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CC BY-NC-ND 4.0 · Asian J Neurosurg 2019; 14(02): 553-556
DOI: 10.4103/ajns.AJNS_241_18
Case Report

White epidermoid of the sylvian fissure masquerading as a dermoid cyst: An extremely rare occurrence

Jaskaran Gosal
Department of Neurosurgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh
,
Jeena Joseph
Department of Neurosurgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh
,
Deepak Khatri
Department of Neurosurgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh
,
Kuntal Das
Department of Neurosurgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh
,
Awadhesh Jaiswal
Department of Neurosurgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh
,
Aviral Gupta
Department of Neurosurgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh
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We report the case of a 30-year-old female with a Sylvian fissure, white epidermoid which was radiologically looking like a dermoid cyst. The female presented with a headache with no neurological deficits. On radiology, the lesion was in Sylvian fissure, T1 hyperintense, T2 hypointense, and with minimal diffusion restriction medially. Hence a preoperative impression of dermoid cyst was made, a quite uncommon location. Intraoperatively, the classical pearly-white flaky appearance of epidermoid was seen which was confirmed histopathologically. White epidermoids appearing so because of high protein content are a rarity and are more likely to cause aseptic meningitis in the event of intraoperative spillage. Differentiating between a dermoid cyst and white epidermoid preoperatively and radiologically is difficult. Dermoids show diffusion restriction and are usually midline, whereas white epidermoids do not show diffusion restriction and are usually lateral. This is the first report of a white epidermoid in Sylvian fissure to the best of our knowledge.

Key-words:

Dermoid cyst - mimicking - Sylvian fissure - white epidermoid

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Publication History

Article published online:
09 September 2022

© 2019. Asian Congress of Neurological Surgeons. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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  • References

  • 1 Puranik A, Sankhe S, Goel N, Mahore A. Cerebral shading sign in a giant intraparenchymal white epidermoid. Neurol India 2012;60:265-6.
  • 2 Conley FK. Epidermoid and dermoid tumors: Clinical features and surgical management. In: Wilkins RH, Rengachary SS, editors. Neurosurgery. 2nd ed. United States of America: McGraw-Hill; 1996. p. 971.
  • 3 Shah A, Makkiyah F, Goel A. Sylvian fissure epidermoid cyst presenting with intention tremor. Asian J Neurosurg 2016;11:174-5.
  • 4 Goel A, Muzumdar D, Desai K. Anterior tentorium-based epidermoid tumours: Results of radical surgical treatment in 96 cases. Br J Neurosurg 2006;20:139-45.
  • 5 Garces J, Mathkour M, Beard B, Sulaiman OA, Ware ML. Insular and sylvian fissure dermoid cyst with giant cell reactivity: Case report and review of literature. World Neurosurg 2016;93:491.e1-5.
  • 6 Horowitz BL, Chari MV, James R, Bryan RN. MR of intracranial epidermoid tumors: Correlation of in vivo imaging with in vitro 13C spectroscopy. AJNR Am J Neuroradiol 1990;11:299-302.
  • 7 Osborn AG. Osborn's Brain: Imaging, Pathology, and Anatomy. Salt Lake City, UT: Amirsys Inc.; 2013. p. 782-5.
  • 8 Glastonbury CM. The shading sign. Radiology 2002;224:199-201.
  • 9 Ramdasi R, Mahore A, Chagla A, Kawale J. White epidermoid at the foramen magnum. Neurol India 2014;62:577-9.
  • 10 Hetts SW, Urban JP, Quiñones-Hinojosa A, Joelson DW, Glastonbury CM. The shading sign in cerebral squamous cell metastases. AJR Am J Roentgenol 2004;182:1087-8.
  • 11 Li F, Zhu S, Liu Y, Chen G, Chi L, Qu F, et al. Hyperdense intracranial epidermoid cysts: A study of 15 cases. Acta Neurochir (Wien) 2007;149:31-9.