Background: Coexistence of multiple primary intracranial tumors of different cell types
Background: Coexistence of multiple primary intracranial tumors of different cell types has rarely been documented; the association of a meningioma and a glioma has been reported as the most common combination. an epidermoid cyst, the second lesion was extraaxial fibrous lesion arising from the falx. Pathology confirmed an atypical meningioma WHO Grade II and an epidermoid cyst. Conclusion: The simultaneous occurrence of primary intracranial tumors of different cell types is usually rare. Epidermoid cysts are slow growing lesions believed to arise from inclusion of ectodermal elements during neural tube closure, while meningiomas arise from arachnoidal cells; their association has rarely been reported previously. strong class=”kwd-title” Keywords: Epidermoid cyst, meningioma, multiple tumors INTRODUCTION Epidermoid cysts are benign, slow growing extraaxial tumors that account for about 1% of all intracranial tumors; they arise from hamartomatous misplacement of embryonic ectoderm during ontogenesis. Meningiomas, on the other hand, arise from arachnoidal cells. Except for cases associated with neurofibromatosis type 2, multiple primary intracranial tumors of different cell types are relatively rare. The most frequent combination of multiple tumors is usually a meningioma with a glioma.[8,20] Association of a meningioma and an epidermoid cyst has rarely been reported before. We present an unusual case of a temporal epidermoid cyst coexisting with an intracranial meningioma and review the possible pathogenesis of association of those lesions. CASE REPORT We report the case of a 37-year-old patient who presented with symptoms of raised intracranial pressure with progressive loss of sight. On admission, patient was conscious with no motor deficit, and fundus revealed bilateral optic atrophy. Magnetic resonance imaging (MRI) revealed isoquercitrin supplier an extra-axial right frontal lesion, hypointense T1, hyperintense T2 slightly enhanced after gadolinium; a second right temporal lesion isointense isoquercitrin supplier T1, hyperintense LAMNB2 T2 non-enhancing was seen [Physique 1]. A right frontotemporal craniotomy was performed that revealed two distinct lesions: The temporal whitish lesion with the pearl appearance reminding of an epidermoid cyst and the second was extraaxial, fibrous arising from the falx reminding of a meningioma. Pathology confirmed an atypical Grade II meningioma and epidermoid cyst [Physique 2]. The patient recovered well following medical procedures and had no neurological deficit except his previous optic atrophy. Postoperative computer tomography (CT) scan showed total removal of both lesions [Physique 3]. Open in a separate window Physique 1 A right extra-axial, frontal lesion hypointense T1, hyperintense T2 slightly enhanced after gadolinium; a second right temporal lesion isointense T1, hyperintense T2 non-enhancing seen Open in isoquercitrin supplier a separate window Physique 2 (a and b) Stratified epithelium made up of keratin and cholesterol reminding of an epidermoid cyst. (c and d) Clear small cells with prominent nucleoli, cell change, infiltration, and necrosis recommending of the atypical meningioma Open up in another window Body 3 Control pc tomography (CT) check displaying total removal of both lesions Dialogue Intracranial epidermoid cysts take into account 0.2C1% of most human brain tumors. They are believed to are based on ectodermal cell inclusions taking place during closure from the neural pipe; embryologically, epithelial the different parts of the cyst wall develop between your 5th and 3rd weeks of embryonic life; posttraumatic acquired illustrations have already been reported. Epidermoid cysts take place mostly on the cerebellopontine angles (40C50%) and parasellar regions, insinuating between brain set ups. These are harmless and gradual developing lesions generally, although uncommon malignant change into squamous cell carcinoma continues to be noted isoquercitrin supplier in the books. Meningiomas, alternatively, arise through the arachnoidal cover cells of arachnoid villi in meninges; these are classified as harmless, atypical, and anaplastic and take into account up to 24C30% of most major intracranial neoplasms, almost all being harmless. Simultaneous occurrences of primary intracranial tumors of different cell types possess rarely been documented. You can find few situations in the books, the coexistence of the meningioma and a glioma getting one of the most reported mixture, accompanied by a meningioma using a vestibular schwannoma and a meningioma using a pituitary adenoma.[3,7,13,14,15,16,17,18,19,21,25] The.