Soldatelli Matheus D, de Oliveira Francine Hehn, de Medeiros Klaes Amália Izaura Nair, da Silva Rafael Sodré, Martins Antunes Ápio Cláudio, Bianchin Marino Muxfeldt, Duarte Juliana Ávila
Departments of Radiology, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil.
Departments of Neuroradiology, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil.
Surg Neurol Int. 2019 Aug 30;10:169. doi: 10.25259/SNI_179_2019. eCollection 2019.
Despite colloid cyst in the third ventricle is a very usual cause of hydrocephalus, its xanthogranulomatous variant is rare. The most important differential diagnosis is the third ventricular craniopharyngioma. To the best of the authors' knowledge, there have been few cases of xanthogranulomatous variant colloid cysts reported in the English literature.
A 77-year-old white woman presented with headaches, memory loss, and abnormal gait for the past 4 months. Magnetic resonance imaging revealed a solid cystic lesion measuring 3.0 cm×2.8 cm×2.9 cm located inside the anterior portion of the third ventricle causing obstructive hydrocephalus. The posterior portion of the lesion was predominantly solid and hypointense on T2 and T1, with areas of post- contrast enhancement, and the anterior portion was predominantly cystic with both hyper- and hypointense areas on T1 and T2, with no suppression on fluid-attenuated inversion recovery and no restriction to diffusion. The patient underwent a left frontal craniotomy with pterional approach, and the lesion was removed microsurgically.
Xanthogranulomatous reaction is rarely described in colloid cysts, which happens as a response to desquamation of epithelial lining, subsequent lipid accumulation, and as tissue inflammatory response to intracystic hemorrhage. Microsurgical resection is the treatment of choice. As compared to the plain colloid cyst, these lesions are difficult to fully excise as the inflammatory reaction to the xanthomatous material leads to adhesions to adjacent structures; therefore, the aspiration of cystic contents without spillage is advisable to achieve maximal resection of cyst walls.
尽管第三脑室胶样囊肿是脑积水的常见病因，但其黄色肉芽肿性变体却很罕见。最重要的鉴别诊断是第三脑室颅咽管瘤。据作者所知，英文文献中报道的黄色肉芽肿性变体胶样囊肿病例很少。
一名77岁白人女性在过去4个月中出现头痛、记忆力减退和步态异常。磁共振成像显示一个大小为3.0 cm×2.8 cm×2.9 cm的实性囊性病变，位于第三脑室前部，导致梗阻性脑积水。病变后部主要为实性，在T2和T1加权像上呈低信号，有强化区域；前部主要为囊性，在T1和T2加权像上有高信号和低信号区域，在液体衰减反转恢复序列上无抑制，在扩散加权成像上无受限。患者接受了经翼点入路的左额开颅手术，并通过显微手术切除了病变。
胶样囊肿中很少描述黄色肉芽肿反应，它是对上皮衬里脱屑、随后脂质积聚以及对囊内出血的组织炎症反应。显微手术切除是首选治疗方法。与普通胶样囊肿相比，这些病变难以完全切除，因为对黄色瘤物质的炎症反应会导致与相邻结构粘连；因此，在不溢出的情况下抽吸囊内容物以最大程度切除囊壁是可取的。
