Endodermal cyst of septum pellucidum and pregnancy: a case report

Supratentorial Neurenteric Cysts: Systematic Literature Review and Case Report

BACKGROUND

Neurenteric cysts (NC) are uncommon, congenital lesions with histopathologic properties derived from the gastrointestinal or respiratory tract. They are typically located in the intradural extramedullary compartment but rarely seen in the supratentorial region. The occurrence of supratentorial NCs (S-NC) presents an interesting quandary regarding their embryopathogenesis.

METHODS

We present a case report and systematic literature review on S-NCs following PRISMA guidelines.

RESULTS

A 57-year-old woman presented with a seizure and paresthesias of the face, hands, and feet. MRI revealed a right temporo-occipital cystic lesion, which was managed with surgical resection. Histologically the cyst was Type A. The patient is without recurrence at 10 months. Including this case, 88 S-NCs are reported in the literature. Common presenting symptoms are headaches and seizures. They were mostly treated with craniotomy, preferably with gross total resection (GTR), although sub-total resection (STR) may be necessary due to adhesions. Resection usually led to symptom improvement (61%). Malignant transformation was seen in 3%. Recurrence was seen in 17%, with a mean time to recurrence of 4.2 years, and was significantly more common after STR than GTR.

CONCLUSIONS

If surgically resected, the cyst wall specimen should be sent for pathology review, because of the potential risk for malignancy. If conservatively managed, serial imaging is warranted to track for changes that may indicate transformation. The embryopathogenesis of these rare congenital lesions remains incompletely understood, but the most comprehensive theory involves enteric cell migration to the neuroectoderm during embryogenesis.

Supratentorial Intraparenchymal Neurenteric Cyst Treated by Neuroendoscopic Fenestration: A Case Report and Review of Literature

Neurenteric cysts (NCs) are rare benign congenital neoplasms in the central nervous system that originate from endodermal elements. NCs are more commonly located in the spine than in the brain. Although almost all intracranial NCs are found in the posterior fossa, some have reported supratentorial NCs. The complete excision of the cyst wall is suggested as a curative treatment; however, endoscopic treatment is less discussed. We present a supratentorial intraparenchymal NC in the frontal lobe treated by neuroendoscopic fenestration and review the literature regarding supratentorial NCs. A 43-year-old woman presenting with right hemiparesis and gait disturbance who was found to have a huge cystic lesion with calcification in her left frontal lobe underwent endoscopic fenestration to the ipsilateral lateral ventricle and biopsy. The histopathological diagnosis was consistent with NC. Postoperatively, her right hemiparesis and gait disturbance disappeared. Postoperative MRI showed shrinkage of the cyst. She was discharged without neurological deficits and no recurrence was seen 1 year after surgery. To the best of our knowledge, there have been no reports of a supratentorial intraparenchymal NC treated by neuroendoscopic fenestration. Minimally invasive treatments, such as neuroendoscopic cyst fenestration, can be considered depending on the location of the cyst.

Spontaneous dissolution of a cyst located within the septum pellucidum in a patient with sarcoidosis: a case report

Sarcoidosis is a granulomatous multisystem disease of unknown etiology. Typically, the disease affects the lungs, causing enlargement of the mediastinal lymph nodes, but other organs can be affected. Neurosarcoidosis is reported in 5-10% of the patients. This case represents a 39-year-old male patient diagnosed with lung sarcoidosis. Due to neurological symptoms, a contrast-enhanced cerebral magnetic resonance imaging was performed. Neurosarcoidosis was presented with meningeal enhancement adjacent to a cyst located within the cavum septum pellucidum. The cyst dissolved spontaneously within six months. The finding of a cyst located within the septum pellucidum is rare.

Intracranial endodermal cyst presenting with nonobstructive hydrocephalus: A case report

RATIONALE

Endodermal cysts are rare benign lesions in the central nervous system. Their common symptoms include headache and neck pain caused by mass effect or inflammatory reaction. We report the case of an elderly woman with intracranial endodermal cyst who presented with nonobstructive hydrocephalus.

PATIENT CONCERNS

A 78-year-old woman presented with acute deterioration of consciousness caused by acute hydrocephalus. She subsequently underwent ventriculoperitoneal shunt placement. Eighteen months after this operation, she developed numbness of extremities and gait and progressive cognitive disturbances.

DIAGNOSIS

Initially, the endodermal cyst could not be recognized, but it became clinically evident in the craniocervical junction after ventriculoperitoneal shunt placement. MRI revealed multiple cystic lesions in the pontomedullary cistern. Postoperative pathology confirmed the diagnosis of endodermal cyst.

INTERVENTIONS

Subtotal resection of the cystic lesion was performed. Intra-operatively, multiple cysts containing a milky white fluid were noted and the medullary surface including the median and lateral apertures of the fourth ventricle were covered by thick, cloudy arachnoid membrane.

OUTCOMES

Although the numbness of extremities improved after the surgery, she remained bedridden due to deterioration in cognitive function and generalized muscle weakness. The patient developed recurrence 2 months after the surgery; however, no additional surgery was performed owing to her poor general condition.

LESSONS

Endodermal cysts rarely present with nonobstructive hydrocephalus caused by recurrent meningitis. In such cases, the lesions are often invisible on initial diagnostic imaging, and complete resection of the lesions is typically difficult because of strong adhesion between the cyst walls and contiguous vital structures.

A Large Endodermal Cyst with Xanthogranuloma at the Frontal Skull Base, Slowly Recurring with Hemorrhage

A 45-year-old man with a past history of the removal of a degenerated hematoma two times presented with general convulsion. Computed tomography (CT) showed a high-density lobular mass growing from the right frontal skull base and occupying the right frontal lobe. Magnetic resonance imaging (MRI) demonstrated a homogeneously hyperintense mass on T₁-weighted imaging and a homogeneously hypointense mass on T₂- and T₂*-weighted imaging. We removed the lesion, which intraoperatively showed a blackish-brown and jellylike mass with machine oil-like fluid. There was a thin and elastic membrane at the boundary between the mass and degenerated brain tissue, and we removed as much of the membrane as possible. On light microscopy, most parts of the mass consisted of a degenerated hematoma with xanthogranuloma, while the thin and elastic membrane revealed one or two layers of non-ciliated columnar epithelial cells based on thin fibrous tissues with microvessels. Immunohistochemical staining showed that these epithelial cells contained periodic acid-Schiff (PAS)-positive granules, and were positive for cytokeratin (CAM5.2), carcinoembryonic antigen (CEA), and epithelial membrane antigen (EMA). Ultrastructual examination showed numerous microvilli at the surface of non-ciliated cells, and an interdigitation-like, dense adhesion structure. On the basis of pathological findings, the patient was considered to have a large endodermal cyst (EC) at the frontal skull base, probably derived from Seessel’s pouch. We speculate that EC developed inflammatory changes with xanthogranuloma, which caused further damage to the blood vessels and continuous hemorrhage.

Intraparenchymal Supratentorial Neurenteric Cyst

Background:

Neurenteric cysts are congenital cysts of the central nervous system that are believed to be of endodermal origin. In this report we present the unique case of a supratentorial neurenteric cyst that is contained entirely within the brain parenchyma.

Methods:

Apatient presented with an intraparenchymal cystic lesion that was subsequently identified as a neurenteric cyst. This lesion is reviewed in light of the available literature.

Case report:

A 35-year-old female presented with a one year history of progressive headaches and seizure-like episodes. Her examination revealed no deficits. Magnetic resonance imaging showed a 4 cm x 4 cm x 4 cm cystic lesion within the parenchyma of the right frontal lobe. A right frontal craniotomy and complete excision of the cystic lesion was performed. Pathologic examination confirmed that it was a neurenteric cyst. Postoperatively the patient's symptoms improved.

Conclusion:

Review of the literature revealed this to be the first case of a surgically excised, pathologically confirmed supratentorial neurenteric cyst, contained entirely within the brain parenchyma.

Supratentorial neurenteric cyst mimicking hydatid cyst: A case report and literature review

Neurenteric (NE) cysts are uncommon congenital cysts of endodermal origin. These cysts are commonly encountered in the posterior fossa surrounding the brain stem structures. We present a case of pathologically proven supratentorial NE cyst that mimicked a hydatid cyst in its clinical presentation and imaging appearance. Including this pathology in the differential diagnosis of supratentorial cystic lesions is important due to the differences in medical and surgical management.

Neurenteric cyst of the anterior cranial fossa: case report and literature review

Intracranial neurenteric cysts are rare congenital lesions that typically occur in the posterior fossa. We report a case of a 70-year-old gentleman presenting with gait disturbance, found to have a neurenteric cyst primarily arising from and expanding the sella turcica. A review of the literature revealed 27 reports of supratentorial neurenteric cysts. Clinical presentation, radiological characteristics, treatment, prognosis and embryological origin are discussed. Intracranial neurenteric cysts should be included in the differential with any well-demarcated cystic lesion without enhancement on magnetic resonance imaging (MRI). Complete surgical excision is the treatment of choice, with good prognosis.

Endodermal cyst presenting as a prenatally diagnosed large intracranial cyst. Case report and review of the literature

Endodermal cysts of the central nervous system are unusual lesions. Most reported cysts develop in the spinal canal, whereas others, which occur intracranially, are usually located in the posterior fossa. Although endodermal cysts are considered congenital, a prenatal diagnosis has not been reported. In this report the authors present an extremely rare case of a large intracranial endodermal cyst detected prenatally and treated successfully after birth.

NEURENTERIC CYST ARISING IN THE HIGH CONVEXITY PARIETAL LESION

OBJECTIVE

Supratentorial neurenteric cysts (NC) are rare; only 16 cases were reported previously, the majority of which were located in the anterior fossa or in the deep midline structure. We report a case of NC arising in the high convexity parietal lesion and briefly discuss the histogenesis of NC in such an unusual location.

CLINICAL PRESENTATION

A 63-year-old man presented with a 1-month history of progressive headache and dizziness. Computed tomographic and magnetic resonance imaging scans demonstrated a 4 × 5 × 5 cm extra-axial cystic lesion in the right parietal convexity adjacent to the sagittal sinus without contrast enhancement. A translucent thin-walled cyst containing a milky-white fluid was partially excised via a right parietal craniotomy.

INTERVENTION

The cyst wall was composed of a thin fibroconnective tissue lined by a single layer of ciliated columnar epithelial cells and pseudostratified columnar epithelium. Mucous-secreting goblet cells of epithelial lining reacted to periodic acid-Shiff staining. The internal epithelial cells were immunoreactive to cytokeratin and epithelial membrane antigen, but not to carcinoembryonic antigen, glial fibrillary acidic protein, or S-100 protein. A follow-up magnetic resonance imaging scan taken 6 months later showed resolution of mass effect without evidence of cyst recurrence. The patient was discharged home in excellent condition.

CONCLUSION

A case of NC arising in the high convexity parietal lesion is described. Supratentorial NCs located far from the location of the primitive endoderm suggest the possibility that NCs could arise from ectopic endodermal tissue through an undetermined process of anomalous differentiation. Total surgical excision of the cyst wall and contents is the best treatment for the symptomatic cases. Subtotal or partial resection without injury to important neurovascular structures are reasonable alternatives, but long-term careful follow-up magnetic resonance imaging or computed tomography is necessary to monitor for recurrence of any residual lesion.

Endodermal Cyst of the Oculomotor Nerve: Case Report

OBJECTIVE:

Endodermal cysts are commonly found in the anterior spinal cord. Reports of intracranial cases are uncommon. We report a case of endodermal cyst located on the left oculomotor nerve.

CLINICAL PRESENTATION:

A 16-year-old female experienced diplopia followed by headache. Neurological examinations revealed left oculomotor nerve palsy. Magnetic resonance imaging scans showed a well-defined multilocular cystic mass in the proximity of the left oculomotor nerve at its exit from the midbrain.

INTERVENTION:

This patient underwent biopsy and drainage of the cyst. At surgery, the cyst seemed to be intrinsic to the oculomotor nerve and could not be totally resected. Pathological examination confirmed the diagnosis of endodermal cyst.

CONCLUSION:

Intracranial endodermal cysts are rare, particularly when associated with the cranial nerves. To our knowledge, this is the second case of endodermal cyst located on the oculomotor nerve. A detailed discussion and review of these case reports are presented.

Intracranial neurenteric cyst with recurrence and extensive craniospinal dissemination

Neurenteric cyst represents a rare cystic lesion of the central nervous system, and is generally thought to result from failure of separation of neuro-ectodermal and endodermal elements during week 3 of embryogenesis. Although recurrences have been reported, only one case of craniospinal dissemination has previously been reported. We describe a unique intracranial neurenteric cyst with recurrence and dissemination to the spinal cord.

Intracranial laterally based supratentorial neurenteric cyst

Neurenteric cysts are rare developmental cysts lined by endodermal derived epithelium. We present the case of a 68-year-old patient presenting with seizures who was found to have an extra-axial low density lesion with associated wall calcification on CT. Aspiration and biopsy of the cyst revealed a neurenteric cyst. Such lesions of the lateral supratentorial convexity are extremely rare and calcification has not been previously reported in these intracranial cysts.

Multiple neurenteric cysts in the posterior fossa and cervical spinal canal--case report

A 46-year-old woman presented with multiple neurenteric cysts in the posterior fossa and spinal canal. Neuroimaging demonstrated neurenteric cysts in the interspace between the left cerebellar hemisphere and vermis, the lateral side of the right cerebellar hemisphere, and the ventral side of the spinal cord at the C-2 and C-4 levels. Total resection of the paravermian cyst and partial removal of the spinal cyst at the C-4 level were performed. Histological examination showed the cyst wall consisted of single or multiple layers of columnar epithelial cells with secretory granules, with mucin secretion verified by periodic acid-Schiff staining. Immunohistochemical staining showed the walls were positive for the cytokeratin, epithelial membrane antigen, and carcinoembryonic antigen, and negative for glial fibrillary acidic protein and S-100 protein. These findings confirmed the endodermal origin. The diagnosis was neurenteric cyst. The paravermian cyst disappeared, but the spinal cyst at the C-4 level recurred 8 months later. Reoperation became necessary 16 months later. The other two cysts also showed enlargement at 6 or 15 months. Total removal of neurenteric cyst is recommended if possible.

Iso-intense neuroenteric cyst in the lower cervical spine treated with ventral resection and anterior fusion utilising sternal notch exposure: case report, technical note and literature review

A 36-year-old female patient with a long-standing asymptomatic lower thoracic scoliosis presented with sensory symptoms involving all limbs. MRI scan demonstrated a rounded ventral intradural mass causing major deformity of the cervical cord at C6 and C7 levels. Unlike most previously reported neurenteric cysts, the MRI signal characteristics of this mass were such that it could not be determined if it is cystic or solid, being iso-intense on T1- and hyperintense T2-weighted images. Resection was performed through a median corporectomy of C6 and C7, the lesion being found to be a neurenteric cyst with an attachment to the anterior median fissure of the cord. Strut graft and cervical locking plate fixation from C5 to C6 was facilitated by extending the cervical incision into the sternal notch, with detachment of left-sided strap muscle insertion. The patient made an excellent recovery with complete resolution of neurological symptoms and solid fusion. The postoperative course was complicated by an anterior cervical CSF collection which resolved spontaneously within 2 months. The literature regarding this rare condition and its management is reviewed. Although the majority of intraspinal neurenteric cysts are situated ventral to the cord, most reports of excision have been from a dorsal approach. Drainage and subtotal excision of neurenteric cysts have been previously advocated; however, the recurrence rate is such that complete excision is advocated. This is facilitated by a ventral approach. A simplified method of utilising the sternal notch exposure is reported. The literature regarding the anatomical peculiarities pertinent to the sternal notch approach, and the reported literature regarding spinal neurenteric cysts is reviewed.