1 case of epidermal cyst in the pineal region

1Medical Record Summaryfemale, 28 years old, was admitted to hospital on April 24, 2018 for "repeated headache for 2 years, with sexual right limb weakness for more than 1 year"In the past 10 years or so recurrent seizure symac-like symptoms, intermittent oral phenytoin sodium, symptom control can beAdmission examination: clear mind, comprehension, memory, directional force, computational force decline, right limb muscle strength 4, muscle tone decreasedhead MRI suggests that the pineal gland area, the left thalamus and the left side of the ventricle triangle occupied, consider the epidermis-like cyst, the ventricle expansionPreliminary diagnosis: epidermal cysts in the pineal gland area, non-traffic hydrocephalusline under the left side of the clot into the road intracranial epidermal cyst ecclestomy, the disease is seen in the real, diameter of about 5 cm, with white gloss encased, obvious calcification thickening, border clearing, less blood supply; First in the encased to remove the contents, and then extend to the surrounding, as far as possible to remove the contents of the sac, because the majority of the sac wall calcified, as far as possible from the inside of the sac wall scraped content, due to the sac wall itself removal difficulties, and implicated deep nerves and vascular structure, only partial removal;postoperative review CT and MRI show: cyst contents have been removed, edge calcification part of the residuePostoperative pathology was confirmed as a epidermal-like cystWithin 2 weeks of surgery, antibiotics, glucocorticoids and repeated lumbar punctures were treated for fever, and after 2 weeks, the symptoms improved and the symptoms disappeared4 months after surgery, the local review MRI show edema shrinks and the ventricle increasesAfter 6 months of telephone follow-up, the patient has been engaged in heavy manual labor, no special discomfort1 pineal gland area, left thalamus and left side ventricle triangular region epidermal cyst1A preoperative MRIT2WI osteoblastic pine algo area, left thalamus and left side ventricle triangular area occupant, border clearing, high signal; 1BDWI indicates high signal in the brain occupanst; 1C, 1D T1 enhances axis image and target The symptoms show that the lesions sac wall is mildly strengthened (arrow shown) with a low signal in the sac; 1E is seen in the lesions as a white envelope (arrow shown), the contents of the sac are a pearl-colored wax-like (arrow shown); 1F the first day of CT sac contents Cut, the sac wall is dotted with line calcification (arrow shown), CT value is about 83HU; on the first day after 1G, MRIT1 enhanced like lesions are reduced compared to preoperative, partial sac wall residue (arrow shows); 4 months after 1H surgery MRIFLAIR cystic disease The lesions largely disappeared, the two-sided ventricle increased2 Discussion 2.1 occurrence mechanism epidermal cysts as congenital intracranial benign lesions, in the embryo formation about 3 to 5 weeks, when the neural tube is closed, the outer embryo cell ectopic alterobes into the neural tube formation It can also be formed by trauma and skin cells implanted into the skull The incidence of epidermal cysts accounted for about 0.5% to 1.8% of whole brain tumors, the best hair site is the bridge cerebellum corner, occurred in the pineal region of the epidermis-like cyst clinically less common, only cases reported at home and abroad 2.2 imaging performance cysts for epidermal cell proliferation, shedding formation of keratin, cholesterol and cell debris and other substances, therefore, its texture is soft, plasticity is strong, easy to resistance to small ventricle, brain pool, brain ditches and other gaps in the growth, showing the "see seam on long" characteristics Its typical imaging is characterized by CT low density, T1 low signal, T2 and DWI high signal, because the cystic wall blood supply is scarce, not reinforced or occasional edge ring thin layer strengthening, no edema belt around When the sac wall is calcified, high density shadow can be seen on the CT, and MRI imaging is not typical when the contents of the sac change The imaging performance of this case is more typical 2.3 clinical manifestations and diagnosis
epidermal cyst growth is slow, the appearance of clinical symptoms have grown more than 10 years, large volume, because of the compression of surrounding brain tissue or around blood vessels, nerves and symptoms, the specific clinical manifestations due to the growth of different parts and size of differences Pine cone sylletc sac pressure in the brain-leading water pipe causes serious symptoms of cranial hypertension and hydrocephalus, such as headache, co-help disorder and so on This case was admitted to hospital with repeated headache accompanied by sexual right limb weakness, consistent with previous literature reports The patient has had repeated interstitastic symptoms over the past 10 years, possibly due to mild aseptic encephalitis The diagnosis of this case is mainly through typical imaging performance, in-surgery and pathological examination, the typical pathology is manifested as a large number of polysemes under the mirror scale epithelial 2.4 treatment method surgical removal of the epidermal cyst in the pineal gland area can obtain good results The surgery should strive for the whole sac wall as far as possible, because the cyst envelope for its active growth part, do not remove easy to lead to recurrence and aseptic meningitis The most critical part of the surgery is to determine the relationship between the sac wall and the deep veins, and previous literature has reported that the veins in the cystic membrane should not be over-separated The tumor volume of this case is too large, and found in the surgery part of the sac wall calcification, and the surrounding tissue adhesion tightly, in the operation to take out, remove the contents of the sac, reduce the volume of the tumor and then separate the envelope, gradually remove the tumor, in order to prevent serious complications caused after surgery, did not try to cut In order to reduce the risk of sterile meningitis after surgery, the exodus of sac contents should be prevented during surgery, and finally the sac cavity or field should be flushed with appropriate amount of salt water but the case after surgery still occurred obvious aseptic meningitis, considered for the following reasons: (1) no intravenous glucocorticoid infusion in surgery prevention, flushing is not complete (2) The sac content sympathising is incomplete, because a little peripheral content hardens and clings to the calcified shell (3) Concerned that the lumbar pool tube will induce infection, after surgery did not carry out the lumbar pool tube out-of-tube drainage, only intermittent lumbar puncture release cerebrospinal fluid, the efficiency is not high Pathological diagnosis is epidermis-like cyst, after surgery whether radiotherapy is required to have different views Recent studies have shown that: intracranial epidermal cysts can be converted into malignant squamous cell carcinoma, especially in children, radiotherapy can not prevent recurrence, so after surgery should increase the number of imaging reviews to observe whether the tumor recurrence The symptoms of aseptic meningitis were overcome after surgery, but long-term observation and follow-up were still required