Huge intraventricular epidermoid cyst: A case report.

Background: Epidermoid cysts originate from ectopic embryonic epithelial cells and are a very common type of benign intracranial tumor. Epidermoid tumors located in the lateral ventricle are exceedingly rare. Case description: We present a rare case of a 55-year-old man complaining of a recurrent headache over a 2 year-period. A non-contrast CT scan and MRI of the head revealed a large mass within the right lateral ventricle. Gross total resection of the lesion was retained but unfortunately the patient refused surgery. The prognosis for patients who undergo surgery is excellent and depends on the quality of tumor removal.

Should Spinal MRI Be Routinely Performed in Patients With Clinically Isolated Optic Neuritis?

A Full-term Infant with Seizures.

Introduction: Ocular neoplasm being the most important cause of morbidity and mortality, early diagnosis and detection of the pathology is crucial for proper treatment and better prognosis. In clinical practice, eye Tumours and Tumour-like lesions can be classified into extra- and intra-ocular. Benign growth of eyelid includes xanthelasma, molluscum, warts, naevus, angioma and other tumers common to skin and cutaneous glands. Present study conducted with following Objectives: 1. To highlight the benign and malignant Tumours of eyelid, conjunctiva and orbit for early diagnosis and management. 2. Histopathological analysis to establish the type and subtype of benign and malignant Tumours. Methodology: This present study was a hospital based, longitudinal study conducted between August 2012 to August 2014. Patients with benign and malignant Tumours of eyelid, conjunctiva and orbit were included in the study and those who had Infective, inflammatory and traumatic lesions of eyelids, conjunctiva and orbit were excluded from study. Results: The study comprised 36 cases, out of them 19 subject had Eyelid, 9 Conjunctival and 8 Orbital Tumours. Among 19 eyelid Tumours, we found 17 Benign Tumours and 2 Malignant Tumours. Most common benign Tumour of eyelid seen in our study was Nevus (7 cases) followed by epidermoid cyst (5 cases), Papilloma(3 cases), xanthelasma(1 case), keratin cyst(1 case). Most common benign tumour of conjunctiva seen in our study was Nevus (4 cases), followed by dermolipoma (2 cases), papilloma (1 case) and dermoid cyst (1 case).All 4 Nevus cases were melanocytic nevus type. Most common benign Tumour of orbit in our study was Hemangioma(3 cases), followed by neurofibroma(2 cases) and Dermoid cyst(2 cases). Conclusion: The clinical evaluation and histopathological examination of the ocular Tumours has immense role in classifying the Tumours, establishing the final diagnosis and also in planning the most effective treatment modalities to reduce the morbidity and mortality to the possible extent.

To investigate the histogenesis of mixed tumor of the skin, apocrine type, the immunophenotypes of 10 cases were examined using 19 different monoclonal anti-keratin antibodies and antibodies against carcinoembryonic antigen (CEA) and involucrin. By using light microscopy, four epithelial elements in this tumor were characterized: tubular branching structures with lumina lined by cuboidal epithelium and those with lumina lined by columnar epithelium, keratinous cysts, and solid aggregates of epithelial cells. The immunohistochemical patterns of cytokeratin expression suggested that cuboidal and columnar cells differentiated, respectively, toward the ductal and secretory cells of apocrine glands, whereas keratinous cysts revealed follicular infundibular differentiation. Furthermore, CEA expression, a marker for sweat-gland differentiation, was present not only on tubules' luminal surfaces but also on the inner surfaces of keratinous cysts. The simultaneous coexpression of CEA and cytokeratins specific for follicular infundibulum in the keratinous cysts, although perplexing, suggested that keratinous cysts may contain some cells differentiating toward the intrafollicular portion of apocrine ducts that enter infundibulae rather than eccrine ducts that have no infundibular association. We conclude that apocrine type of mixed tumors of the skin demonstrate differentiation toward all components of apocrine units.

Background: Intraoperative MRI (iMRI) is an important modality in brain tumor surgery to identify residual tumors, however, it is problematic due to patient positional limitations. In this study, we investigated the usefulness of iMRI for posterior fossa lesions. Materials and Methods: Of 320 cases of brain tumors removed using iMRI from June 2016 to April 2023, 24 cases of posterior fossa lesions were included. Tumor type, approach method, imaging availability, tumor removal rate, and complications were examined retrospectively. Results: Tumor types included 8 gliomas, 5 epidermoid cysts, 4 meningiomas, 3 metastatic brain tumors, 1 schwannoma, and 3 others. Eleven patients underwent midline suboccipital approach in the supine position, 8 patients underwent lateral suboccipital approach, 2 patients underwent occipital transtentorial approach, and 2 patients underwent anterior transpetrosal approach in the supine position. transpetrosal approach in 2 cases and subtemporal approach in 1 case. iMRI showed residual lesion in 14 of 24 patients. More than half of the gliomas and epidermoid cysts had intraoperative residual disease, whereas only one meningioma did. Total resection was achieved except for one case of intentional residual schwannoma and two cases of glioma. Discussion: iMRI requires the upper body to fit within a gantry, and it is difficult to image in the park bench position. However, various approaches is possible by using a supine-lateral or semi-prone position. In the concorde position, where the fourth ventricle and upper cerebellum are approached, it is useful to insert a mat in the anterior thoracic and raise the upper body. For tumors in the dorsal brainstem and upper cerebellum, the occipital transtentorial approach was used. iMRI is effective in the removal of all tumors, including gliomas in intramedullary tumors and epidermoid cysts in extramedullary tumors. Conclusion: iMRI can be used in posterior cranial fossa lesions.

This case report describes unusual dermoid and epidermoid cysts in the oral region. This lesion was presented clinically as a coexistence case of a large dermoid cyst and a small epidermoid cyst of the floor of the mouth. A 21 year-old man was seen on February 14, 1989, because of swelling under the tongue. On palpation there was a large mass with slight pressure pain. The large mass was removed with another smaller mass under general anesthesia. Histologically, the large mass was a dermoid cyst and small mass was a epidermoid cyst.

An epidermoid cyst is a benign tumor in many locations. The symptoms of an epidermoid cyst depend on its location. The brain or spine MRI can confirm the lesion. Removing total decompression is the first choice in treatment with a symptomatic cyst.

Pulmonary tumor types induced in Wistar rats of the so-called “19-dust study”

A 37-year-old woman with an uncomplicated pregnancy was admitted to our hospital for delivery of her baby. During the birthing process, it was found that her birth canal was obstructed by a large presacral mass. Delivery of the infant was by cesarian section and the mass was subsequently evaluated. Computed tomography and magnetic resonance imaging scans (Figure 1) showed a 5.6 × 5.3-cm, well-circumscribed, hypodense, cystic lesion in the presacral region to the left of midline. The patient underwent an exploratory laparotomy and excision of the mass. During surgery, the mass was adherent to, but easily separated from, the rectum. The patient made an uneventful postoperative recovery and was discharged home after 3 days. The surgical specimen consisted of 2 fragments of fibrofatty tissue, the larger of which measured 6 × 5 × 2.5 cm and represented a ruptured cystic mass. The lining of the cyst was focally hemorrhagic with bright yellow areas. Microscopic examination revealed the wall to be composed of smooth muscle lined by a variety of epithelia, including stratified squamous, stratified and pseudostratified ciliated columnar, and transitional (Figures 2 through 4). Histologic sections of the bright yellow areas of the cyst wall revealed denuded epithelium with extensive xanthogranulomatous reaction.What is your diagnosis?We present a case of a 37-year-old woman with a presacral mass that was causing obstruction of the birth canal during delivery of her baby. Computed tomographic scans showed a circumscribed, hypodense, cystic mass. A laparoscopic excision of the mass was performed. The cyst wall was composed of smooth muscle lined by a variety of epithelia, consistent with a tailgut cyst.Tailgut cysts are rare developmental cysts in the presacral space and have been described under different names such as cyst of postanal intestine, retrorectal cystic hamartoma, mucus-secreting cyst, enterogenous cyst, simple cyst, myoepithelial hamartoma of the rectum, and retrorectal cysts.12 They are believed to arise from the remnants of the embryonic hindgut. The embryo at the 3.5- to 8.0-mm stage (28–35 days) of development possesses a true tail and the primitive hindgut extends into this tail caudal to the site of subsequent formation of anus. This is called the tailgut or postanal gut. It normally atrophies by the eighth week. Persistence of this tailgut is believed to be the origin of the tailgut cyst. A second theory is that it develops from remnants of the neurenteric canal.2Fewer than 100 cases have been reported to date; the largest series of 53 cases was reported by Hjermstad and Helwig from the Armed Forces Institute of Pathology.2 Tailgut cysts are more common in women (female-to-male ratio, 3:1). Nearly half the patients are asymptomatic and the other half present with symptoms of mass effect or pain. The cysts may be unilocular or multilocular and range in size from 2 to 12 cm in greatest dimension. They are soft, well-circumscribed masses, limited to the presacral space, with no communication with the rectum. Cysts may be filled with clear to straw-colored thin, watery fluid or thick, mucoid fluid. A variety of epithelial linings may be seen including stratified squamous, cuboidal, transitional, stratified columnar, mucinous, or ciliated columnar. Interrupted bundles and wisps of smooth muscle are present, separated from the epithelium by a thin layer of fibrous tissue; however, there is no distinct nerve plexus.12 Inflammation, including xanthogranulomatous type, is present about half the time. Complications include infection, inflammation, recurrent perianal fistulae, and malignant transformation; adenocarcinoma and carcinoid are the 2 commonest malignancies reported.1 Complete surgical excision is the treatment of choice, which eliminates the problem of recurrent draining sinuses as well as the possibility of malignant change.The presacral (retrorectal) space is a potential space bounded anteriorly by the rectum, posteriorly by the sacrum, superiorly by the peritoneal reflection, and inferiorly by the levator ani and coccygeus muscle. Congenital lesions are the most common causes of tumors and cysts in this location; teratomas in children and chordomas in adults are the most frequent.3 The differential diagnosis of tailgut cysts includes rectal duplication cysts, cystic teratoma, and dermoid and epidermoid cysts. Rectal duplication cysts are rare with fewer than 70 cases reported in the literature.4 Duplication cysts are more common in the ileum. They are also known as enteric cyst, enterogenous cyst, or enterocystoma. They are thought to result from incomplete separation of notochord, defects of recanalization, caudal twinning, or persistence of epithelial buds. Three main characteristics that separate rectal duplication cyst from tailgut cyst are firm attachment to the gastrointestinal tract, well-developed smooth muscle layer with myenteric plexus, and a mucosal lining reflective of the gastrointestinal tract with muscularis mucosae, villi, and crypts. Presacral teratomas are rare and contain derivatives from all 3 germ layers of ectoderm (squamous epithelium, and skin appendages), endoderm (respiratory or gastrointestinal epithelium, and pancreas), and mesoderm (connective tissue, smooth muscle, cartilage, and bone). The incidence of malignancy in presacral teratomas is said to be 10% to 50% with a sharp increase if diagnosed after 2 months of age. Dermoid and epidermoid cysts are unilocular and lined by stratified squamous epithelium. Dermal appendages are present in dermoid cyst and absent in epidermoid cyst.

A young boy with recurrent headache, lethargy, and hyponatremia

The cerebral cavernous malformations are benign vascular hamartomas, with thin and dilated vascular walls and therefore constantly susceptible to hemorrhage. Clinically, they present with recurrent headaches, acute intracranial hemorrhage and focal neurological deficits. They are considered as angiographically occult vascular malformations and the imaging technique of choice for their diagnosis is magnetic resonance tomography. We present the case of a female patient with acute-onset symptomatology, congruent with a lesion in the basal pons. Her medical history included an intracranial hemorrhage due to a cavernoma, which was surgically removed. The magnetic resonance imaging of the brain revealed two new cavernomas, which were not identified in the imaging conducted in the past. In literature, the cases of de novo appearance of cavernomas are considered highly rare, especially in patients with no consistent family history or medical history of radiation therapy. Resultantly, they should be considered as dynamic lesions, regarding their number, size and behavior.

ReportA 56-year-old man was assessed for progressive behavioral changes, naming difficulties, and memory impairment in the last 3 months.Initial examination revealed dysarthria, orolingual apraxia, mixed dysphasic features, alexia, no pupil contraction on light reflex with conserved accommodation reflex on near vision (Argyll-Robertson pupil) (Video 1), coarse lingual tremor (Video 2), and areflexia in lower limbs.Blood tests excluded metabolic disturbances and vitamin deficiencies.The fluorescent Treponemal Antibody-Absorption (FTA-ABS) and rapid plasma reagin (RPR) were positive (1:8 titer dilution).The brain magnetic resonance imaging showed bilateral frontal and temporal atrophy.The cerebrospinal fluid examination revealed lymphocytic pleocytosis, hyperproteinorrachia, normal glycorrhachia, and positivity on the Venereal Disease Research Laboratory test (CSF-VDRL); it was aseptic in bacterial culture.The electroencephalogram and electromyogram were unremarkable.On directed anamnesis, the patient recalled having been seen 10 years earlier for a maculopapular rash on palms and soles.Syphilis screening was recommended, but he never underwent it.Neurosyphilis was diagnosed.He began therapy with penicillin G 24 million IU every 4 h for 14 days.After treatment, dysarthria and tongue tremor resolved, but cognitive alterations persisted, with a predominance of attentional deficit and amnesic dysfunction (Video 3).

Voluntary alcohol intake after noise exposure in adolescent rats: Hippocampal-related behavioral alterations

296 -The effects of early intervention on autism spectrum disorder prognosis: a narrative review