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
