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Suprasellar keratinous cyst: A case report and review on its radiological features and treatment outcome

BACKGROUND: Keratinous or epidermoid cysts (ECs) are encapsulated lesions lined by squamous cell epithelium. They comprise approximately 1% of intracranial lesions. Contrary to dermoid cysts, they lack dermal elements such as sebaceous or apocrine glands and hair follicles. The sellar region is the...

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Autores principales: Huo, C. W., Caputo, C., Wang, Y. Y.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Medknow Publications & Media Pvt Ltd 2018
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5806421/
https://www.ncbi.nlm.nih.gov/pubmed/29497568
http://dx.doi.org/10.4103/sni.sni_269_17
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author Huo, C. W.
Caputo, C.
Wang, Y. Y.
author_facet Huo, C. W.
Caputo, C.
Wang, Y. Y.
author_sort Huo, C. W.
collection PubMed
description BACKGROUND: Keratinous or epidermoid cysts (ECs) are encapsulated lesions lined by squamous cell epithelium. They comprise approximately 1% of intracranial lesions. Contrary to dermoid cysts, they lack dermal elements such as sebaceous or apocrine glands and hair follicles. The sellar region is the second most common intracranial site following the cerebellopontine angle. Here, we report a case of EC in a patient who complained of endocrine disturbances. We also performed a systematic review on previously published cases to analyze clinical and radiological characteristics and report the treatment outcomes of suprasellar ECs. CASE DESCRIPTION: A 42-year-old woman presented with a one-year history of amenorrhea, weight gain, severe headache, and visual disturbances for 6 months. Work-up identified an elevated prolactin level and a temporal field defect of the right eye. Magnetic resonance imaging (MRI) showed a cystic suprasellar lesion pushing on the optic chiasm. She underwent endoscopic trans-sphenoidal surgery, which confirmed a keratinous cyst on histology. Postoperatively, complete resection was confirmed on imaging. She did well although her hospital stay was prolonged due to diabetes insipidus and hypocortisolism. CONCLUSION: Chronic endocrine disturbances can be the presenting complaints of a suprasellar EC, whose T1-weighted MRI appearance can be non-specific, mimicking other differential diagnoses, such as a Rathke's cleft cyst. However, the T2-weighted MRI appearances of ECs are generally hyper-intense and lesions show diffusion restriction. Treatment is surgical and yields good outcomes in most cases reported.
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spelling pubmed-58064212018-03-01 Suprasellar keratinous cyst: A case report and review on its radiological features and treatment outcome Huo, C. W. Caputo, C. Wang, Y. Y. Surg Neurol Int Skull Base: Case Report BACKGROUND: Keratinous or epidermoid cysts (ECs) are encapsulated lesions lined by squamous cell epithelium. They comprise approximately 1% of intracranial lesions. Contrary to dermoid cysts, they lack dermal elements such as sebaceous or apocrine glands and hair follicles. The sellar region is the second most common intracranial site following the cerebellopontine angle. Here, we report a case of EC in a patient who complained of endocrine disturbances. We also performed a systematic review on previously published cases to analyze clinical and radiological characteristics and report the treatment outcomes of suprasellar ECs. CASE DESCRIPTION: A 42-year-old woman presented with a one-year history of amenorrhea, weight gain, severe headache, and visual disturbances for 6 months. Work-up identified an elevated prolactin level and a temporal field defect of the right eye. Magnetic resonance imaging (MRI) showed a cystic suprasellar lesion pushing on the optic chiasm. She underwent endoscopic trans-sphenoidal surgery, which confirmed a keratinous cyst on histology. Postoperatively, complete resection was confirmed on imaging. She did well although her hospital stay was prolonged due to diabetes insipidus and hypocortisolism. CONCLUSION: Chronic endocrine disturbances can be the presenting complaints of a suprasellar EC, whose T1-weighted MRI appearance can be non-specific, mimicking other differential diagnoses, such as a Rathke's cleft cyst. However, the T2-weighted MRI appearances of ECs are generally hyper-intense and lesions show diffusion restriction. Treatment is surgical and yields good outcomes in most cases reported. Medknow Publications & Media Pvt Ltd 2018-01-22 /pmc/articles/PMC5806421/ /pubmed/29497568 http://dx.doi.org/10.4103/sni.sni_269_17 Text en Copyright: © 2018 Surgical Neurology International http://creativecommons.org/licenses/by-nc-sa/3.0 This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 3.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.
spellingShingle Skull Base: Case Report
Huo, C. W.
Caputo, C.
Wang, Y. Y.
Suprasellar keratinous cyst: A case report and review on its radiological features and treatment outcome
title Suprasellar keratinous cyst: A case report and review on its radiological features and treatment outcome
title_full Suprasellar keratinous cyst: A case report and review on its radiological features and treatment outcome
title_fullStr Suprasellar keratinous cyst: A case report and review on its radiological features and treatment outcome
title_full_unstemmed Suprasellar keratinous cyst: A case report and review on its radiological features and treatment outcome
title_short Suprasellar keratinous cyst: A case report and review on its radiological features and treatment outcome
title_sort suprasellar keratinous cyst: a case report and review on its radiological features and treatment outcome
topic Skull Base: Case Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5806421/
https://www.ncbi.nlm.nih.gov/pubmed/29497568
http://dx.doi.org/10.4103/sni.sni_269_17
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