- Department of Neurosurgery, Mohamed Vth University, School of Medicine, Hospital Ibn Sina, CHU Ibn Sina, Rabat 10100, Morocco
Correspondence Address:
Claire Karekezi
Department of Neurosurgery, Mohamed Vth University, School of Medicine, Hospital Ibn Sina, CHU Ibn Sina, Rabat 10100, Morocco
DOI:10.4103/2152-7806.178135
Copyright: © 2016 Surgical Neurology International This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 3.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.How to cite this article: Karekezi C, Fatemi NE, Egu K, Ibrahimi M, El Maaqili MR, Abbadi NE. Unusual coexistence of an epidermoid cyst with an atypical meningioma: Case report and review of the literature. Surg Neurol Int 04-Mar-2016;7:24
How to cite this URL: Karekezi C, Fatemi NE, Egu K, Ibrahimi M, El Maaqili MR, Abbadi NE. Unusual coexistence of an epidermoid cyst with an atypical meningioma: Case report and review of the literature. Surg Neurol Int 04-Mar-2016;7:24. Available from: http://surgicalneurologyint.com/surgicalint_articles/unusual-coexistence-of-an-epidermoid-cyst-with-an-atypical-meningioma-case-report-and-review-of-the-literature/
Abstract
Background:Coexistence of multiple primary intracranial tumors of different cell types has rarely been documented; the association of a meningioma and a glioma has been reported as the most common combination. Hereby, we report an unusual case of a temporal epidermoid cyst coexisting with an atypical meningioma.
Case Presentation:A 37-year-old male presented with progressive symptoms of raised intracranial progression with progressive loss of vision without any neurological deficit. On admission, magnetic resonance imaging (MRI) revealed a right frontal lesion appearing hypointense T1, hyperintense T2 slightly enhanced after gadolinium and a second right temporal, isointense T1, hyperintense T2 non-enhancing lesion. A right frontotemporal craniotomy was performed that revealed two distinct lesions: The whitish temporal lesion with the pearl appearance reminding of an epidermoid cyst, the second lesion was extraaxial fibrous lesion arising from the falx. Pathology confirmed an atypical meningioma WHO Grade II and an epidermoid cyst.
Conclusion:The simultaneous occurrence of primary intracranial tumors of different cell types is rare. Epidermoid cysts are slow growing lesions believed to arise from inclusion of ectodermal elements during neural tube closure, while meningiomas arise from arachnoidal cells; their association has rarely been reported previously.
Keywords: Epidermoid cyst, meningioma, multiple tumors
INTRODUCTION
Epidermoid cysts are benign, slow growing extraaxial tumors that account for about 1% of all intracranial tumors;[
CASE REPORT
We report the case of a 37-year-old patient who presented with symptoms of raised intracranial pressure with progressive loss of sight. On admission, patient was conscious with no motor deficit, and fundus revealed bilateral optic atrophy. Magnetic resonance imaging (MRI) revealed an extra-axial right frontal lesion, hypointense T1, hyperintense T2 slightly enhanced after gadolinium; a second right temporal lesion isointense T1, hyperintense T2 non-enhancing was seen [
DISCUSSION
Intracranial epidermoid cysts account for 0.2–1%[
Simultaneous occurrences of primary intracranial tumors of different cell types have rarely been documented. There are few cases in the literature, the coexistence of a meningioma and a glioma being the most reported combination, followed by a meningioma with a vestibular schwannoma and a meningioma with a pituitary adenoma.[
Much speculation remains regarding the origin of multiple tumors of different histological type. Some authors support the theory of locally acting oncogenic factors and others believe it would just be a pure coincidence.[
Epidermoid cysts are known to possess an arachnoid cap, which is a cerebrospinal fluid (CSF) collection surrounding the tumor.[
Treatment approach can be a debate topic. In the literature, the glial tumor usually had been the first target.[
Nowadays, both CT and MRI are useful for intra- and extra-axial brain tumors. Diagnosis from CT scans can sometimes lead to misinterpretation where low-density areas may represent edema, ischemic change, or a low- to medium-grade astrocytoma.[
Frequently, operative management is undertaken for what is assumed to be a single tumor, but the surgeon should be alerted to the existence of a second tumor by the presence of edema not consistent with the first tumor or when the first tumor does not correlate with the preoperative radiographic findings.
CONCLUSION
Multiple primary intracranial tumors of different histological origins are rare; their possibility ought to be considered when symptoms and signs, intraoperative findings, or unexpected postoperative events do not correlate with radiological findings. Their treatment approach should be decided depending on the prognosis of the lesions and their localization in brain.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
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