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Year : 2003  |  Volume : 13  |  Issue : 2  |  Page : 209-211
Teratodermoid in parasellar region - a rare entity imaging finding


G.B. Pant Super Specialty Hospital and MAM College, New Delhi-2, India

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   Abstract 

A 16- year- old male patient with history of seizures and headache, was found to have a well circumscribed heterogenous mass lesion with evidence of calcification, fat and hair, Mass showed peripheral enhancement on CECT. MR also revealed it to be a heterogeneous mass, enhancing on Gadolinium peripherally as well as centrally. Diffusion, ADC and perfusion images showed it to be a predominantly non-vascular mass lesion. The mass was completely excised and on histopathology proved it to be Teratodermoid. The patient improved on follow up.

Keywords: Teratodermoid; Brain, CT; MR; functional MR

How to cite this article:
Sharma A, Singh S, Anandmoyee, Makwane U K, Sharma N. Teratodermoid in parasellar region - a rare entity imaging finding. Indian J Radiol Imaging 2003;13:209-11

How to cite this URL:
Sharma A, Singh S, Anandmoyee, Makwane U K, Sharma N. Teratodermoid in parasellar region - a rare entity imaging finding. Indian J Radiol Imaging [serial online] 2003 [cited 2019 Jul 24];13:209-11. Available from: http://www.ijri.org/text.asp?2003/13/2/209/28663

   Introduction Top


Dermoid tumors are non-neoplastic developmental masses originating from ectoderm rests. They are slow growing and present in third and fifth decade. The reported incidence is between 0.2 to 1.8% of all intracranial tumors. There is insidious onset of symptoms with mean duration of 8.2 years [1],[2]. Patient presents with seizures or headache. Dermoids may cause symptoms secondary to local mass effect, rupture or infection. In ruptured dermoid diffuse subarchanoid and intraventrclular deposits are found, resulting chemical meningitis


   Case Report Top


A 16-Year- old male patient presented with a history of seizures and headache for last 1 year. Other clinical features were unremarkable. Patient underwent plain and CECT. On plain CT, there was well- circumscribed lesion with calcification, fat and hair with a layering effect in right parasellar region. On CECT, evidence of rim enhancement was seen with minimal enhancement in the central part of lesion. Retrospectively plain x-ray skull showed an evidence of calcification also [Figure - 1][Figure - 2][Figure - 3][Figure - 4]. MR showed a well circumscribed heterogeneous lesion on coronal flair images [Figure - 5] and a hyperintense lesion on T2 weighted images [Figure - 6] . On GD-enhanced images, rim enhancement as well as focal central enhancement was noted. [Figure - 7]. On diffusion images, the lesion was hyper intense with linear hyprintensities and hypointense outer rim. On ADC, the rim became hyperintense and lesion became ISO-to hyperintense with well-defined hypointense streaking [Figure - 8][Figure - 9]. On perfusion images, small hyperintesity was seen in the off terato-dermoid was put forward which was confirmed at surgery and histopathology.


   Discussion Top


Dermoids are generally situated in the midline and most often involves the basal surface of the brain [1]. They are circumscribed and a dermal sinus tract is often present in the adjacent soft tissues.

CT showed a markedly decreased attenuation due to the fatty nature of the tumor. Calcification is generally seen in the lesion. An osseous defect can also been seen at the sinus tract [2]. In our case, there was a well-circumscribed mass lesion with an evidence of calcification, fat and hair. In addition to this there was a linear effect and rim enhancement of the lesion on CECT. No evidence of osseous defect could be demonstrated but there was thinning of the adjacent temporal due to mass effect of the tumor. It has also been reported that when a dermoid is discovered, dedicated attention should be paid to the CSF spaces, because small fatty droplets may be easily overlooked. Fat droplets may be seen floating within the frontal horns on axial or sagital images in supine patients. These findings indicate rupture of the dermord into the ventricular of subarchanoid space [3]. However, in the present case we were not able to demonstrate such findings.

On MR these lesions exhibit heterogenous signal, but most dermoids exhibit some component of high signal on T1 weighted images representing fat component. Fat suppression images may be useful, although not all dermoids will suppress [3]. Similar findings were observed in the present cases. We have also described findings on diffusion, ADC and perfusion, which couldn't be traced in literature and are not described to best of knowledge. The primary differential diagnosis is teratoma/lipoma. If contrast enhancement is noted centrally, teratoma is more likely, however rim enhancement has been observed in the setting of superimposed infection [4],[5]. In our case, there was evidence of peripheral rim enhancement as well as central enhancemeant to Gd-enhanced images. This was the finding which supported the diagnosis of Terato dermoid which was confirmed at surgery and histopathology.

 
   References Top

1.Johnston F, HAC, Dermoid, epidermoid and neuroenteric Cysts. In: Kayo A, Laws EJ, eds. Brain Tumors. New fort: Churchill Livingston, 1995:895-905.  Back to cited text no. 1    
2.Wilm G, Casselman J, Demaerel P, etal. CT and MRI of ruptured intracranial dermoids. Neuroradiology 1991;33:149-151.  Back to cited text no. 2    
3.Smith A, Benson J, Blasser S, etal. Diagnosis of ruptured dermoid Cyst: Value of MR over CT. AJNR Am. J Neuroradiol 1991; 12:175-180.  Back to cited text no. 3    
4.Simonetta A. Imaging of suprasellar and parasellar tumours. Neuro Imag clin North Am 1999;9:717-732.  Back to cited text no. 4    
5.Li F, Kelly W, Newton D, etal. Short T1/T2 epidermoids? lipid or water signal. Am sco Neuroradiol 1990;63.  Back to cited text no. 5    

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Correspondence Address:
A Sharma
C-10 Kendriya Vihar, Sector 51, Noida 201 307
India
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Source of Support: None, Conflict of Interest: None


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    Figures

[Figure - 1], [Figure - 2], [Figure - 3], [Figure - 4], [Figure - 5], [Figure - 6], [Figure - 7], [Figure - 8], [Figure - 9], [Figure - 10]

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    Abstract
    Introduction
    Case Report
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    References
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