Cent Eur Neurosurg 2004; 65(1): 32-35
DOI: 10.1055/s-2004-44886
Case Report

© Georg Thieme Verlag Stuttgart · New York

Giant Intradiploic Epidermoid Cyst of the Occipital Bone

Gigantische intradiploische Epidermoidzyste des Os occipitaleF. Maiuri1 , M. Del Basso De Caro3 , G. D'Acunzi1 , F. Tortora2 , F. Esposito1
  • 1Department of Neurological Sciences, Section for Neurosurgery, University Federico II, School of Medicine, Naples, Italy
  • 2Department of Neurological Sciences, Section for Neuroradiology, University Federico II, School of Medicine, Naples, Italy
  • 3Department of Biomorphological Sciences, Section for Pathology, University Federico II, School of Medicine, Naples, Italy
Further Information

Publication History

Publication Date:
24 February 2004 (online)

Abstract

A rare case of giant intradiploic epidermoid cyst of the occipital bone with large intracranial extension in the posterior fossa is described. The lesion was discovered when the patient presented with headache and subcutaneous swelling in the occipital region, in the absence of signs of neurological involvement.
CT scan showed extensive destruction of the occipital bone, mainly of the inner table, up to the foramen magnum. On MRI the lesion was hypointense in T1 and hyperintense in T2-weighted images; signal inhomogeneity was due to cellular debris and cholesterol crystals. The enhancing rim due to the thickened dura confirmed the extradural location. Complete removal of the cyst was easily accomplished despite its large size.
We found only 3 documented cases in the literature of giant intradiploic infratentorial epidermoid cysts, none of which was studied by MRI. The radiological features and differential diagnosis are discussed.

Zusammenfassung

Es wird der seltene Fall einer riesenhaften intradiploischen Epidermoidzyste des Os occipitale mit großer intrakranieller Ausdehnung in die hintere Schädelgrube beschrieben. Zur Entdeckung der Läsion führten Kopfschmerzen und eine subkutane Schwellung okzipital bei fehlenden neurologischen Ausfällen. Die Computertomographie konnte die extensive Destruktion des Okzipitalknochens gut darstellen, insbesondere der Tabula interna bis hinunter zum Foramen magnum. Im Kernspintomogramm war die Läsion hypointens in T1- und hyperintens in T2-gewichteten Bildern. Wegen des zellulären Debris und der Cholesterolkristalle bestanden Signalinhomogenitäten. Der Kontrastmittel aufnehmende Rand der verdickten Dura bestätigte die extradurale Lokalisation. Trotz ihrer ausgedehnten Größe war die komplette Entfernung der Epidermoidzyste leicht durchführbar. Aus der Literatur konnten nur drei Fälle von riesenhafter intradiploischer Epidermoidzyste im intratentoriellen Bereich gesammelt werden, von denen kein Bericht MRT-Befunde enthielt. Die radiologischen Charakteristika und die Differenzialdiagnosen werden diskutiert.

References

  • 1 Arana E, Latorre F F, Revert A, Menor F, Riesgo P, Liano F, Diaz C. Intradiploic epidermoid cysts.  Neuroradiology. 1996;  38 306-311
  • 2 Boyko O B, Scott J A, Muller J. Intradiploic epidermoid cyst of the skull: case report.  Neuroradiology. 1994;  36 226-227
  • 3 Canale D J, Clarke H A, Pak Y H. Giant primary intradiploic epidermoid tumor of the skull: case report.  Surg Neurol. 1974;  2 51-54
  • 4 Chambers A, Lukin R R, Tomsick T A. Cranial epidermoid tumors: Diagnosis by computed tomography.  Neurosurgery. 1977;  1 276-280
  • 5 Ciappetta P, Artico M, Salvati M, Raco A, Gagliardi F M. Intradiploic epidermoid cyst of the skull: report of 10 cases and review of the literature.  Acta Neurochir. 1990;  102 33-37
  • 6 Constans J P, Meder J F, de Divitiis E, Donzelli R, Maiuri F. Giant intradiploic epidermoid cysts of the skull. Report of two cases.  J Neurosurg. 1985;  62 445-448
  • 7 Cushing H. A large epidermal cholesteatoma of the parietotemporal region deforming the left hemisphere without cerebral symptoms.  Surg Gynecol Obstet. 1922;  34 557-566
  • 8 Dias P S, May P L, Jakubowski J. Giant epidermoid cysts of the skull.  Br J Neurosurg. 1989;  3 51-57
  • 9 Di Benedetto G, Pierangeli M, Scalise A, Pauri F, Bertani A. Gigantic epidermoid cyst of the skull.  Plast Reconstr Surg. 1996;  97 1246-1248
  • 10 Djindjian M, Keravel Y, Lepresle E, Caron J P, Ruel M, Gaston A. Kyste epidermoide intra-osseux occipital entrainant un tableau clinique simulant une hypertension intra-cranienne benigne. Cas clinique.  Neurochirurgie. 1987;  33 395-398
  • 11 Garcia J, Lagier R, Hoessly M. Computed tomography-pathology correlation in skull epidermoid cyst. Case report.  J Comput Assist Tomog. 1982;  6 818-820
  • 12 Guidetti B, Gagliardi F M. Epidermoid and dermoid cysts: Clinical evaluation and late surgical results.  J Neurosurg. 1977;  47 12-18
  • 13 Guridi J, Oilier J, Aguilera F. Giant intradiploic epidermoid tumor of the occipital bone: Case report.  Neurosurgery. 1990;  27 978-980
  • 14 Inagaki T, Saito K, Okuyama T, Hirano A, Takahashi A, Inamura S. A case of diploic epidermoid invading intradurally, which was diagnosed by MR diffusion-weighted image.  No Shinkei Geka. 1998;  96 917-921
  • 15 Lazorthes G, Anduze-Acher H. Les signes radiologiques des quistes épidermoides cranio-encéphaliques d'après 9 cas opérés.  Neurochirurgie. 1957;  31 336-338
  • 16 Piotin M, Gailloud P, Reverdin A, Schneider P A, Pizzolato G, Rufenacht D A. Epidermoid cyst of the skull with nonpulsatile tinnitus.  Neuroradiology. 1998;  40 452-454
  • 17 Pumar J, Otero E, Castineira A. Intradiploic epidermoid tumor of the occipital bone: X-ray, CT and MR findings.  Eur Radiol. 1993;  3 183-185
  • 18 Rengachary S, Kishore P RS, Watanabe I. Intradiploic epidermoid cyst of the occipital bone with torcular obstruction: Case report.  J Neurosurg. 1978;  48 475-478
  • 19 Roosen N, Sprick C U. Completely reversible, severe, acute neurological deterioration with an otherwise asymptomatic, huge intradiploic calvarial epidermal cyst.  Surg Neurol. 1986;  5 169-172
  • 20 Rubin G, Scienza R, Pasqualin A, Rosta L, Da Pian R. Craniocerebral epidermoids and dermoids. A review of 44 cases.  Acta Neurochir. 1989;  97 1-16
  • 21 Sami A, Ait Ben Ali S, el Kamar A, Boucetta M. Kyste epidermoide de la voute du crane. A propos d'une observation.  Neurochirurgie. 1999;  45 58-61
  • 22 Tampieri D, Melanson D, Ethier R. MR imaging of epidermoid cysts.  AJNR. 1989;  10 351-356
  • 23 Toglia J V, Netsky M G, Alexander E. Epithelial (epidermoid) tumors of the cranium.  J Neurosurg. 1965;  23 384-393
  • 24 Zulch K J. Brain Tumors. Their Biology and Pathology. 3rd ed. Springer, New York 1988; pp 433-437

Prof. Francesco Maiuri

Dipartimento di Scienze Neurologiche

Cattedra di Neurochirurgia

Facoltà di Medicina e Chirurgia

Università Federico II

Via S. Pansini, 5

80131-Napoli

Italy

Phone: +39/0 81-7 46 25 76

Email: frmaiuri@unina.it