A rare case of a pediatric white epidermoid cyst
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CASE REPORT
A rare case of a pediatric white epidermoid cyst Paige Lundy 1
&
Paul Grabb 1,2,3
Received: 25 March 2019 / Accepted: 8 January 2020 # Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract White epidermoid cysts are a rare entity that present with atypical signal characteristics on MRI in comparison to typical epidermoid cysts. This can mislead a practitioner when trying to formulate a differential diagnosis based on imaging. We present the case of 15-year-old girl who presented with a pontine-medullar junction mass. This mass did not follow typical signal characteristics for known lesions. The mass was ultimately found to be an epidermoid cyst based on pathology findings. This lesion has rarely been reported in pediatric patients (J Pediatr Neurosci 9(1):52–54, 2014; Singap Med J 53(8):179–181, 2012). Here we present a rare case of an intracranial white epidermoid in a pediatric patient (Neurol India 62(5):577–579, 2014; Singap Med J 53(8):179–181, 2012; Am J Neuroradiol 19:1111–1112, 1998). Keywords Epidermoid cyst . White epidermoid . Contrast enhancing . Pontomedullary
Background and importance White epidermoid cysts are a rare variant of intracranial epidermoid cysts that do not follow the classic signaling characteristics on magnetic resonance imaging (MRI). Instead of following cerebrospinal fluid (CSF) signaling, they present as hyper-intense on T1 sequences and hypo-intense on T2 sequences [1, 2, 5]. This lesion has rarely been reported in pediatric patients [2, 6]. Here we present a rare case of an intracranial white epidermoid in a pediatric patient.
Clinical presentation A 15-year-old girl had an MRI in February 2015 for work up of autonomic orthostatic dysfunction and * Paige Lundy [email protected] 1
Department of Neurological Surgery, University of Kansas, 3901 Rainbow Blvd, MS 3021, Kansas City, KS 66160, USA
2
Children’s Mercy Hospital, Kansas City, MO, USA
3
University of Missouri at Kansas City, Kansas City, MO, USA
unexplained syncopal episodes. MRI revealed a left pontine-medullar junction homogenous lesion that was hyper-intense on T1 sequences of a non-contrasted MRI, and isointense on T2 sequences. With gadolinium administration, the lesion mildly enhanced on T1 sequences (Fig. 1). The lesion was felt to be a benign mass and serial MRIs over 33 months displayed slight expansion of the extra-axial mass. She again presented with a persistent severe headache. Computerized tomography (CT) of the head showed the known hyperdense lesion but no other acute pathology (Fig. 2). She was referred for neurosurgical evaluation at that time. She reported debilitating headaches radiating from her left occiput as well as intermittent blurred vision in her left eye. Her neurological examination revealed no deficits. Options of continued observation versus resection were discussed. She and family elected for surgical removal. A left retrosigmoid craniectomy and microsurgical resection was performed with cranial nerve and brainstem auditory evoked response (BAER) monitoring
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