A giant intradiploic epidermoid cyst with perforation of the dura and brain parenchymal involvement

Orbital Intradiploic Epidermoid Cyst: A Case Report of a Rare Entity

Cranial epidermoid cysts are relatively rare. More frequently reported in middle-aged men with a wide variety of signs and symptoms such as headache, seizures, cerebellar and cranial nerve deficits/visual disturbance. The approach for surgical removal of the cyst depends on its size and location. In addition, a multidisciplinary team must be involved due to the common occurrence of misdiagnosis. We present the unusual age of presentation for intradiploic epidermoid cysts. A 14-year-old boy is complaining of a 2-month history of painless progressive swelling of the right eyebrow. Magnetic resonance imaging revealed an intradiploic cystic mass within the right frontal bone. The cystic mass was removed, and histological examination confirmed the diagnosis of an epidermoid cyst. This case illustrated the potential of developing intradiploic epidermoid cysts in pediatrics.

Epidermal cyst protruding from the occipital region of the scalp: a case report

Introduction and importance

Epidermal cysts are the most common subcutaneous tumor typically observed on the scalp, face, neck, back, or trunk. Epidermal cysts conventionally range in size from 1 to 5 cm, with sizes greater than 5 cm rarely reported.

Case presentation

Here, we present a case of a 58-year-old female housewife who presented to our surgery outpatient department (OPD) with a history of a mass in the left occipital region. The mass was first noticed 3 years back and was small and associated with mild itching. The mass progressively increased in size over the course of 3 years. Her present complaint was a painful mass associated with itching, headache, and pus discharge when compressed. The pain was relieved by taking medication.

Clinical discussion

The epidermal cyst was confirmed on biopsy, and subsequent excision of the cyst was done under general anesthesia; the occipital bone was eroded by the inferior part of the cyst - reconstruction of scalp defect done by rotational scalp flap.

Conclusion

Epidermal cysts, being a slow-growing benign tumor, can pose diagnostic difficulties, especially when located in the scalp area. In addition to that, when cranial bones and intracranial structures are affected by the cyst, they can even lead to complications and interventional difficulties.

Giant epidermoid cyst penetrating the skull: a case report and literature review

Intracranial epidermoid cyst is a rare pseudotumor of the nervous system, accounting for 0.2%-1.8% of all intracranial tumors. It is usually located in the cerebellopontine Angle or parasellar area, with insipid onset, slow growth and usually less than 2 cm in diameter. Giant epidermoid cysts that invade the bone have rarely been reported in the literature. Herein, we report a case of giant ECs extradural to the parietal bone, penetrating the skull and continuing to expand outward. In addition, a systematic search of four authoritative databases was conducted to collect the relevant reports of giant epidermoid cyst with diameter > 5cm for the first time, and to discuss the clinical and radiographic features of patients with giant epidermoid cyst and the influence of treatment options.

Rare Giant Infected Intradiploic Skull Epidermoid Cysts

Infections associated with giant intradiploic cranial epidermoid cysts are rare. This case report describes the successful surgical management of a 71-year-old diabetic man with a giant intradiploic cranial epidermoid cyst associated with a secondary infection. The patient underwent successful resection of the infected lesion with washout, debridement, and obliteration of the eustachian canal and external auditory canal. At the six-month follow-up, the infection was resolved and the patient was doing well clinically. Intradiploic epidermoid cysts are rare, and the presence of a superimposed otogenic infection is exceptionally rare and infrequently reported in the neurosurgical literature.

A Good Aesthetic Outcome After Gross Total Tumor Resection in Combination With the Skull Reconstruction on Giant Epidermal Cyst Involving Both Intracranial and Extracranial Tissues

ABSTRACT

Epidermal or epidermoid cysts are 1 of the most frequent benign masses, they rarely grow to a huge size, and only a few cases have been reported. We report a rare case of a 52-year-old man with giant neoplasm growing invasively in the frontal region, including both intracranial and extracranial extensions, and caused extensive brain deformation and skull lesions. It is worth noting that the patient did not present any significant neurological symptoms and deficits for more than 40 years on admission. A combination of gross total tumor resection and cranioplasty was performed. The patient was satisfied with the results of the surgery, and no evidence of recurrence or complications were found in the 2 years follow-up. The authors reported the case not only to propose the first-stage aesthetic treatment option for this unusual mass on the scalp but also hinted at the vigilance and importance of systematic monitoring of the small skull mass for avoiding the potential risk of tumor progression, malignant transformation, operative trauma, and financial burden.

Intradiploic Epidermoid Cyst Causing Otitis Media with Effusion: Case Report and Review of the Literature

BACKGROUND

Epidermoid cysts are rare, slow-growing, benign tumors. They commonly occur at the cerebellopontine angle or the suprasellar region, and they can also occur in the skull. Intradiploic epidermoid cysts are often detected incidentally, but their progression can cause various symptoms.

CASE DESCRIPTION

The patient was a 49-year-old woman who was diagnosed with otitis media with effusion based on a reported sensation of left ear blockage. Thorough examination revealed a mass lesion in the left occipital bone. Computed tomography depicted a mass lesion on the left occipital bone, part of which reached the inner table of the skull and eroded the mastoid air cell. On magnetic resonance imaging, T1-weighted signal was low but T2-weighted signal and diffusion-weighted signal were high. An intradiploic epidermoid cyst was suspected on the basis of imaging results, and it was surmised that mastoid cellulitis by the mass lesion accompanied by bone destruction had progressed to otitis media with effusion. The pathologic diagnosis was epidermoid cysts. Six months after the operation the otitis media with effusion had improved, and there had been no recurrence of epidermoid cysts.

CONCLUSIONS

We experienced a case of occipital bone intradiploic epidermoid cysts diagnosed in conjunction with otitis media with effusion.

Posttraumatic Giant Intradiploic Epidermoid Cyst of Orbital Roof

ABSTRACT

Epidermoid cysts are rare benign tumors that account for 0.3% to 1.8% of all intracranial space-occupying lesions. They are usually congenital in origin and are thought to derived from ectodermal cell inclusions occurring during closure of the neural tube around third to fifth week of gestation. They are most commonly located in the cerebellopontine angle and the parasellar area, and their location in the diploic space is very rare. In this article, a case of giant epidermoid cyst located in the orbital roof intradiploic space is presented with clinical, radiologic features and surgical treatment.

A Rare Case of Giant Intradiploeic Epidermal Cyst of the Frontal Bone with Intracranial Extension

Calvarial intradiploeic epidermal cyst are very rare neoplasms which can have intracranial extension. These cysts can attain a large size and can cause lytic destruction of the calvarium resembling malignancy. Since these lesions are benign complete excision is curative. We report the case of a 77-year-old male patient who presented with a large swelling on the forehead. Computed tomography and magnetic resonance imaging showed an expansile lytic lesion with intracranial extension. Complete excision of the lesion with cranioplasty was done. Histopathology was consistent with the epidermal cyst. These cysts attaining gigantic proportions are very few in literature.

Intradiploic epidermoid cyst with intracranial hypertension syndrome: Report of two cases and literature review

INTRODUCTION

Intradiploic epidermoid intracranial cysts (IEIC) derive from ectodermal cells and are covered with stratified squamous epithelium. They are extremely rare, and most common locations are in the occipital, frontal and parietal bones. They have a very slow growth and can be asymptomatic until becoming evident by the deformation produced. The treatment is based on the removal of the lesion, and subsequent histopathological confirmation.

PRESENTATION OF CASE

Two cases are reported, with intracranial hypertension syndrome, which is very uncommon because of the slow growth of this type of pathology; however, decompensations occurring in the space-occupying lesions at intracranial level explain this type of clinical presentation.

DISCUSSION

The most common presentation of intracranial intradiploic epidermoid cysts (IEIC) is asymptomatically, which is made evident by the prominence at the level of the soft tissues and then presenting less frequently local pain and cephalea; rarely the size of the lesion can cause focal neurological signs.

CONCLUSION

These benign lesions, although they are of low incidence, are seen very rarely in intradiploic locations and above all, of significant size, may produce significant mass effect in patients, which was initially tolerated because of its slow growth, however, they may become decompensate and cause intracranial hypertension syndrome.

Staged scalp soft tissue expansion before delayed allograft cranioplasty: a technical report

BACKGROUND

Hemicraniectomy is an established neurosurgical procedure. However, before cranial vault reconstruction, it is imperative that sufficient scalp soft tissue is available for coverage of the reconstructed skull.

OBJECTIVE

To present 2 complex cases of posttraumatic patients requiring soft tissue expansion of the scalp before definite cranioplasty with use of a synthetic polyethylene graft.

METHODS

Two patients underwent decompressive hemicraniectomy for trauma and required delayed cranioplasty. Both patients had developed significant scalp contraction and presented with a paucity of soft tissue. These patients underwent a staged cranioplasty in which we first achieved scalp-tissue expansion adjacent to the craniectomy site over a prolonged interval. In a second stage, the patient underwent definite reconstructive surgery in which the subgaleal expanders were removed and polyethylene allograft cranioplasty was performed.

RESULTS

Cutaneous coverage of the underlying defect could be achieved in this setting without causing tension on the incision line secondary to the now available excess scalp tissue.

CONCLUSION

Repair of a cranial defect requires detailed attention to the available scalp and its size relationship to the skull defect to achieve a successful outcome with an aesthetically pleasing, reliable, and lasting result. Preoperative scalp tissue expansion is a valuable step in taking care of patients presenting with scalp soft tissue defect. This technique reduces the morbidity associated with conventional rotational and free-flap techniques.

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

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.

Differential diagnosis of soft scalp lumps

A 56-year-old man presented with a painless cyst on the top of his head which has been increasing in size in the last 6 months. Due to his learning disability, he could not be dissuaded from his belief that the lump was a sign of brain prolapse which led to increasing agitation in the next 2 weeks. A provisional diagnosis of benign lipoma was made and prompt excision was performed in his best interests. The lesion was more cystic and fluctuant than that of a lipoma and hence it was sent for histological diagnosis. The report came back as a trichilemmal cyst with no signs of proliferation. Cosmetic outcome was reasonable at follow-up after 3 months. The patient was scheduled for regular review every 6 months.