Lateral intraventricular epidermoid cyst: A case report

Epidermoid cysts, originating from ectopic embryonic epithelial cells, are a common type of benign intracranial tumor. However, intraventricular epidermoid cysts are rare, with those occupying the lateral ventricles being exceptionally uncommon. This report details the case of a 59-year-old male presenting with recurrent headaches over an 8-month period, accompanied by behavioral changes, memory impairment, and seizures. Magnetic resonance imaging of the brain revealed a large intraventricular mass consistent with an epidermoid cyst. The patient underwent subtotal resection via a transfrontal transventricular approach, resulting in good postoperative recovery.

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.

Background: Spinal epidermoid accounts for <1% of all primary spinal cord tumors. They occur due to the invagination of epidermal elements into the neural tube during the embryonic period. Even more infrequent are spinal epidermoid cysts that occur without attendant spinal dysraphism (e.g., as occurs with the iatrogenic inoculation of epithelial cells in the subarachnoid space following a lumbar puncture).Case Description: A 38-year-old female with a history of epidural spinal blocks at L2-3 for two previous pregnancies presented with low back pain, right lower extremity weakness (4/5 level), hyporeflexia, and tingling/ numbness in the right L3-5 distribution. The lumbar MR demonstrated an intradural extramedullary lesion at the L2-L3 level that compressed the cauda equina/nerve roots. MR findings were compatible with an epidermoid cyst, this was histologically confirmed following a microsurgical L2-3 laminectomy for lesion resection. Pathologically, the lesion demonstrated a keratinized stratified squamous epithelium with keratin content without cutaneous attachments, thus confirming the diagnosis of an epidermoid cyst. Postoperatively, her sensory complains improved and her motor strength fully recovered to the 5/5 level.Conclusion: Patients with spinal epidermoid cysts typically present with underlying spinal dysraphism, but only rarely do iatrogenic cases arise. Here, we presented a patient who developed a spinal lumbar epidermoid cyst in a female patient after undergoing spinal epidural anesthesia during pregnancy. Notably, this was successfully treated a with decompressive laminectomy and microsurgical resection.

Various surgical approaches to treat intraventricular cysticercosis have been practiced over the years. We now present our experience with the use of the endoscope in the removal of intraventricular cysticercal cysts in patients with intraventricular cysticercal lesions associated with hydrocephalus. From 1995 to 1998, we have excised intraventricular cysticercal cysts from 9 patients. They were located in lateral ventricle in 4, in the third ventricle in two and in the fourth ventricle in three patients. A Gaab's rigid neuroendoscope system was used to enter and excise cysts in the lateral and third ventricle. The flexible fiberoptic scope was used for excising cysts in the fourth ventricle, through a transaqueductal route. In all cases a precoronal frontal burr hole was used for entry. All have been treated with albendazole in the postoperative period. All the cysts were removed successfully using endoscopic neurosurgery alone. One patient had a superficial injury to the rigid side of the aqueduct with a postoperative deficit, which improved. Three septal perforations, three third ventriculostomies, and one aqueductoplasty were done in the same sitting after cyst removal for CSF diversion. None of the nine cases required further surgery up to date. The follow-up period varied from 12 to 45 months with a median of 18 months. Endoscopic neurosurgery is a minimally invasive technique enabling removal of intraventricular cyticercal cysts from all locations, avoiding major craniotomies/posterior fossa explorations and shunts.

IntroductionThe most successful surgical management of periventricular and intraventricular cysts is still a matter of debate. Up to the early 1990s, open cyst fenestration and cystoperitoneal shunts were the only options available. Recently, different endoscopic approaches to these lesions have gained popularity.MethodsEighteen endoscopic procedures were performed for the treatment of arachnoid cysts in 18 patients. Sylvian fissure arachnoid cysts were excluded from this study. Ten of them were females and eight were males with their ages ranging from 6 months to 50 years with a mean of 16 years. All patients were prospectively observed.ResultsSeven of the arachnoid cysts were in the suprasellar region, 5 in the quadrigeminal region, 2 in the posterior fossa, 2 parietal, and 2 intraventricular. Seventeen cases (94%) had hydrocephalus. The main presenting manifestations were those of increased intracranial pressure. All fenestrations were done in the lateral ventricle except for the 2 cases with posterior fossa arachnoid cysts, the fenestrations were done to the fourth ventricle. Endoscopic ventriculocytostomies (VC) were performed in 14 cases without operative complications and no stents were placed. Endoscopic cystocisternostomies (C) were done in all suprasellar cases. Endoscopic cystoventriculostomies (CV) were done in 4 cases. The mean surgical time was 1 h. The mean follow-up period was 15 months. Symptoms improved in 17 cases. Seventeen cases demonstrated a significant decrease of the cysts’ size in the postoperative computed tomography (CT) and magnetic resonance imaging (MRI). A single case developed a complication in the form of subdural hygroma which required no intervention and was managed conservatively.ConclusionEndoscopic management of periventricular and intraventricular arachnoid cysts is a useful safe option in the management of arachnoid cysts related to the ventricular system.

An 8-year-old boy presented with a history of holocranial headache for 4 weeks which was mild to moderate in intensity. There was history of intermittent vomiting for the same duration. The patient was drowsy for the last 10 days. Non-contrast CT scan of head showed a space-occupying lesion in lateral ventricles with hydrocephalus. MRI showed a large lobulated well-defined heterogeneous mass lesion filling up both lateral ventricles at the posterior and temporal horns, bilaterally reaching up to the level of the foramen magnum. The mass lesion was hypointense on T2-weighted images (T2W) and isointense to grey mater on T1W images. On contrast images there was intense homogeneous enhancement seen at the lesion (Fig. 1). Right fronto-temporo-parietal craniotomy with decompression of the tumor was performed. Perioperatively, the tumor was yellowish in color, firm, not able to be aspirated and minimally vascular. Clinical diagnosis of choroid plexus tumor was considered.

This study has been made to define the role of endoscopy and the most appropriate approach and technique of endoscopic fenestration of paraventricular and intraventricular CSF cysts according to the cyst size and location. Twenty-two patients with intraventricular (13 cases) and paraventricular (9 cases) CSF cysts, operated upon by endoscopic technique in three Italian neurosurgical centers, are reviewed. Paraventricular hemispheric cysts have been treated by endoscopic fenestration from the cyst to the lateral ventricle. Midline intraventricular cysts (2 of the septum pellucidum and 4 of the velum interpositum) underwent fenestration from the right lateral ventricle to the cyst, with fenestration in both lateral ventricles in one case. Cysts of the choroid plexus have been fenestrated from the homolateral enlarged ventricle (4 cases) or from the contralateral compressed ventricle (2 cases). Twenty patients (more than 90%) were definitively cured by the endoscopic procedure, whereas only 2 patients required a shunt or a direct approach. We think that the endoscopic fenestration must be considered the treatment of choice of intraventricular and paraventricular CSF cysts.

Dermatologists often attend children with benign skin tumors and cysts. The decision to perform dermatologic surgery in children may be difficult to make, especially in cases of benign tumors. The objective of this study was to determine the nature of non-melanocytic benign skin tumors amenable to dermatologic surgery in children. Histopathologic studies of skin tumors in children treated by our department between January 2004 and December 2005 were studied. Malignant and melanocytic tumors were excluded. Age, sex, type of tumor, diagnostic category, site, size, reason for removal, type of anesthesia, and any other associated disorders were recorded. The records revealed that 121 patients presented 129 non-melanocytic benign skin tumors (73 in boys and 56 in girls). A total of 27 different anatomopathologic diagnoses were found. The most frequent was pilomatrixoma with 27 cases (20.9%), followed by infundibular cyst with 14 (10.9%), and molluscum contagiosum with 13 (10.1%). Tumors were located on the head and neck (45.7%), trunk (34.1%), and limbs (20.1%). The most frequently affected age group was children aged 11-14 years, which included 50 patients (38.8%). The main type of anesthesia used was local in 54.6% of the cases, sedation plus local anesthesia in 39.7%, and general anesthesia in 5.7%. The reasons that led to removal of the tumors were: increase in the size of the tumor (49%); various types of discomfort, such as severe itching or pain (30%); parental concern (4%); diagnostic uncertainty (16%); and esthetic reasons (1%). There is a wide diversity of non-melanocytic benign skin tumors in children, some of which require surgical treatment. Pilomatrixomas appear to be the most frequent benign tumors; there are also high frequencies of infundibular cysts, pyogenic granulomas, and viral tumors. Most can be removed under local anesthesia, with or without sedation.

Epidermoid cysts, also known as follicular cysts, are benign tumors that typically arise from hair follicle infundibulum. These cysts are most commonly seen in subcutaneous tissues, though intraosseous epidermoid cysts (IEpC) are rare, with few reports of their occurrence in the phalanges and even more infrequently in the ankle. This case report discusses a 61-year-old male who presented with progressively enlarging swelling on the lateral aspect of his right ankle. Initially asymptomatic, the lesion became painful, inflamed, and discharged purulent material, prompting concern for an infection. Diagnostic imaging, including magnetic resonance imaging (MRI), suggested a possible infected ganglion or tumorous cyst. Laboratory tests confirmed mild leukocytosis and elevated inflammatory markers. Following unsuccessful drainage, surgical excision was performed, revealing a 7×5×2.4 cm cystic mass. Histopathological examination confirmed the diagnosis of an epidermoid inclusion cyst. The patient’s recovery was uneventful, with no recurrence of symptoms.

Study designThis was a retrospective study.ObjectiveThe aim of this study was to analyze the clinical characteristics and discuss the treatment options for epidermoid cysts in the lumbar spine.Summary of background dataEpidermoid cysts are rare benign neoplasms, which account for less than 1% of all intraspinal tumors. Due to their rarity, there are only a few case reports in the literature. Complete excision is the recommended treatment for an epidermoid cyst, but this is difficult to achieve in the spine. In spite of their benign nature, local recurrence is not uncommon for spinal epidermoid cysts after incomplete excision.MethodsSix patients with an epidermoid cyst in the lumbar spine underwent surgical treatment in our center between 2004 and 2011. A total excision using microsurgical techniques and reconstruction was successfully undertaken in all patients. Clinical data and detailed pathologic results were retrospectively analyzed. All cases were followed up for a median time of more than 4 years. The clinical data and surgical efficacy were analyzed to suggest treatment options for epidermoid cysts in the lumbar spine on the basis of a literature review and our own experience.ResultsThe mean age of the patients in this study was 37.7 years and the mean duration of pre-operative symptoms was 29.7 months (2 to 120 months). All patients were disease-free during their follow-up period. Radicular pain nearly disappeared, and patients suffering from neurologic deficits and defecation disorders recovered well.ConclusionsAlthough an epidermoid cyst is a benign tumor, it is apt to recur locally following inadequate removal. Therefore, complete excision with preservation of neural function is an ideal protocol for intraspinal epidermoid cysts. Microsurgical techniques are very useful.

Idiopathic calcinosis cutis is characterized by multiple nodules present on scrotal skin. They are usually seen in young adults and present as painless, asymptomatic, round, and firm nodules. A 30-year-old male presented with painless, multiple scrotal nodules. The serum levels of calcium, phosphorus, calcitonin, and parathyroid hormone were within normal limits. There was also no history of trauma. Clinically, it was diagnosed as sebaceous cyst. Fine-needle aspiration cytology examination was suggestive of epidermal inclusion cyst. Histopathology examination confirmed the diagnosis of idiopathic scrotal calcinosis cutis, thus suggesting that the dystrophic calcification of epidermal inclusion may be an initiating event in the pathogenesis of the idiopathic scrotal calcinosis cutis. The documentations regarding the association of idiopathic calcinosis cutis with epidermal cyst are not enough. Hence, this case report may enrich the scanty existing data.

The use of the endoscope for lesions of the central nervous system has been progressively widened in the past decades. Among these lesions, the intraventricular cyst is one of the most attractive targets for this less invasive procedure. Between 2003 and 2007, ten consecutive patients with IVC underwent endoscopic surgery in our department. The location of the cyst was the lateral ventricle in nine, the lateral and third ventricles in one. The cyst was resected or fenestrated according to the degree of adhesion of the cyst wall with the ventricular wall. The follow-up ranged from 6 months to 54 months (mean: 22.5 months). The cyst was totally removed in three, subtotally removed in one, and fenestrated in six cases. Except for transient fever, there was no post-operative morbidity. During follow-up, all patients were doing well. The endoscopic technique is a good treatment option with the advantage of minimal invasiveness and less complications. The extension of the cyst and whether the hemisphere involved is dominant or not, determines the ideal endoscopic trajectory. The long-term efficacy of the endoscopic technique in treatment of IVC needs further evaluation.

Detailed clinical features other than parotid mass have not been investigated in detail for parotid tumors. Symptoms and signs are useful for the differentiation of benign versus malignant, and may also be of value to determine the grade of malignancy and histological type as well as the assessment of prognosis. We reviewed symptoms and signs of 965 patients with benign tumors and 200 patients with malignant tumors. Symptoms and signs included pain/tenderness, adhesion to surrounding tissues, and facial nerve palsy. We reviewed the incidence in benign and malignant tumors, in histological type of benign tumors, and in grade and histology of malignant tumors. For each symptom or sign, covariates were analyzed, and their correlation with the prognosis was investigated. The incidence of symptoms and signs was significantly higher in malignant than benign tumors, and more frequent in higher grade of malignancy. Facial nerve palsy was observed in 18.0% of malignant tumor cases, while none occurred in benign tumor cases. Pain/tenderness was more commonly observed in adenoid cystic carcinoma, while adhesion to surrounding tissues and facial nerve palsy were most frequently noted in salivary duct carcinoma. The prognosis of patients with these symptoms and signs was significantly poor. A detailed investigation of symptoms and signs in parotid gland tumors is the first step that leads to the diagnosis of malignant tumors. Symptoms and signs are also useful for estimating the grade of malignancy and histological type, and they are important information for predicting prognosis.

In this report the authors review their 3-year experience with the endoscopic management of patients with hydrocephalus who harbored cysticercal cysts within the third and lateral ventricles. The management plan was to utilize an endoscopic approach to remove the cysts and to incorporate techniques useful in treating obstructive hydrocephalus. The ultimate goals were to avoid having to place a complication-prone cerebrospinal fluid shunt and to eliminate the risk of complications related to cyst degeneration. A retrospective analysis of 10 patients with hydrocephalus and cysticercal cysts within the third or lateral ventricles who were endoscopically managed was performed. A general description of the instrumentation and technique used for removal of the intraventricular cysts is given. At presentation, neuroimaging revealed findings suggestive of obstructive hydrocephalus in eight patients. Seven of the 10 patients treated endoscopically were spared the necessity of shunt placement. Three successful third ventriculostomies and one therapeutic septum pellucidotomy were performed. Despite frequent rupture of the cyst walls during removal of the cysts, there were no cases of ventriculitis. The endoscopic approach allowed successful removal of a cyst situated in the roof of the anterior third ventricle. One patient suffered from recurrent shunt obstructions secondary to a shunt-induced migration of cysts from the posterior fossa to the lateral ventricles. The endoscopic removal of third and lateral ventricle cysticercal cysts, combined with a third ventriculostomy or septum pellucidotomy in selected cases, is an effective treatment in patients with hydrocephalus and should be considered the primary treatment for this condition.

In this report the authors review their 3-year experience with the endoscopic management of patients with hydrocephalus who harbored cysticercal cysts within the third and lateral ventricles. The management plan was to utilize an endoscopic approach to remove the cysts and to incorporate techniques useful in treating obstructive hydrocephalus. The ultimate goals were to avoid having to place a complication-prone cerebrospinal fluid shunt and to eliminate the risk of complications related to cyst degeneration. A retrospective analysis of 10 endoscopically managed patients with hydrocephalus and cysticercal cysts within the third or lateral ventricles was performed. A general description of the instrumentation and the technique used for removal of the intraventricular cysts is given. At presention, neuroimaging revealed findings suggestive of obstructive hydrocephalus in eight patients. Seven of the 10 patients treated endoscopically were spared the necessity of shunt placement. Three successful third ventriculostomies and one therapeutic septum pellucidotomy were performed. Despite frequent rupture of the cyst walls during removal of the cyst, there were no cases of ventriculitis. The endoscopic approach successfully allowed removal of a cyst situated in the roof of the anterior third ventricle. One patient suffered from recurrent shunt obstructions secondary to a shunt-induced migration of cysts from the posterior fossa to the lateral ventricles. The endoscopic removal of third and lateral ventricle cysticercal cysts, combined with a third ventriculostomy or septum pellucidotomy in selected cases, is an effective treatment in patients with hydrocephalus and should be considered the primary treatment for this condition.