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Intraparenchymal endodermal cyst with spontaneous intracystic hemorrhage in the temporal lobe of an adult

View Article: PubMed Central - PubMed

ABSTRACT

Background:: Endodermal cysts (EC) are rare but well-known congenial lesions of the central nervous system mainly located in the spinal subdural space. Intracranial ECs are rare and commonly encountered in the posterior cranial fossa as extra-axial lesions; an intraparenchymal location is exceedingly rare. A complete removal is the best surgical strategy and any residue can cause recurrence. It is necessary to exclude EC in patients with intracranial cystic lesions. We present a case of intraparenchymal EC with spontaneous intracystic hemorrhage in the temporal lobe of an adult.

Methods:: A 43-year-old man presented with headache and memory deterioration. Brain computed tomography and magnetic resonance imaging showed a slightly enhanced temporal lobe cystic lesion, which was homogenously hyperintense on T1-and T2-weighted images. There was a suspicion of brain abscess at admission. The lesion was totally removed with a left subtemporal craniotomy. Histological examination revealed an EC with intracystic hemorrhage.

Results:: The preoperative symptoms were relieved after surgery and 3-month follow-up magnetic resonance imaging found no cystic signs.

Conclusion:: This case suggests that EC should be considered in the differential diagnosis of intracranial cystic lesions and a complete removal is the best strategy of choice.

No MeSH data available.


Related in: MedlinePlus

Macroscopic photographs of the appearance (A) and the contents (B) of the cyst. The cyst was about 2.6 × 2 × 2 cm in size.
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Figure 2: Macroscopic photographs of the appearance (A) and the contents (B) of the cyst. The cyst was about 2.6 × 2 × 2 cm in size.

Mentions: After 3 days of antibiotic treatment, a subtemporal craniotomy was performed for removing the cyst. During surgery, a brain needle could not be inserted into the cyst due to a tough wall and thereby the lesion was excised totally. We found that the cyst was of intraparenchyma and had a sharp demarcation with adjacent brain tissue. The cyst wall was grayish and solid enough to resist a brain needle (Fig. 2). The cyst contained about 10 mL dark brown mucoid fluids. After contents were collected, the cyst was fixed in 10% formalin, dehydrated, and embedded in paraffin for histological test. Histological examination of the wall showed a thin fibrous membrane lining with columnar epithelial cells and plenty of macrophages, myofibroblasts, inflammatory cells, and cholesterol crystal (Fig. 3A–C). Immunohistochemical staining showed that epithelium was positive for cytokeratin AE1/AE3 (Fig. 3B) and carcinoembryonic antigen CD68 (Fig. 3C) but negative for glial fibrillary acidic protein (GFAP), S-100, and vimentin (not shown), ruling out the epithelium of ectodermal origin. Sporadic staining of CD34 and smooth muscle actin was observed in cyst wall, supporting the cyst of endodermal origin (Fig. 3D and E). Moreover, some epithelial cells stained positive for Ki-67 (Fig. 3F). Cytology of cyst fluid revealed a mixture of white blood cells and red blood cells, indicating intracystic hemorrhage. Sterile culture of cyst fluids showed no bacterial growth. A final diagnosis was EC based on histological findings.


Intraparenchymal endodermal cyst with spontaneous intracystic hemorrhage in the temporal lobe of an adult
Macroscopic photographs of the appearance (A) and the contents (B) of the cyst. The cyst was about 2.6 × 2 × 2 cm in size.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC5120888&req=5

Figure 2: Macroscopic photographs of the appearance (A) and the contents (B) of the cyst. The cyst was about 2.6 × 2 × 2 cm in size.
Mentions: After 3 days of antibiotic treatment, a subtemporal craniotomy was performed for removing the cyst. During surgery, a brain needle could not be inserted into the cyst due to a tough wall and thereby the lesion was excised totally. We found that the cyst was of intraparenchyma and had a sharp demarcation with adjacent brain tissue. The cyst wall was grayish and solid enough to resist a brain needle (Fig. 2). The cyst contained about 10 mL dark brown mucoid fluids. After contents were collected, the cyst was fixed in 10% formalin, dehydrated, and embedded in paraffin for histological test. Histological examination of the wall showed a thin fibrous membrane lining with columnar epithelial cells and plenty of macrophages, myofibroblasts, inflammatory cells, and cholesterol crystal (Fig. 3A–C). Immunohistochemical staining showed that epithelium was positive for cytokeratin AE1/AE3 (Fig. 3B) and carcinoembryonic antigen CD68 (Fig. 3C) but negative for glial fibrillary acidic protein (GFAP), S-100, and vimentin (not shown), ruling out the epithelium of ectodermal origin. Sporadic staining of CD34 and smooth muscle actin was observed in cyst wall, supporting the cyst of endodermal origin (Fig. 3D and E). Moreover, some epithelial cells stained positive for Ki-67 (Fig. 3F). Cytology of cyst fluid revealed a mixture of white blood cells and red blood cells, indicating intracystic hemorrhage. Sterile culture of cyst fluids showed no bacterial growth. A final diagnosis was EC based on histological findings.

View Article: PubMed Central - PubMed

ABSTRACT

Background:: Endodermal cysts (EC) are rare but well-known congenial lesions of the central nervous system mainly located in the spinal subdural space. Intracranial ECs are rare and commonly encountered in the posterior cranial fossa as extra-axial lesions; an intraparenchymal location is exceedingly rare. A complete removal is the best surgical strategy and any residue can cause recurrence. It is necessary to exclude EC in patients with intracranial cystic lesions. We present a case of intraparenchymal EC with spontaneous intracystic hemorrhage in the temporal lobe of an adult.

Methods:: A 43-year-old man presented with headache and memory deterioration. Brain computed tomography and magnetic resonance imaging showed a slightly enhanced temporal lobe cystic lesion, which was homogenously hyperintense on T1-and T2-weighted images. There was a suspicion of brain abscess at admission. The lesion was totally removed with a left subtemporal craniotomy. Histological examination revealed an EC with intracystic hemorrhage.

Results:: The preoperative symptoms were relieved after surgery and 3-month follow-up magnetic resonance imaging found no cystic signs.

Conclusion:: This case suggests that EC should be considered in the differential diagnosis of intracranial cystic lesions and a complete removal is the best strategy of choice.

No MeSH data available.


Related in: MedlinePlus