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LETTER TO EDITOR
Year : 2015  |  Volume : 63  |  Issue : 5  |  Page : 796-797

Corpus callosal lipoma with extracranial extension as a scalp swelling


Department of Neurosurgery, Seth G.S. Medical College and K.E.M. Hospital, Parel, Mumbai, Maharashtra, India

Date of Web Publication6-Oct-2015

Correspondence Address:
Survendra Kumar Rai
Department of Neurosurgery, Seth G.S. Medical College and K.E.M. Hospital, Parel, Mumbai, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0028-3886.166565

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How to cite this article:
Rai SK, Rangarajan V, Shah A, Goel A. Corpus callosal lipoma with extracranial extension as a scalp swelling. Neurol India 2015;63:796-7

How to cite this URL:
Rai SK, Rangarajan V, Shah A, Goel A. Corpus callosal lipoma with extracranial extension as a scalp swelling. Neurol India [serial online] 2015 [cited 2019 Dec 16];63:796-7. Available from: http://www.neurologyindia.com/text.asp?2015/63/5/796/166565


Sir

A 40-year-old male patient presented with a painless, nonpulsatile, and cystic swelling over the forehead, just behind hairline in the midline since birth [Figure 1]. He presented only with headache and had no neurological deficits. Imaging revealed a large hyperintense lesion on T1- and T2-weighted images in the callosal and supracallosal region extending into the subgaleal region through a defect in the frontal bone. The MR features were typical of a lipoma. This was associated with corpus callosal agenesis [Figure 2] and [Figure 3]. Some of the common clinical differential diagnosis of swellings at this location include a dermoid cyst, epidermoid cyst, atretic cephalocele, ossified cephalhematoma, eosinophilic granuloma and hemangioma. Rarely, lesions such as multiple myeloma, vascular malformation, nasal glioma, sinus pericranii, pilomatrixoma, fibrous dysplasia, aneurysmal bone cyst, osteoma, metastasis, and leptomeningeal cyst in children, may present in a similar location. Our patient was kept under observation and no intervention was performed.
Figure 1: Extracranial extension of the intracranial lipoma is seen as a hemispherical swelling near the center of the forehead just within the hairline

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Figure 2: Sagittal section of the T1-weighted image showing the corpus callosal lipoma as a hyperintense lesion connected with the subcutaneous fat through a bony defect in the frontal region

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Figure 3: Axial T2-weighted image showing the corpus callosal lipoma within the interhemispheric fissure as a hyperintense lesion encasing the anterior cerebral artery

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Lipomas account for about 0.34% of all intracranial tumors and 5% of primary brain tumors.[1] Pericallosal lipomas (PCLs) constitute almost half of all intracranial lipomas. PCLs are often associated with agenesis of corpus callosum, and rarely may extend into the ventricles or be associated with frontonasal dysplasia. They are usually sporadic but may sometimes be familial.[2]

Failure of resorption and maldifferentiation of the primitive meningeal tissue leads to the development of the mesenchymal tissue including mature adipose tissue, calcifications, and mature bone tissue between the 8th and the 10th weeks of intrauterine pregnancy. The region of the lamina terminalis is the most common site for intracranial lipomas because the meninx in this region is the last to be resorbed.[2]

PCL can be divided into two types. The tubulonodular type is characterized by nodular lesions and may be associated with fronto-facial abnormalities. The curvilinear type is located posteriorly, is usually of less than 1 cm size and may be associated with hypoplasia of the corpus callosum. Embryologically, the tubulonodular lipomas develop before closure of the anterior neuropore while the curvilinear lipomas have a later development. Hence, tubulonodular lipomas interfere with the brain and calvarial development.[3],[4]

The embryological basis for the development of this lesion has been proposed. The primitive mesenchyme gives rise to the meninx primitiva as well as to the fronto-facial skeleton. Thus, a disturbance of the neural crest may give rise to these combined lesions.[2],[5] These lesions are also associated with various vascular abnormalities such as distension, kinking, engulfment or narrowing of arteries and veins and the presence of arteriovenous malformations and aneurysms.

Asymptomatic patients require only observation while those with a large lipoma with severe headache require surgical debulking for reducing the mass effect. Radical excision should be avoided to preserve pericallosal arteries. Hence, any scalp swelling for which surgery is contemplated should be thoroughly investigated to rule out any intracranial extension.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
Kash F, Brown G, Smirniotopoulos JA, Boyer R, Osborn AG. Intracranial lipomas – Pathology and imaging spectrum. Int J Neuroradiol 1996;2:109-16.  Back to cited text no. 1
    
2.
Guion-Almeida ML, Richieri-Costa A, Saavedra D, Cohen MM Jr. Frontonasal dysplasia: Analysis of 21 cases and literature review. Int J Oral Maxillofac Surg 1996;25:91-7.  Back to cited text no. 2
    
3.
Demaerel P, Van de Gaer P, Wilms G, Baert AL. Interhemispheric lipoma with variable callosal dysgenesis: Relationship between embryology, morphology, and symptomatology. Eur Radiol 1996;6:904-9.  Back to cited text no. 3
    
4.
Tart RP, Quisling RG. Curvilinear and tubulonodular varieties of lipoma of the corpus callosum: An MR and CT study. J Comput Assist Tomogr 1991;15:805-10.  Back to cited text no. 4
    
5.
Reddy SR, Panigrahi M, Varma R. Intracranial lipoma with subgaleal extension: An interesting case report with review of literature. Neurol India 2012;60:444-6.  Back to cited text no. 5
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    Figures

  [Figure 1], [Figure 2], [Figure 3]

This article has been cited by
1 Corpus callosal lipoma extending as nasal encephalocoel/cranial lipomeningocoel
Abhidha Shah,Survendra Rai,Atul Goel
Journal of Clinical Neuroscience. 2017; 45: 157
[Pubmed] | [DOI]



 

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