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Synchronous Primary Brain Tumors
Joseph Junewick, MD FACR
over 9 years ago
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Epidermoid

Case Detail

Anatomy: Brain-Spine
Borders
Heather Borders, MD
Diagnostic Category: Developmental or Congenital
Created: over 7 years ago
Updated: over 7 years ago
Tags: PEDS
Modality/Study Types: MRI
Activities:
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History

8 year old with history of “tics” and cyst diagnosed on outside CT.


Case Images


Diagnosis

Epidermoid

Findings

Mildly heterogeneous hypointense T1, hyperintense T2 (not shown) extra axial cyst with associated restricted diffusion in the suprasellar region. No central enhancement.

Discussion

Epidermoids develop from ectoderm; congenital rests from incomplete separation of the neuroectoderm and cutaneous ectoderm. Epidermoid is more common than dermoid.

The location of epidermoids is variable, whereas dermoids are typically midline. Most frequently these are found in the posterior fossa. Other locations include pineal, suprasellar and middle cranial fossa.

CT usually shows a low density lobulated mass in one of the above mentioned locations. Density is usually equal to CSF. MRI demonstrates a mildly heterogeneous lobulated extra axial mass with prolonged T1 and T2 relaxation times. No enhancement after contrast. Differentiation from an arachnoid cyst may be difficult, particularly when small. Diffusion weighted imaging is definitive, and will demonstrate restricted diffusion. Lesions will usually be hyperintense on FLAIR.

Reference

Barkovich: Pediatric neuroimaging. pp. 539-541.



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