Brain Tumor Res Treat.  2021 Apr;9(1):21-25. 10.14791/btrt.2021.9.e3.

Giant Intradiploic Epidermoid Cyst in the Occipital Bone: A Case Report

• Choo Y
• Seo Y
• Choi J

• KMID: 2515078
• DOI: http://doi.org/10.14791/btrt.2021.9.e3

Abstract

Epidermoid cysts are uncommon intracranial tumors. As one of the extradural types of epidermoid cysts, intradiploic epidermoid cysts are even rarer tumors and occur in any part of the skull. We herein report a rare case of a giant intradiploic epidermoid cyst of the occipital bone. A 57-year-old woman presented with a 1-year history of localized headache in the occipital area. CT and MRI showed an extradural mass measuring 50×70 mm in the occipital bone with bony destruction. The patient underwent surgical resection. The tumor was completely removed with its capsule. There was no extension to the intradural space. The pathological report confirmed that the tumor was an epidermoid cyst. Follow-up MRI 24 months after the operation showed no recurrence. The headache was well controlled without any medications. We report a rare case of intradiploic epidermoid cyst with clinical and radiologic features and surgical treatment. It is important to consider this diagnosis for a patient with persistent regional headache with or without a growing scalp mass.

Keyword

Epidermoid cyst; Skull; Occipital bone; Headache; Skull neoplasm.

Figure

• 

  Fig. 1 CT and MRI shows an extradural mass measuring 50×70 mm in the occipital bone. MRI also reveals compression in the right occipital lobe and cerebellar hemisphere. A: T2-weighted MRI shows hyperintensity with a low intratumoral signal. B: T1-weighted MRI shows hypointensity with a high intratumoral signal. C: Diffusion-weighted imaging shows restricted diffusion with characteristic hyperintensity. D: CT scanning shows a large hypodense mass with sharply demarcated bony defects in the right occipital bone. E and F: T1-weighted contrast MRI shows no enhancement of the mass. There is no abnormal signal change in the brain.

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  Fig. 2 The cyst is unilocular and consisted of a grayish brown, sticky material. A and B: The cyst wall is gray-white and smooth. C: Histologic examination shows that the cyst is lined by mature squamous epithelium (arrow) and filled with anucleate laminated keratin material (arrowhead) (hematoxylin-eosin stain, ×100).

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  Fig. 3 A follow-up MRI at 24 months after surgery shows no residual or recurrent mass. A: T2-weighted MRI. B: T1-weighted MRI. C: Diffusion-weighted imaging. D: T1-weighed gadolinium-enhanced MRI.

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