White epidermoid: an important radiological mimic of the dermoid
- PDF / 163,908 Bytes
- 2 Pages / 595.276 x 790.866 pts Page_size
- 51 Downloads / 167 Views
LETTER TO THE EDITOR
White epidermoid: an important radiological mimic of the dermoid Jaskaran Singh Gosal 1
&
Mayank Garg 1 & Sarbesh Tiwari 2 & Kuntal Kanti Das 3 & Deepak Kumar Jha 1
Received: 1 September 2020 / Accepted: 7 September 2020 # Springer-Verlag GmbH Germany, part of Springer Nature 2020
Dear Editor: We read with great interest the article “A rare case of a pediatric white epidermoid cyst” by Lundy et al. published recently in the Child’s Nervous System [5]. The authors have described a rare case of the white epidermoid cyst of the left cerebellomedullary cistern in a 15year-old girl. The atypical white epidermoid is a fascinating rare radiological variant of the classical “black” epidermoid, constituting only 3% of all the epidermoids [3]. The authors are to be commended for reporting this atypical variant, which, according to them, is even rarer in the pediatric population. We had earlier described the first case of the white epidermoid of the sylvian fissure, which mimicked the dermoid radiologically [3]. Still, to our surprise, it was an epidermoid intraoperatively. We believe that preoperative differentiation of the dermoid and the atypical white epidermoids is difficult owing to similar radiological characteristics; however, some fine radiological points help to differentiate between the two. Preoperative radiological diagnosis of the white epidermoid has important implications as white epidermoids have a higher tendency of intraoperative spillage and subsequent aseptic meningitis compared with the dermoids and classic “black” epidermoids [3]. Via this
* Jaskaran Singh Gosal [email protected]; [email protected] 1
Department of Neurosurgery, All India Institute of Medical Sciences (AIIMS), Jodhpur, Rajasthan 342005, India
2
Department of Radiodiagnosis & Intervention Radiology, All India Institute of Medical Sciences (AIIMS), Jodhpur, Rajasthan 342005, India
3
Department of Neurosurgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences (SGPGI), Lucknow 226014, India
communication, we want to elaborate on the critical radiological differences between these two entities so as to make a confident preoperative diagnosis. A differentiation between the white epidermoids and the dermoids becomes more complicated when white epidermoids occur in the pediatric population (as in the author’s case). It is because the dermoids also usually present in this age group [3]. In general, intracranial epidermoids are more common (1%) than the dermoids (0.3%) and tend to present at a later age in the third to fourth decade than the latter, which usually present early in the second decade [2, 3]. Dermoids are known to occur in the midline (sometimes with an external tract), whereas the epidermoids are typically unilateral [3, 4]. On computed tomography (CT) brain, dermoids are hypodense, whereas the atypical “white” epidermoids can either be hypo- or hyperdense (as in the author’s case). Interestingly, calcification occurs in 20% of the dermoids, but it has not been reported in the
Data Loading...
