine angle intracranial epidermoid cyst. Histologically this lesion is equivalent to in intradiploic epidermoid cyst and/or cholesteatoma

All of these lesions are similar, differing primarily in the location. 

PlayAdd to Share

Case information

rID: 60115
Published: 2nd Jun 2018
Last edited: 14th Aug 2019
Inclusion in quiz mode: Included

Updating… Please wait.

 Unable to process the form. Check for errors and try again.

 Thank you for updating your details.