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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, Liebigstraße 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

Magnetic resonance imaging T1 weighted image past gadolinium shows a thickening of the dura, but no enhancement within the epidermoid tumor.
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Figure 5: Magnetic resonance imaging T1 weighted image past gadolinium shows a thickening of the dura, but no enhancement within the epidermoid tumor.

Mentions: The MRI scan T2 weighted images (Philips Achieva 1.5 T) revealed an inhomogeneous, mainly hyperintense mass without penetration of the dura. Significant compression of brain hemispheres and ventricles without cerebral edema suggested a slow growing tumor. In diffusion weighted images there was a restriction of diffusion with low signal in the ADC maps (Figure 4a/b). The contrast enhanced T1 weighted images (0.1 mmol/kg Gadovist (gadobutrolum), Bayer Health Care) showed a mild thickening of the intact dura. No enhancement in the epidermoid tumor was found (Figure 5).


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)

Magnetic resonance imaging T1 weighted image past gadolinium shows a thickening of the dura, but no enhancement within the epidermoid tumor.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 5: Magnetic resonance imaging T1 weighted image past gadolinium shows a thickening of the dura, but no enhancement within the epidermoid tumor.
Mentions: The MRI scan T2 weighted images (Philips Achieva 1.5 T) revealed an inhomogeneous, mainly hyperintense mass without penetration of the dura. Significant compression of brain hemispheres and ventricles without cerebral edema suggested a slow growing tumor. In diffusion weighted images there was a restriction of diffusion with low signal in the ADC maps (Figure 4a/b). The contrast enhanced T1 weighted images (0.1 mmol/kg Gadovist (gadobutrolum), Bayer Health Care) showed a mild thickening of the intact dura. No enhancement in the epidermoid tumor was found (Figure 5).

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, Liebigstraße 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