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Giant intradiploic epidermoid cyst with large osteolytic lesions of the skull: a case report.

Krupp W, Heckert A, Holland H, Meixensberger J, Fritzsch D - J Med Case Rep (2012)

Bottom Line: Considering his age and the absence of neurological deficits or pain, the patient refused the option of tumor removal and cranioplasty, yet agreed to a biopsy, which confirmed the suspected diagnosis.This is an impressive example of the chance to lead a long and satisfying life without specific medical treatment, avoiding the inherent risks of these procedures.Yet, there is a clear indication for surgery of intradiploic epidermoids in most cases described in the literature.

View Article: PubMed Central - HTML - PubMed

Affiliation: University Clinic Leipzig, Department of Neurosurgery, Liebigstra├če 20 in 04103 Leipzig, Germany. Wolfgang.Krupp@medizin.uni-leipzig.de.

ABSTRACT

Introduction: We report a case of tumor growth over a period of four decades, presenting with large multicentric lytic lesions of the skull and a profound mass effect, without neurological deficits. Clinical and radiological features of a patient with a giant intradiploic epidermoid and its impact on the choice of treatments are discussed.

Case presentation: An 81-year-old Caucasian man, who had first noticed a painless subcutaneous swelling over the left frontal scalp about 40 years ago, presented after a short episode of dizziness, which he experienced after treatment of focal retinal detachment. Computed tomography (CT) and magnetic resonance imaging (MRI) examinations revealed an exceptionally large tumor involving major parts of the skull with extensive destruction of the bone and distinct deformation of the brain. Considering his age and the absence of neurological deficits or pain, the patient refused the option of tumor removal and cranioplasty, yet agreed to a biopsy, which confirmed the suspected diagnosis.

Conclusions: The course of the disease demonstrates that even patients with large tumors, inducing distinct pathomorphological changes, do not necessarily experience significant impairment of their quality of life without surgery. This is an impressive example of the chance to lead a long and satisfying life without specific medical treatment, avoiding the inherent risks of these procedures. Yet, there is a clear indication for surgery of intradiploic epidermoids in most cases described in the literature.

No MeSH data available.


Related in: MedlinePlus

Coronal reconstruction of computed tomography (CT) scan reveals the lack of the outer table and the thinning of the inner table due to the expansive intradiploic cystic mass. Intratumoral calcification is shown on the right side.
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Figure 3: Coronal reconstruction of computed tomography (CT) scan reveals the lack of the outer table and the thinning of the inner table due to the expansive intradiploic cystic mass. Intratumoral calcification is shown on the right side.

Mentions: A spiral computed tomography (CT) (Philips Brilliance 64 CT-scanner) with surface volume rendering technique revealed a large swelling of the scalp, especially over the left hemisphere (Figure 1). Computed tomography (CT) with surface reconstructing and insets of axial, coronal, and sagittal scans demonstrated a giant cystoid lesion of the skull, with large calvarial defects on both sides, left more than right. The outer and the inner table of the skull bone were widely destroyed; in some areas the inner table was thinned out (Figure 2). A distinct compression of both brain hemispheres was caused by the tumor, with a slight midline shift to the right side (Figure 3).


Giant intradiploic epidermoid cyst with large osteolytic lesions of the skull: a case report.

Krupp W, Heckert A, Holland H, Meixensberger J, Fritzsch D - J Med Case Rep (2012)

Coronal reconstruction of computed tomography (CT) scan reveals the lack of the outer table and the thinning of the inner table due to the expansive intradiploic cystic mass. Intratumoral calcification is shown on the right side.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3351746&req=5

Figure 3: Coronal reconstruction of computed tomography (CT) scan reveals the lack of the outer table and the thinning of the inner table due to the expansive intradiploic cystic mass. Intratumoral calcification is shown on the right side.
Mentions: A spiral computed tomography (CT) (Philips Brilliance 64 CT-scanner) with surface volume rendering technique revealed a large swelling of the scalp, especially over the left hemisphere (Figure 1). Computed tomography (CT) with surface reconstructing and insets of axial, coronal, and sagittal scans demonstrated a giant cystoid lesion of the skull, with large calvarial defects on both sides, left more than right. The outer and the inner table of the skull bone were widely destroyed; in some areas the inner table was thinned out (Figure 2). A distinct compression of both brain hemispheres was caused by the tumor, with a slight midline shift to the right side (Figure 3).

Bottom Line: Considering his age and the absence of neurological deficits or pain, the patient refused the option of tumor removal and cranioplasty, yet agreed to a biopsy, which confirmed the suspected diagnosis.This is an impressive example of the chance to lead a long and satisfying life without specific medical treatment, avoiding the inherent risks of these procedures.Yet, there is a clear indication for surgery of intradiploic epidermoids in most cases described in the literature.

View Article: PubMed Central - HTML - PubMed

Affiliation: University Clinic Leipzig, Department of Neurosurgery, Liebigstra├če 20 in 04103 Leipzig, Germany. Wolfgang.Krupp@medizin.uni-leipzig.de.

ABSTRACT

Introduction: We report a case of tumor growth over a period of four decades, presenting with large multicentric lytic lesions of the skull and a profound mass effect, without neurological deficits. Clinical and radiological features of a patient with a giant intradiploic epidermoid and its impact on the choice of treatments are discussed.

Case presentation: An 81-year-old Caucasian man, who had first noticed a painless subcutaneous swelling over the left frontal scalp about 40 years ago, presented after a short episode of dizziness, which he experienced after treatment of focal retinal detachment. Computed tomography (CT) and magnetic resonance imaging (MRI) examinations revealed an exceptionally large tumor involving major parts of the skull with extensive destruction of the bone and distinct deformation of the brain. Considering his age and the absence of neurological deficits or pain, the patient refused the option of tumor removal and cranioplasty, yet agreed to a biopsy, which confirmed the suspected diagnosis.

Conclusions: The course of the disease demonstrates that even patients with large tumors, inducing distinct pathomorphological changes, do not necessarily experience significant impairment of their quality of life without surgery. This is an impressive example of the chance to lead a long and satisfying life without specific medical treatment, avoiding the inherent risks of these procedures. Yet, there is a clear indication for surgery of intradiploic epidermoids in most cases described in the literature.

No MeSH data available.


Related in: MedlinePlus