CorrespondenceMalignant transformation of epidermoid cyst with diffuse leptomeningeal carcinomatosis on skull base and trigeminal perineural spread
Section snippets
Case depiction
A 70-year-old patient presented with a 2 years history of left trigeminal neuralgia. Initial head MRI revealed an extra-axial cystic lesion of the left cerebellopontine angle (CPA) with low signal intensity on T1-weighted images, high signal intensity on T2-weighted images and restricted diffusion (Fig. 1A–C), consistent with an epidermoid cyst (EC). Peripheral enhancement was observed on post-contrast T1-weighted images (Fig. 1D). Because of cardiac comorbidities contraindicating general
Discussion
Intracranial EC account for 0.2%–1.8% of all intracranial tumors [1] and are the third most common tumor of the CPA. They usually are histologically benign, slow growing tumors, and result from inclusion of ectodermal elements during neural tube closure [1].
EC typically exhibits low signal intensity on T1-weighted images, high signal intensity on T2-weighted images and restricted diffusion [3]. After contrast administration, minimal rim enhancement may be seen in 25% of the patients. The
Conclusion
We reported a case of a diffuse leptomeningeal carcinomatosis on skull base of a SCC complicating an EC and extending along the trigeminal nerve. Our report highlights the importance of complete resection of EC whenever possible, and otherwise the importance of regular and long-time imaging follow-up, where tumor growth and enhancement must be scrutinized.
Disclosure of interest
The authors declare that they have no competing interest.
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Cited by (2)
Treatment and Survival Outcomes of Primary Intracranial Squamous Cell Carcinoma
2019, World NeurosurgeryCitation Excerpt :The patient was self-sufficient with mild neurologic deficit; however, he was lost to further follow-up. In total, 62 cases of primary intracranial SCC including the patients presented here were identified (Table 1).2,4,5,8-62 The mean age at diagnosis of malignancy was 53.6 ± 12.2 years, and 32 (51.6%) patients were women.
- 1
All authors contributed significantly to the manuscript.