Intracranial epidermoid cyst: atypical location

Case contributed by Dr Bruno Di Muzio

Presentation

Chronic headache.

Patient Data

Age: 50-year-old
Gender: Female

MRI Brain

Modality: MRI

 

A sharply circumscribed 3.9 x 4.7 x 3.7 cm left posterior inferior frontal mass approaches CSF signal on most sequences, with areas of ill-defined incomplete flair suppression. The presence of marked diffusion restriction in the lesion is characteristic of an epidermoid.

Mass effect effaces and displaces superiorly and to the right the left frontal horn, and causes subfalcine herniation of the left inferior frontal parenchyma. The mass extends posteriorly to the level of the foramen of Monro, which is partially effaced but not obstructed. Faint linear enhancement about the periphery of the mass.

Minimal surrounding gliosis or oedema.

A few small T2 hyperintense white matter foci compatible with mild age-related change chronic small vessel ischaemia. No parenchymal susceptibility artefact. No further mass lesion or pathological contrast enhancement. No hydrocephalus.

Conclusion: Large left frontal epidermoid.​

Case Discussion

In this case, although the unusual location, the lesion signal features are typical and characteristic for an epidermoid: sharply circumscribed lesion which approaches CSF signal on most sequences, with areas of ill-defined incomplete FLAIR suppression, and marked diffusion restriction.

Because of their avascular nature and composition (cholesterol and keratin) epidermoid tumours typically have no enhancement on post-contrast images.

Intracranial epidermoid cysts are benign tumours that are commonly found in the cerebellopontine angle (40-50%), suprasellar cistern (10-15%), and fourth ventricle (~17%), however, they can also happen in unusual locations such as exposed in this case. 

The tumour in this case was surgically removed and confirmed as an epidermoid cyst. 

 

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Case Information

rID: 40579
Case created: 27th Oct 2015
Last edited: 20th Dec 2015
Tag: rmh
Inclusion in quiz mode: Included

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