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| LETTER TO EDITOR |
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| Year : 2019 | Volume
: 67
| Issue : 6 | Page : 1551-1552 |
Do All Displaced Midline Ectodermal Cells Assimilate into Epidermoid Cysts?
Sumedha Anjankar1, SD Anjankar2
1 Department of Anatomy, JNMC, Sawangi (M), Wardha, Maharashtra, India
2 Department of Neurosurgery, JNMC, Sawangi (M), Wardha, Maharashtra, India
| Date of Web Publication | 20-Dec-2019 |
Correspondence Address:
Dr. S D Anjankar
Plot No 50, Ganesh Nagar, S.D. Hospital, Nagpur, Maharashtra
India
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/0028-3886.273624
How to cite this article:
Anjankar S, Anjankar S D. Do All Displaced Midline Ectodermal Cells Assimilate into Epidermoid Cysts?. Neurol India 2019;67:1551-2 |
Sir,
A 51-year-old male presented with generalized tonic-clonic seizures, vomiting, and unconsciousness. On clinical examination, he was drowsy, his Glasgow Coma Scale score was 9/15 (E2V2M5), his pupils bilaterally responsive and his vital stable. A CT scan showed a large calcified lesion of 8.1 × 7.7 × 7.2 cm size in the right parietal region suggestive of calcified meningioma or hydatid cyst. [Figure 1] The patient underwent a right parietal craniotomy and excision of lesion. Intraoperatively, the lesion was closely adherent to the dura, avascular, greyish white with firm, capsulated, with putty-like material inside. Complete excision of the lesion was carried out. The patient recovered well from anesthesia and was extubated. Postoperatively, the patient was oriented and was following commands but aspirated on the 3rd day post-operation. The patient was re-intubated but later expired on the 10th day post-operation due to sepsis. Histopathology of the lesion was suggestive of an epidermoid cyst [Figure 2]. | Figure 1: NCCT brain showing hyper dense lesion at right parietal region
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 | Figure 2: Microscopic picture showing fibrous wall lined by keratinizing shamus epithelium, features suggestive of epidermoid
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Intracranial epidermoid cysts comprise of 0.2% to 1% of all intracranial neoplasms.[1] They arise from displaced midline ectodermal cells between third to fifth weeks of gestation, during closure of the neural tube. These tumors have an affinity for basal subarachnoid cisterns and they enlarge slowly through accumulation of normally dividing cells with growth rate resembling the growth of human epidermis.[2] Epidermoid cysts are usually hypodense on CT, sometimes they can be hyperdense as in the present case and are referred as “white epidermoid”.[3] Supratentorial epidermoid cysts tend to grow larger in size, and the present case is the largest epidermoid reported so far in the literature.[4] Intracranial lesions result from abnormal development during embryogenesis.
These lesions are divided into three main categories: Neoplasms, choristomas (lesions formed from mal-developed tissue that is normally absent at the site of the lesion), and hamartomas (lesions that result from mal-development of tissue that is normally present at the site of the lesion but that develops and grows at virtually the same rate as the surrounding normal tissue).[5] Epidermoid cysts are the choristomas, a result of embryological flaw, but present late in the third to fourth decade of life. There is a possibility of embryological defect in many embryos but not all develop an epidermoid cysts, possibly because these cells get removed by macrophages or scavenger-like cells.
Further research is required to confirm this hypothesis and know the causes of these choristomas. Furthermore, genetic studies are required as well as exploration of the scavenger cells which may remove such displaced ectodermal cells in intrauterine life.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
| » References | |  |
| 1. | Hasegawa H, Bitoh S, Nakata M, Fujiwara M, Yasuda H. Intracranial epidermoid mimicking meningioma. Surg Neurol 1981;15:372-4.  |
| 2. | Tekkök IH, Cataltepe O, Saĝlam S. Dense epidermoid cyst of the cerebellopontine angle. Neuroradiology 1991;33:255-7. |
| 3. | Ramdasi R, Mahore A, Chagla A, Kawale J. White epidermoid at the foramen magnum. Neurol India 2014;62:577-9. [ PUBMED] [Full text] |
| 4. | Puranik A, Sankhe S, Goel N, Mahore A. Cerebral shading sign in a giant intraparenchymal white epidermoid. Neurol India 2012;60:265-6. [Full text] |
| 5. | Golnik Karl C. Tumors of maldevelopmental origin and related lesions. In: Neil R. Miller, editor. Walsh and Hoyt's Clinical Neuro-Ophthalmology. 6 th ed. Philadelphia: Lippincott Williams and Wilkins; 2005. p. 1547. |
[Figure 1], [Figure 2]
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