Main Article Content
Tumors of the skull usually affect adult patients and less than twenty percent of pediatric patients. As the tumors grow, the surrounding bone may undergo destruction and erosion. When the tumors are located in the fontanel, the timely closure of the fontanel may be inhibited. Epidermoid cysts are benign tumors that are intracranially located and very rarely in the midline of the cranium. Meanwhile about 32% of stratified-squamous epithelial epidermoid cysts affect the head and neck region and only 6.7% occur in the scalp. We report an unusual epidermoid cyst located and growing in the anterior fontanel of a pediatric patient and inhibiting fontanel closure.
A 21-month-old boy and his parents visited our polyclinic because there was a lump on his anterior fontanel since four months before they came to the hospital. The lump was initially the size of a peanut and had grown to become as large as a quail’s egg. The physical examination was normal and the brain CT-scan showed bone destruction without any intracranial lesion. The tumor was excised on the preoperative diagnosis of dermoid cyst. Histopathology examination showed the characteristics of an epidermoid cyst. The cyst had a wall and was full of keratin flakes without hair follicles or sebaceous glands. Follow-up one year after complete excision did not reveal any recurrence.
Epidermoid cysts in the skull of pediatric patients must be completely excised as soon as possible because their growth can damage the bone and inhibit the closure of the sutures.
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.The journal allow the authors to hold the copyright without restrictions and allow the authors to retain publishing rights without restrictions.
Liu H, Zhang X, Zhang M, et al. Skull bone tumor: a review of clinicopathological and neuroimaging characteristics of 426 cases at a single center. Cancer Commun 2019;39:8. doi:10.1186/s40880-019-0353-0.
Hoang VT, Trinh CT, Nguyen CH, Chansomphow V, Chansomphow V, Tran TTT. Overview of epidermoid cyst. Eur J Radiol Open 2019;6:291-301. doi: 10.1016/j.ejro.2019.08.003.
Enchev Y, Kamenov B, William A, Karakostov V. Posttraumatic giant extradural intradiploic epidermoid cysts of posterior cranial fossa: case report and review of the literature. J Korean Neurosurg Soc 2011;49:53-7. doi: 10.3340/jkns.2011.49.1.53.
Nigam JS, Bharti JN, Nair V, et al. Epidermal cysts: a clinicopathological analysis with emphasis on unusual findings. Int J Trichol 2017;9:108-12. DOI: 10.4103/ijt.ijt_16_17.
Oommen A, Govindan J, Peroor DS, Azeez CR, Rashmi R, Jalal MJA. Giant occipital intradiploic epidermoid cyst. Asian J Neurosurg 2018;13:514-17. doi:10.4103/1793-5482.181146.
Kalfas F, Ramanathan D, Mai J, Schwartz S, Sekhar LN. Petrous bone epidermoid cyst caused by penetrating injury to the external ear: case report and review of literature. Asian J Neurosurg 2012;7: 93-7. doi: 10.4103/1793-5482.98656.
Lim J, Cho K. Epidermoid cyst with unusual magnetic resonance characteristics and spinal extension. World J Surg Oncol 2015; 13:240. DOI 10.1186/s12957-015-0651-1.
Lakhsmi V, Thirumurthy KS, Rabia S, Chaitra V. Intradiploic epidermoid cyst-a pearl within the skull. J Diagn Pathol 2015;9:38-42. doi.org: 10.4038/jdp.v9i2.7660.
Law EKC, Lee RKL, Ng AWH, Siu DYW, Ng HK. Atypical intracranial epidermoid epidermoid cysts: rare anomalies with unique radiological features. Case Rep Radiol 2015;2015:528632. doi.org:10.1155/528632.
Reissis D, Pfaff MJ, Patel A, Steinbacher DM. Craniofacial dermoid cysts: histological analysis and inter-site comparison. Yale J Biol Med 2014;87:349-57. PMID:25191150.
Gaivas S, Rotariu D, Dumitrescu G, Iliescu B. Intradiploic cyst of the skul : case report. Romanian Neurosurg 2011;XVIII:1-5.
Bharti P, Gupta U, Bharti SK. Rare case of anterior fontanelle epidermoid/dermoid. J Pediatr Neurosci 2015;10:247-9. doi:10.4103/1817-1745.165679.
Arko L, Berry CT, Desai AS, Weaver M. Intradiploic epidermoid tumors of the cranium: case report with review of the literature. J Neurol Surg A Cent Eur Neurosurg 2017;78:167-79. doi: 10.1055/s-0036-1585544.
Choudhary G, Udayasankar U, Saade C, Winegar B, Maroun G, Chokr J. A systematic approach in the diagnosis of paediatric skulls lesions: what radiologists need to know. Pol J Radiol 2019;84;e92-111. doi: 10.5114/pjr.2019.83101.
Sakamoto A, Okamoto T, Matsuda S. Characteristic MRI findings of epidermal cysts categorized by size. Open Orthop J 2018;12:462-8. DOI: 10.2174/1874325001812010462.
Di Giustino F, Pecci R, Giannoni B, Vannucchi P. Cerebellopontine angle epidermoid cyst: case report. Int J Otorhinolaryngol Head Neck Surg 2013;2:5-7. doi: 10.4236/ijohns/2013.21002.
Agarwal S, Rishi A, Suri V, et al. Primary intracranial squamous cell carcinoma arising in an epidermoid cyst-a case report and review of the literature. Clin Neurol Neurosurg 2007;109:888-91. doi.org: 10.1016/j.clineuro.2007.07.026.
Mascarenhas A, Parsons A, Smith C, Molloy C, Jukes A. Malignant squamous cell carcinoma arising in a previously resected cerebellopontine angle epidermoid. Surg Neurol Int 2017;8:186. doi: 10.4103/1817-1745.165679.
Ding S, Jin Y, Jiang J. Malignant transformation of an epidermoid cyst in the temporal and parapontine region: report of a case and differential diagnosis. Oncol Lett 2016;11:3097-100. doi: 10.3892/ol.2016.4368.