Hemorrhagic colloid cyst: Case report and review of the literature

Abstract

Colloid cysts are cystic lesions located at the anterior part of third ventricle, close to foramen of Monro and contain colloid material. Hemorrhage in a colloid cyst is very rare. On literature review, we found only six cases of hemorrgic colloid cyst; among them, four were diagnosed at postmortem examination. We report a rare case of a hemorrhagic colloid cyst in a young lady who presented with sudden onset severe headache and vomiting. Computed tomography (CT) scan showed isodense lesion located at foramen of Monro with hyperdense areas suggestive of hemorrhage with foraminal obstruction. The lesion was not enhancing on contrast. Magnetic resonance imaging (MRI) brain revealed a well-defined cystic mass lesion located at the foramen of Monro which was hyperintense on T1 and hypointense on T2-weighted images. Excision of the colloid cyst was performed which revealed hemorrhagic clot instead of colloid material. Histopathological examination revealed a colloid cyst with hemorrhage. We believe that this is the first such reported case of successful clinical outcome following early diagnosis and excision of a hemorrhagic colloid cyst in an adult.

Keywords: Colloid cyst; hemorrhage; third ventricle.

Figure 1

CT brain (axial view). (a) Isodense lesion located at foramen of Monro with hyperdense areas suggestive of hemorrhage with foraminal obstruction. (b) No evidence of enhancement on contrast.

Figure 2

MRI brain (axial view). (a) Homogenously hyperintense lesion at foramen of Monro in T1-weighted sequence. (b) Lesion appears uniformly hyperintense on T2-weighted sequence

Figure 3

Photomicrograph. (a) Pseudostratified columnar epithelial cells with occasional ciliated and goblet cells with a thin capsule of fibrous connective tissue suggestive of colloid cyst presence of red blood cells, hemosiderin laden macrophages, rhomboid cholesterol crystals, and chronic inflammatory cells suggestive of hemorrhage in colloid cyst (H and E staining, Magnification 10×). (b) showing cuboidal-to-pseudostratified columnar epithelial cells (H and E staining, Magnification 40×).