Epithelial (epidermoid) tumors of the cranium. Their common nature and pathogenesis

Parasellar epidermoid tumor presenting as painful ophthalmoplegia

In 1964, a 51-year-old man experienced a right abducens nerve palsy, which resolved spontaneously. In 1978, he developed painful ophthalmoplegia on the right with paresis of the right oculomotor and trigeminal nerves. Neuroradiographic evaluation was reported unremarkable, and the painful ophthalmoplegia was attributed to the Tolosa-Hunt syndrome. High-dose corticosteroids were administered with transient improvement of signs and symptoms. In 1979, cranial computerized tomography demonstrated a low-density lesion adjacent to the right cavernous sinus, which at operation proved to be an epidermoid tumor.

Cranial epidermoid tumor associated with subacute extradural hematoma. Case report

The authors present a case of cranial epidermoid tumor that caused a subacute epidural hematoma after minor trauma. The radiological, operative, and pathological findings are described, and indications for elective excision of cranial epidermoid tumor are discussed.

[Sphincter disorders secondary to an intramedullary epidermoid tumor. Report of a case]

A case of intraspinal epidermoid tumor of the lower thoracic and lumbar area resulting in bladder and bowel disturbances in a 10-year-old boy is reported. A brief review of literature is done and clinical and radiological aspects of this condition are discussed.

Cerebral convexity epidermoid tumor subsequent to multiple percutaneous subdural aspirations. Case report

✓ While occasional spinal epidermoid tumors may arise subsequent to lumbar punctures, the association of cerebral epidermoid tumors with percutaneous subdural taps has not been made. The case is reported of a 30-year-old man with a right frontal convexity epidermoid tumor beneath the coronal suture, through which, as an infant, he had had multiple percutaneous subdural taps.

Primary intracranial epidermoid carcinoma. Case report

✓ A case is presented of primary intracranial epidermoid carcinoma in the right cerebellopontine angle which was visualized as a homogeneously enhanced mass on computerized tomography. At autopsy the malignant tissue was found to have invaded the brain stem.

Morphological, biochemical, ultrastructural, tissue culture and clinical observations of typical and aggressive craniopharyngiomas

Craniopharyngiomas are tumors of the suprasellar area, which are often cystic, encapsulated and slow-growing. Certain of these tumors can behave in an aggressive manner and either invade surrounding structures or recur. In order to determine characteristics which may aid in distinguishing typical from atypical lesions, a study of biopsy and tissue culture specimens from 25 human craniopharyngiomas was undertaken. Tissue culture observations reveal two distinct cell populations. Typical lesions grew in culture in an orderly epithelial pattern and had desmosome-tonofibril aggregates and smooth surface topography demonstrable by electron microscopy. In the atypical tumors the cell growth was irregular, with mitotic activity, cholesterol crystals and features characteristic of neoplastic transformation, such as surface microvilli, an increase of cytoplasmic basophilia, size and number of nucleoli and retraction of cytoplasm. Correlation with the clinical status of the patients suggests that tumors of the four patients which exhibited atypical features in culture behaved more aggressively.

Intradiploic epidermoid cyst of the occipital bone with torcular obstruction. Case report

The authors describe a patient with a giant occipital intradiploic epidermoid cyst with compression of the torcular and other posterior fossa structures.

Growth rates of epidermoid tumors

Consideration of the most likely method of growth of epidermoid tumors, either congenital or traumatic in origin, suggests that they grow linearly, at rates approximately those reported for normal human skin, rather than exponentially, as most tumors do. Such a linear rate of growth would be expected of tumors derived from a single layer of basal germinal cells spread out over a surface area.

[Malignant degeneration in a parapontine epidermoid (author's transl)]

A case of malignant degeneration in a right parapontine epidermoid cyst giving rise to leptomeningeal carcinomatosis in a 57 year old woman is presented. The malignant tissue had infiltrated the right cerebellar hemisphere and produced a symptomatic trigeminal neuralgia, a change in the psychological state of the patient, and an acute conus and cauda syndrome following metastasis implantation. Only eight unequivocal previous reports of malignant transformation of intracranial epidermoid cyst have been reported in the literature with metastases in four.

Computed tomography of tumors of the pineal region

Eight pathologically proven cases of pineal region tumors examined by computed tomography (CT) were found upon reviewing 11,000 consecutive CT studies at the Massachusetts General Hospital. The CT scan findings of the eight cases are described and related to a pathological classification of pineal tumors.

Craniopharyngiomas: a clinical and pathological review

Two hundred and forty-five cases of craniopharyngiomas were obtained from the files of the AFIP and reviewed statistically with reference to their gross and microscopic appearance and clinical data. The majority of the tumors were cystic and microscopically, cysts were formed by squamous epithelial maturation, by degeneration of the stellate cells at the centers of adamantinomatous nests, or by degeneration of the stroma. Transitional forms were seen between adamantinomatous and squamous epithelium and keratohyaline granules and keratin were present in some cases. Because of this overlap, differentiation between craniopharyngiomas and suprasellar epidermoid cysts often is not possible. Significantly increased acturial survival rates were associated with absence of calcification in plain skull films in adults, negative CSF examination, and tumor size under 3.0 cm.

Fulminating parapontine epidermoid carcinoma in a four-year-old boy

An unique case of primary intracranial epidermoid carcinoma in a 4-year-old boy is described. Its parapontine localization and malignant features combined to produce a fulminating clinical course simulating an intra-axial mass lesion. The probable origin of the carcinoma from a benign epidermoid cyst is discussed. A review of the world's literature establishes not only the rarity of cyst-derived intracranial epidermoid carcinoma, but also its unprecedented occurrence in a child.

[An intracranial epidermoid caused by trauma (author's transl)]

A report of an epidermoid caused by trauma. The traumatic genesis was conclusively demonstrated in the course of an almost uninterrupted 28-year observation. The differential diagnostic difficulties and the consequences following therefrom are emphasized.

Intrathalamic epidermoid tumor. Case report

A case of an intrathalamic epidermoid tumor is reported, and the literature is reviewed with regard to the incidence, location, and etiology of intracerebral epidermoid tumors. The high frequency of mental symptoms associated with these tumors is also discussed.

Giant intracranial dermoid cyst: Case report and review of the literature on intracranial dermoids and epidermoids

A 45-year old man was referred to the Johns Hopkins Hospital with a seven-year history of repeated episodes of light-headedness, increasing irriability and forgetfulness. Examinations revealed a right superior, incongruous quadrantanopsia. EEG showed an abnormality in the left temporal lobe, and a cerebral angiogram outlined an avascular mass in the left cerebral hemisphere. At operation, the patient was found to have a giant dermoid cyst involving the left frontal, temporal and parietal lobes. Over the last 30 years we have encountered only 6 cases of intracranial epidermoids and 3 cases of intracranial dermoids. These cases are cited, and a discussion of the embryology, histology, clinical characteristics, and treatment of these lesions with a review of the literature is undertaken.

[Intraspinal dermoid and epidermoid tumors]

São relatados dois casos de tumores epidermóides e um de tumor dermóide, todos intrarraquianos. Este último era de localização epidural ao nível da coluna torácica (caso 3); os dois tumores epidermóides situavam-se na coluna tóraco-lombar (caso 1) e lombar (caso 2), respectivamente, sendo o primeiro intramedular e o segundo intradural. Em dois casos (casos 2 e 3) os tumores associavam-se a fístula dérmica congênita. Um paciente (caso 3) foi operado aos dois meses de idade; a descoberta do tumor deveu-se à realização da raquimanometria que revelou bloqueio, apesar do paciente não apresentar qualquer sinal neurológico de compressão medular. Os autores são de opinião que, em presença de fístula dérmica congênita ao nível da coluna vertebral, principalmente quando localizada acima do segmento lombosacro, deve-se sempre suspeitar da possibilidade do tumor epidermóide ou dermóide intrarraquiano, mesmo na ausência de sinais neurológicos. A combinação de sintomas neurológicos de longa duração, a evidência radiológica de erosão e alargamento do canal raquiano e a história de fístula dérmica congênita proporcionaram o diagnóstico pré-operatório correto no caso 2.