Intraparenchymal endodermal cyst with spontaneous intracystic hemorrhage in the temporal lobe of an adult

Abstract

Background: Endodermal cysts (EC) are rare but well-known congenial lesions of the central nervous system mainly located in the spinal subdural space. Intracranial ECs are rare and commonly encountered in the posterior cranial fossa as extra-axial lesions; an intraparenchymal location is exceedingly rare. A complete removal is the best surgical strategy and any residue can cause recurrence. It is necessary to exclude EC in patients with intracranial cystic lesions. We present a case of intraparenchymal EC with spontaneous intracystic hemorrhage in the temporal lobe of an adult.

Methods: A 43-year-old man presented with headache and memory deterioration. Brain computed tomography and magnetic resonance imaging showed a slightly enhanced temporal lobe cystic lesion, which was homogenously hyperintense on T1-and T2-weighted images. There was a suspicion of brain abscess at admission. The lesion was totally removed with a left subtemporal craniotomy. Histological examination revealed an EC with intracystic hemorrhage.

Results: The preoperative symptoms were relieved after surgery and 3-month follow-up magnetic resonance imaging found no cystic signs.

Conclusion: This case suggests that EC should be considered in the differential diagnosis of intracranial cystic lesions and a complete removal is the best strategy of choice.

Figure 1

Brain CT and MRI at admission. Nonenhanced (A) and enhanced (B) CT; T1-weighted (C) and T2-weighted (D) MRI; axial (E) and coronal (F) enhanced T1-MRI. CT = computed tomography, MRI = magnetic resonance imaging.

Figure 2

Macroscopic photographs of the appearance (A) and the contents (B) of the cyst. The cyst was about 2.6 × 2 × 2 cm in size.

Figure 3

Histology of the cyst wall: (A) HE and (B–F) IHC. (B) AE1/AE3, (C) CD68, (D) SMA, (E) CD34, and (F) Ki-67 (original magnification: A–D, ×100; E and F, ×40). HE = hematoxylin-eosin, IHC, immunohistochemical, SMA = smooth muscle actin.

Figure 4

Three-month follow-up MRI. Axial T1-weighted (A) and T2-weighted (B) MRI; axial (C) and coronal (D) enhanced T1-MRI. MRI = magnetic resonance imaging.