1/3. MRI of testicular epidermoid cyst.This report presents and discusses the magnetic resonance imaging (MRI) and pathological findings of a case of testicular epidermoid cyst. A 35-year old man consulted a physician after he felt an enlargement of the right testis. Physical examination revealed a painless, non-tender, elastic hard mass in the right testis. A radiological examination was performed. MRI demonstrated an enlarged right testis, with a mass in it. The mass showed slightly low signal intensity on T1-weighted imaging, and high signal intensity on T2-weighted imaging. Both the T1- and T2-weighted images revealed a peripheral low signal intensity rim. The mass showed no enhancement. A right orchiectomy was carried out for epidermoid cyst. Pathologic examination showed a well-encapsulated nodule within the right testicular parenchyma, filled with a cheesy, yellow-white material similar in appearance to atheroma. The bull's-eye appearance is considered to depend on the presence of calcification. From the viewpoint of pathology, testicular epidermoid cysts do not always show bull's-eye. We then must recognize that some testicular tumors may be epidermoid cysts even without the bull's-eye findings.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
2/3. Malignant transformation of posterior fossa epidermoid cyst.The authors report the case of a 45-year-old man who presented with a short duration of a painful ophthalmoparesis. Initial magnetic resonance imaging revealed an extraaxial petroclival mass characteristic of an epidermoid cyst, with the exception of a contiguous contrast-enhancing lobule. A subtotal resection was performed with the histopathological diagnosis revealing malignant transformation of an epidermoid cyst. Despite aggressive postoperative adjuvant therapy, the patient developed leptomeningeal metastasis and died shortly thereafter. The presence of contrast enhancement at the site of an epidermoid cyst combined with an acute, progressive neurological deficit should alert the treating physician to the possibility of a malignant transformation. When transformation does occur, the clinical and radiological course is quite aggressive as compared with the indolent growth of epidermoid cysts. Treatment options include surgery with adjuvant chemotherapy or radiotherapy. We review the pertinent features of this case along with the relevant literature regarding primary intracranial squamous cell carcinomas.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
3/3. Fingernail deformities secondary to ganglions of the distal interphalangeal joint (mucous cysts).Twenty-six nail deformities secondary to ganglions of the distal interphalangeal joint were retrospectively reviewed to assess the important aspects of their management. The patients' ages ranged from 41 to 79 years. The long and index fingers were most commonly involved. A depression or groove was present in 23 of 26 digits reviewed. Two had gross disruption of the nail. Fifty-eight percent of the cysts had spontaneously drained or had been drained by the patient or a physician preoperatively. Degenerative arthritic changes were seen in 87 percent of those with x-rays or a radiology report available. Most underwent surgical removal of the cyst and debridement of associated osteophytes of the distal interphalangeal joint. The cyst was located above the germinal matrix in all but two digits. Osteophytes were found in all 20 digits in which the joint was explored. No recurrences were seen in those available for postoperative follow-up (22 of 25). Normal nail growth was found in 14 of 22, although follow-up was short in one. All eight postoperative nail deformities were quite mild and of little concern to the patient. There was no correlation between preoperative cyst drainage and aesthetic postoperative nail growth. Nail removal at the time of surgery appeared to be unnecessary unless the nail was grossly disrupted.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |