title: Insular and Sylvian Fissure Dermoid Cyst with Giant Cell Reactivity: Case Report and Review of Literature.
abstract: BACKGROUND
  Dermoid cysts are rare intracranial tumors that are most commonly found infratentorially and along the midline. Characterized by slow growth and often found incidentally, these lesions can nonetheless have severe complications, notably rupture leading to chemical meningitis. They infrequently present as a supratentorial and lateralized mass. As such, sylvian fissure dermoid cysts are exquisitely rare. We present a rare case of a dermoid cyst with giant cell reactivity suggestive of focal rupture and chronic inflammation.
  
  
  METHODS
  A 61-year-old female presented with new-onset seizures. Magnetic resonance imaging revealed a right insular mass measuring 4.3 × 4.5 cm with compression of the ipsilateral frontal and temporal lobes. The mass was nonenhancing; however, it was bright on diffusion-weighted imaging, suggesting a dermoid cyst. She underwent craniotomy for tumor resection. Histologic analysis revealed keratinizing squamous epithelium, sebaceous glands, and hair follicles associated with giant cell reaction involving the capsule of the cyst consisted with dermoid cyst. At 2.5 years post operation, she is seizure free and without evidence of recurrence.
  
  
  CONCLUSIONS
  The dermoid cyst in our patient was not grossly ruptured, but histopathologic analysis revealed giant cell reactivity, which may indicate focal rupture or chronic inflammation. The relationship between rupture of dermoid cysts and inflammation is not well elucidated. It is not known whether symptoms occur immediately after rupture or as an acute manifestation of a chronic process following rupture. As these lesions are quite rare and rupture is even rarer, more diligence on our part regarding details of histopathology for dermoid cysts is necessary.
authors.affiliation: Department of Neurosurgery, Ochsner Health System, New Orleans, Louisiana, USA; Department of Neurosurgery, Tulane Medical Center, New Orleans, Louisiana, USA.
authors.forename: Juanita
authors.initials: J
authors.lastname: Garces
authors.affiliation: Department of Neurosurgery, Ochsner Health System, New Orleans, Louisiana, USA; Department of Neurosurgery, Tulane Medical Center, New Orleans, Louisiana, USA; Division of Neurosurgery, Department of Surgery, Jazan University, Jazan, Saudi Arabia. Electronic address: mmathkour@outlook.com.
authors.forename: Mansour
authors.initials: M
authors.lastname: Mathkour
authors.affiliation: Department of Neurosurgery, Tulane Medical Center, New Orleans, Louisiana, USA.
authors.forename: Bryce
authors.initials: B
authors.lastname: Beard
authors.affiliation: Department of Neurosurgery, Ochsner Health System, New Orleans, Louisiana, USA.
authors.forename: Olawale A R
authors.initials: OA
authors.lastname: Sulaiman
authors.affiliation: Department of Neurosurgery, Ochsner Health System, New Orleans, Louisiana, USA.
authors.forename: Marcus L
authors.initials: ML
authors.lastname: Ware
mesh_terms: D001932:Brain Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology*; D002535:Cerebral Aqueduct / Q000000981:diagnostic imaging / Q000473:pathology; D002540:Cerebral Cortex / Q000000981:diagnostic imaging / Q000473:pathology; D003884:Dermoid Cyst / Q000000981:diagnostic imaging* / Q000473:pathology*; D003937:Diagnosis, Differential; D005260:Female; D015726:Giant Cells / Q000473:pathology*; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008875:Middle Aged
keywords: Chronic inflammation; Dermoid cyst; Focal rupture; Giant cell reactivity; Insular cortex; Supratentorial; Sylvian fissure