Supratentorial neurenteric cyst associated with a intraparenchymal subependymoma

Abstract

Neurenteric cyst is a rare developmental lesion that very infrequently is localised supratentorially. Intraparenchymal subependymoma is an even more rare benign tumour. The authors report the case of a 45-year-old gentleman with a background of drug resistant epilepsy. An MRI was performed which showed a left frontal cystic lesion with a solid component. Histopathology confirmed a type C neurenteric cyst associated with an intraparenchymal subependymoma. Following enlargement of the lesion and worsening of symptoms he was referred to our institution for further management. A frontotemporal craniotomy was performed for excision of the lesion but recurrence occurred within 1 year. The lesion was further excised and 19 months post re-excision the patient is seizure free with no evidence of recurrence on MRI.

Figure 1

MRI showing the cyst before the first surgical procedure, after a stereotactic attempt of biopsy and drainage of cyst content. The cyst was 3.1×3.6×3.7 cm (width × rostro-caudal × anterior-posterior). A and B: coronal and sagittal T1-weghted images. C: axial T1-weighted image after contrast enhancement.

Figure 2

Histological section showing the pluristratified ciliated epithelium that lined the cys (H&E, x400).

Figure 3

Clustered nuclei and fibrillary stroma reminding a subependymoma (H&E, x400).

Figure 4

MRI at time of recurrence: T1-weighted images after gadolium administration. The cyst was slightly enlarged to 3×3.9×4 cm (width × rostro-caudal × anterior-posterior).