Morishita Takashi, Watanabe Takao, Ohta Takashi, Fukushima Masamichi, Katayama Yoichi
Division of Neurosurgery, Department of Neurological Surgery, Nihon University School of Medicine, Tokyo, Japan.
Neurol Med Chir (Tokyo). 2009 Oct;49(10):492-4. doi: 10.2176/nmc.49.492.
A 63-year-old man presented with an unusual supracallosal epidermoid cyst with repetitive hemorrhages that initially manifested as severe headache in 2003. Physical examination found no neurological deficit. Computed tomography demonstrated a homogeneously high density mass lesion measuring 3 x 3 cm in the supracallosal area, and the clinical diagnosis was cavernous malformation. No change occurred in neurological findings except for headache, but the lesion underwent hemorrhages several times over a 4-year period and increased in size to 4 x 5 cm. Surgery revealed a pearly cyst filled with old blood and debris. Histological examination disclosed keratinizing, stratified squamous epithelium without hair follicles or sebaceous glands, consistent with the diagnosis of epidermoid cyst. Surgery was successfully performed without complications such as akinetic mutism, motor weakness, or chemical meningitis. The present case suggests that epidermoid cyst should be considered in the differential diagnosis of suspected cavernous malformation in any location.
一名63岁男性患者，患有罕见的胼胝体上表皮样囊肿并反复出血，最初于2003年表现为严重头痛。体格检查未发现神经功能缺损。计算机断层扫描显示胼胝体上区域有一个大小为3×3 cm的均匀高密度肿块病变，临床诊断为海绵状畸形。除头痛外，神经学检查结果无变化，但该病变在4年期间多次出血，大小增至4×5 cm。手术发现一个充满陈旧血液和碎屑的珍珠样囊肿。组织学检查显示为角化的复层鳞状上皮，无毛囊或皮脂腺，符合表皮样囊肿的诊断。手术成功进行，未出现诸如运动不能性缄默症、肌无力或化学性脑膜炎等并发症。本病例提示，在任何部位疑似海绵状畸形的鉴别诊断中都应考虑表皮样囊肿。
