title: Posterior fossa epidermoid cysts presenting with unusual radiological appearances--two case reports.
abstract: Intracranial epidermoid cysts generally appear as hypodense on computed tomography (CT), hypointense on T(1)-weighted magnetic resonance (MR) imaging, and hyperintense on diffusion-weighted MR imaging. We report two cases of posterior fossa epidermoid cysts with unusual radiological features. A 49-year-old male presented with facial dysesthesia and a 12-year-old male presented with diplopia and internuclear ophthalmoplegia. CT of both cases revealed hyperdense lesions. MR imaging showed the first case as hypointense in the posterior part and hyperintense in the anterior part of the tumor on diffusion-weighted imaging, and the second case as hyperintense on diffusion-weighted and T(1)-weighted MR imaging. Surgical exploration revealed that the tumors consisted of creamy materials, instead of the usual semi-solid or flaky texture in epidermoid cysts. Xanthochromic serous fluid was also contained in the superoposterior half of the cyst of the first case. These unusual contents of the cyst may be responsible for the unusual neuroimaging findings. Histological examination showed both cysts were lined with stratified squamous epithelium and contained keratinaceous materials. Therefore, epidermoid cysts can occasionally present with unusual radiological characteristics giving rise to a diagnostic pitfall.
authors.affiliation: Department of Neurosurgery, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan.
authors.forename: Manoj
authors.initials: M
authors.lastname: Bohara
authors.forename: Hajime
authors.initials: H
authors.lastname: Yonezawa
authors.forename: Ryosuke
authors.initials: R
authors.lastname: Hanaya
authors.forename: Sinnichiro
authors.initials: S
authors.lastname: Takeshita
authors.forename: Masayuki
authors.initials: M
authors.lastname: Sumida
authors.forename: Kazunori
authors.initials: K
authors.lastname: Arita
mesh_terms: D002526:Cerebellar Diseases / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery*; D002530:Cerebellopontine Angle / Q000473:pathology / Q000601:surgery; D002648:Child; D003389:Cranial Nerve Diseases / Q000209:etiology; D003399:Craniotomy; D038524:Diffusion Magnetic Resonance Imaging; D004814:Epidermal Cyst / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery*; D020546:Fourth Ventricle / Q000473:pathology / Q000601:surgery; D006801:Humans; D007091:Image Processing, Computer-Assisted; D008297:Male; D008875:Middle Aged; D009460:Neurologic Examination; D013396:Suction; D014057:Tomography, X-Ray Computed