PMC7567175_01
Axial CT image showing large intracranial fat density lesion with patchy peripheral calcification in left temporal fossa causing mass effect on surrounding structures.
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The lesion also extended to the left frontal region (Fig. 1) with posterior displacement of the first and second part of the left middle cerebral artery and medial displacement of the anterior cerebral artery.
Axial T1 W image (A) and T2 W image (B) showing hyperintense mass.
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The lesion appeared hyperintense on T1-weighted (Fig. 2A), FLAIR images and heterogeneously hyperintense on T2-weighted images (Fig. 2B).
Axial Fat suppressed image showing hypointensity within the lesion.
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The lesion was heterogeneously hypointense on FAT SAT images (Fig. 3).
Axial T1W image showing the mass with hyperintense foci in intepeduncular cistern, right ambient cistern along the external capsule suggesting rupture of the cyst.
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Similar hyperintense foci were seen in interpedencular, right ambient cistern and in left cortical sulci (Fig. 4), suggesting features consistent with mild rupture of the intracranial epidermoid cyst.
Microscopic picture showing sheets of keratin flakes with keratin pearls (H&E 40x).
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Microscopic examination showed sheets of keratin flakes with occasional area showing cystically dilated space lined by squamous epithelium along with thick bundles of keratin (Fig. 5).
Microscopic picture showing area of dystrophic calcification (arrow) with surrounding keratin flakes (H&E 40x).
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Focal area showed dystrophic calcification (Fig. 6).
Post operative follow up T1 W contrast axial (A) and coronal (B) images showing recurrence of tumor.
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Contrast MRI head revealed non enhancing well defined lobulated mass measuring 8.4 x 40 x 42 mm in the left anterior temporal region extending superiorly to the frontal horn of the left lateral ventricle causing a mild mass effect on adjacent surfaces.The lesion was hyperintense on T1-weighted (Fig. 7A), heterogeneously hyperintense on T2-weighted images (Fig. 7B).