PituitaryEpidermoid cyst of the sphenoid sinus with extension into the sella turcica presenting as pituitary apoplexy: case report
Section snippets
Background
Epidermoids typically occur between the ages of 20 and 60 with a peak incidence in the fourth decade. There is no gender predilection [9], [10]. They comprise 1% of all intracranial tumors [23] and are usually found off midline in the extraaxial, subdural regions, most commonly the cerebellopontine angle cistern (40%-50%), followed by the parasellar/middle fossa space (10%-15%) [1], [3], [10]. About 10% are extradural, most commonly the cranial diploic spaces [21] of the frontal, parietal, and
Case description
A previously healthy 25-year-old man presented with acute severe headache and worsening diplopia. He denied any nausea, vomiting, weakness, numbness, or constitutional symptoms. Examination revealed an afebrile well-nourished young male with right-sided ptosis and paresis of the right third cranial nerve. Visual acuity was 20/60 OD and 20/40 OS by handheld acuity testing. No gross visual field defects were found. The rest of the neurological examination findings were normal. Complete blood
Discussion
In 1829, Cruveilhier [7] reported the first description of the “tumeurs perlees.” Several years later, after recognizing the presence of cholesterol crystals in a diploic epidermoid, Müller [13] introduced the term “cholesteatoma,” but Virchow [25] soon recommended the abandonment of the term after realizing cholesterol was neither essential nor constantly seen in these tumors.
The location of this tumor with sellar extension and the acute neurological deterioration caused by such a slow-growing
Conclusion
Epidermoids should be considered as part of the differential diagnosis of sphenoid sinus or sellar region masses. Despite being slow growing, they can present acutely with sudden neurological deficit requiring immediate neurosurgical intervention.
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Intrasellar epidermoid cyst. A case report
2022, Endocrinologia, Diabetes y NutricionMagnetic resonance imaging of the hypothalamo–pituitary region
2021, Handbook of Clinical NeurologyCitation Excerpt :Due to their slow growth, there is absence of surrounding edema on imaging. On MRI imaging, epidermoids and dermoid cysts may have variable signal intensity; usually there is homogenous hyperintensity on T1-weighted images and hypo- to mixed signal on T2-weighted imaging due to the presence of lipids in the cyst (Sani et al., 2005; Pan et al., 2017) (Fig. 6.13). Arachnoid cysts are usually incidental findings and may develop from splitting of the arachnoid membrane during congenital development or can occur secondary to intraventricular hemorrhage, head trauma, infection, or surgery.
The sellar and suprasellar region: A “hideaway” of rare lesions. Clinical aspects, imaging findings, surgical outcome and comparative analysis
2016, Clinical Neurology and NeurosurgeryCitation Excerpt :ECs may present in every location of the intracranial space, with the most common site being the cerebellopontine angle. In the SSR they comprise 0,2-0,7% of all tumors and are usually diagnosed in middle age [8,19,35,66,67,76,85]. Besides headache and visual deficits, pituitary apoplexy has also been reported in ECs of the SSR [27].
Rathke's cleft cyst
2014, Handbook of Clinical NeurologyIntrasellar epidermoid cyst presenting as pituitary apoplexy
2008, Journal of Clinical NeuroscienceCitation Excerpt :The patient’s diplopia may be explained by the expanded tumor compressing the cavernous sinus. In a case of epidermoid cyst with sellar expansion, Sani et al. claimed that these acute signs were caused by microrupture of a tumor into the subarachnoid space, causing an inflammatory response or meningitis, or acute mass effect.9 Epidermoids tend to present during the third to fifth decades of life, in contrast to the predominance of craniopharyngiomas in the first to second decades, which should be kept in mind in the differential diagnosis.4
Nasal sinuses cholesteatoma: case series and review of the English literature
2023, European Archives of Oto-Rhino-Laryngology