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LETTER TO EDITOR
Year : 2012  |  Volume : 60  |  Issue : 5  |  Page : 542-543

Giant intradiploic dermoid cyst of the frontal bone with involvement of frontal sinus in an elderly patient


Department of Neurosurgery, SCB Medical College and Hospital, Cuttack, Odisha, India

Date of Web Publication3-Nov-2012

Correspondence Address:
Ashis Patnaik
Department of Neurosurgery, SCB Medical College and Hospital, Cuttack, Odisha
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0028-3886.103218

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How to cite this article:
Patnaik A, Mishra SS, Das S, Senapati SB. Giant intradiploic dermoid cyst of the frontal bone with involvement of frontal sinus in an elderly patient. Neurol India 2012;60:542-3

How to cite this URL:
Patnaik A, Mishra SS, Das S, Senapati SB. Giant intradiploic dermoid cyst of the frontal bone with involvement of frontal sinus in an elderly patient. Neurol India [serial online] 2012 [cited 2020 Apr 1];60:542-3. Available from: http://www.neurologyindia.com/text.asp?2012/60/5/542/103218


Sir

In the craniofacial region, dermoid cysts are rare and most cases involve the orbit, nasal, and paranasal spaces close to the midline. They arise near the suture lines. We describe the case of a giant intradiploic dermoid cyst involving the frontal bone and frontal sinus.

A 50-year-old female, presented with a slowly enlarging, painless swelling over the right forehead. The swelling was firm in consistency, free from the overlying skin. There was vision difficulty, as the large swelling was obstructing the normal vision [Figure 1], but there were no neurological deficits. A computed tomography (CT) scan showed an isodense lesion in the intradiploic space of the right frontal bone and frontal sinus. The outer table of the skull was eroded and part of the tumor was just beneath the scalp tissue. The inner table was intact, with no intracranial extension [Figure 2]. There was no contrast enhancement [Figure 3]. Operative intervention was planned purely for cosmetic reasons and for removing the visual obstruction. Intraoperatively, the mass was well-circumscribed and contained hairs of a keratin-like material. The outer table of the skull was completely destroyed. Complete excision of the mass was done. There was no sinus tract or tumor component going into the intracranial compartment. Bone reconstruction through cranioplasty was planned, but the patient refused, due to financial reasons. Histopathology showed keratin with sebaceous glands and dermal elements, confirming the diagnosis of a dermoid [Figure 4].
Figure 1: A large globular swelling over the right side forehead, causing obstruction to the vision

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Figure 2: A non-contrast CT scan showing an isodense mass in the frontal sinus, eroding the outer table of the skull

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Figure 3: Contrast CT scan showing no enhancement. The upper cuts show the true intradiploic nature of the lesion. The lower coronal cuts show the lesion not involving the orbit

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Figure 4: Histopathology showing keratin material, sebaceous glands, and other dermal elements

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Craniofacial dermoids are most commonly seen in frontonasal-sphenoidal suture lines and the periorbital region in early life. Nasal dermoids are a special variety of dermoids associated with dermal sinus tract into the intracranial cavity. Although they are considered to be rare, they are well described in literature. [1],[2] Orbital dermoids frequently have an intracranial extension. Extension into the frontal sinus has also been reported in the literature. [3] Few cases of pure intradiploic dermoids have been reported in the literature, occurring in young individuals. [4],[5] Our patient, an elderly female, was exclusive, in that it she had an isolated intradiploic lesion, with no intracranial extension, fistulous tract, or orbital nasal extension. Complete resection followed by bone reconstruction is the only treatment needed for these lesions. Our case illustrates that an intradiploic dermoid must be kept in differential diagnosis of a slow-growing, calvarial mass in an elderly person.

 
 ╗ References Top

1.Locke R, Kubba H. Unusual variants of midlinenasaldermoidcysts: A series of three cases. J Laryngol Otol 2012;126:83-7.  Back to cited text no. 1
    
2.Bahloul K, Dhouib M, Chaari I, Abdelmoula M. Nasaldermoïdcystwith intracranial extension: Which approach? Neurochirurgie 2011;57:125-8.  Back to cited text no. 2
    
3.Pham NS, Dublin AB, Strong EB. Dermoid cystof the orbit andfrontalsinus: A case report. Skull Base 2010;20:275-8.  Back to cited text no. 3
    
4.Gulsen S, Yilmaz C, Serhat C, Altinors N. Rupturedintradiploicdermoid cystoverlying the torcularherophili. Neurol Neurochir Pol 2010;44:308-13.  Back to cited text no. 4
    
5.De Moraes Junior LC, Wanderly EC, Montini A, Haseqawa M. Intradiploicdermoid cystof the skull: Report of a case. Arg Neuropsiquiatr 1984;42:68-71.  Back to cited text no. 5
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4]

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