Introduction

Epidermoid cyst in the spinal cord is a rare condition, constituting only 0.6–1.1% of all spinal tumors. The majority of spinal epidermoid cysts are subdural and extramedullary, while intramedullary localization is very rare.

Intramedullary epidermoid cyst is common in lumbosacral and thoracic regions; two frequent localizations are T4–T6 andT 11–T12, while only three cases have been reported with cervical cord involvement. The symptoms at presentation of epidermoid cysts in the lower thoracic and upper lumbar regions are usually neurologic, such as progressive paraparesis and motor-sensory complaints; sphincter troubles may occur later.

We report a case of a 13-year-old patient with an intramedullary epidermoid cyst presenting with urological
manifestations.

Case report

This 13-year-old girl was referred to our hospital with a 12-month history of recurrent low urinary tract infections (UTI), urinary frequency and nocturnal enuresis. The first diagnostic evaluation had included renal filling phase of the cystometric curve, with worsening ultrasonography and voiding cystouretrography that were normal. In addition, urological studies had been completed with cystometrography in order to evaluate compliance, involuntary detrusor contractions, bladder volume and desire to void. Urodynamic findings had shown detrusor instability, defined as presence of uninhibited contractions of the bladder muscle at pressure more than 15 cm/H2O, occurring during the bladder compliance. Urological symptoms persisted despite antibiotic and anticholinergic treatment with oxybutynin chloride (0.1 mg/kg/die).

Abstract. The “excessive functional activity” of some cancer cells first found by Caspersson has been observed in fixed, stained smears of cervical epidermoid carcinomas from four patients. Preliminary results suggest that there may be a characteristic difference between the absorption profiles of some epidermoid can- cer cells and other cells found in cytological smears. It is our belief that with an appropriate electronic scanning system such cells can be detected by measure- ments of their absorptions at two different wavelengths. However, the effect on the absorptions of cells with abnormalities other than cancer, and whether every epidermoid carcinoma will contain such cells, must yet be determined.

The techniques developed by Papani- colaou (1) for preparing cytological smears of body surfaces or fluids are efficient for demonstrating the presence of cancer cells and are now widely used as a means of diagnosing certain cancers in an early and curable stage. It is known that use of the Papani- colaou techniques in a mass screening of the population may lead to early diagnosis of cancer of the uterine cervix with resulting reduction of morbidity and mortality (2). The wider application of the techniques is limited, however, by the requirement for highly trained technicians to engage in the time-consuming and tedious search for abnormal cells in each preparation. This limitation could be circumvented if a device were available for screening out a major portion of the clearly negative cases so that the cytotechnologist need only be concerned with a small fraction of the total cases.

Attempts have been made to auto-mate the screening process based on measuring the size and visible light absorption of the nuclei of specially stained and isolated cells (3) and the fluorescence of cells stained with a fluorescent dyestuff (4). These studies have not yet resulted in a usable device. Furthermore, they require stains other than the standard Papanicolaou stain, which may be disadvantageous because they make unavailable the wealth of experience already accumu- lated with this stain. Thus, suspicious or problem cases must also be proc- essed by the Papanicolaou technique for review and final evaluation. Also, many of these other preparations are not permanent and are awkward to handle on a community-wide basis.

OBJECTIVE. The purpose of this study is to analyze the appearance of testicular epidermoid cysts on high-resolution sonography and MR imaging and correlate imaging features with histopathologic findings.

CONCLUSION. Intratesticular epidemıoid cysts may show imaging features that correlate with their histopathologic findings. Concentric rings of alternating hypo- and hyperechogenicity on sonography and alternating high and low signal intensity on MR imaging (‘ıonion ringı appearance) correspond to the pathologic finding of multiple layers of keratin debris. Absence of flow on color Doppler sonography and absence of contrast enhancement on MR imaging is als consistent with the avascular nature of these lesions. The ability of preoperative imaging studies to suggest the diagnosis of epidermoid cyst may prompt a testis-sparing surgery instead of an orchiectomy.

Epidermoid cysts account for approximately l-2% of all resected testicular masses  [I , 2]. There is evidence that these lesions have a benign biologic behavior and no malignant potential [3. 4]. Therefore, if the diagnosis can be suggested preoperatively. enucleation of the lesion can be performed rather than orchiectomy. the standard surgical treatment for potentially malignant testicular masses [3-5]. We describe five consecutive patients at a single institution in whom the diagnosis of epidermoid cyst of the testicle was surgically confirmed and correlate imaging findings with histopathology.

Authors: F. A. Timmer, M. Sluzewski, M. Treskes, W. J. J. van Rooij, J. L. J. M. Teepen, and D. Wijnalda

Summary: Chemical analysis of the contents of a so-called bright epidermoid of the posterior fossa with unusual CT and MR imaging characteristics suggested that a combination of high protein content and high viscosity were responsible for the atypical imaging findings.

Epidermoid tumors are rare congenital lesions of the brain that account for 0.2% to 1% of all intracranial neoplasms (1). We report a case of an epidermoid tumor with an unusually dense appearance on CT scans, high signal intensity on T1-weighted MR images, and low signal intensity on T2-weighted MR images. The results of pathologic examination and chemical analysis of the contents of the cyst are discussed.

Case Report

A 47-year-old woman had a 10-year history of bilateral facial nerve paresis, deafness, and tongue atrophy. More recently, the symptoms had worsened and she reported difficulty swallow- ing. CT scans showed a dense mass in the posterior fossa of the left cerebellar hemisphere (Fig 1A). At MR imaging, the lesion showed high signal intensity on T1-weighted sequences and low signal intensity on T2-weighted sequences (Fig 1B and C). A small nodule was present at the periphery of the lesion. No enhancement was seen after administration of gadopentetate dimeglumine. On both the CT and MR studies, an arachnoid cyst was seen on the right side of the posterior fossa. The epidermoid showed mass effect on the brain stem. There was no hydrocephalus.

At surgery, a dark brown cyst with highly viscous, toffeelike contents was found and removed. The arachnoidal cyst was also evacuated. At pathologic examination, the cystic wall was composed of fibrous tissue lined with stratified squamous epithelium, consistent with the diagnosis of epidermoid. The cystic wall was partly disintegrated by chronic inflammation, with foreign-body reaction and reactive fibrous proliferation. This proliferation corresponded to the peripheral nodule seen at MR imaging.

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Physical examination revealed a 4 × 3-cm firm, painless tumor of submandibular region; it was fixed to superficial and deep planes. The patient had poor dentition. Laryngoscopic examination was normal. Ultrasound revealed the presence of a relatively well-demarcated submandibular tumor with a central necrotic area. The radiography of the chest was normal.

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Intramedullary epidermoid cyst is common in lumbosacral and thoracic regions; two frequent localizations are T₄–T₆ and T₁₁–T₁₂, while only three cases have been reported with cervical cord involvement.

The symptoms at presentation of epidermoid cysts in the lower thoracic and upper lumbar regions are usually neurologic, such as progressive paraparesis and motor–sensory complaints; sphincter troubles may occur later.

We report a case of a 13-year-old patient with an intramedullary epidermoid cyst presenting with urological manifestations.

Read Full Article »