N EZZAAIRI M MAATOUK MA JELLALI WMNARI A ZRIG W HARZALLAH RSALEM M GOLLI Service dimagerie médicale CHU Fattouma Bourguiba Monastir TUNISIE NR 32 Colloid cysts CC are relatively rare intracranial benign congenital tumors ID: 566036
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COLLOID CYST OF THE THIRD VENTRICLE: REPORT OF TWO CASES
N. EZZAAIRI, M. MAATOUK, M.A. JELLALI, W.MNARI, A. ZRIG, W. HARZALLAH, R.SALEM, M. GOLLIService d’imagerie médicale, CHU Fattouma Bourguiba Monastir –TUNISIE
NR 32Slide2
Colloid cysts (CC) are relatively rare intracranial benign congenital tumors
accounting for 0.5%–1% of primary brain tumors and 15%–20% of intraventricular masses.Colloid cysts are slowly growing non-neoplastic cysts that are predominantly arising in the anterior region of the 3rd ventricle
(more than 99%).
They are classically presenting during the 3rd to 4th decades.
IntroductionSlide3
Typically, patients are asymptomatic, although colloid cysts may cause symptoms by obstructing the foramen of
Monro. Both magnetic resonance imaging (MRI) and computed tomography (CT) can be used for the diagnosis. IntroductionSlide4
In this report, we present 2 cases of CC of the 3rd ventricle, along with the findings of radiological imaging
.Case reportSlide5
A 57-year-old man,
admitted following head injury.A unenhanced CT scan (NECT) did not demonstrate any intracranial hemorrhage but there hyperdense foramen of Monro mass.Patient oneSlide6
MRI confirmed the presence of a small colloid cyst at the foramen of
Monro
which was homogeneously
hyperintense to brain on T1 WI (B). T2WI (C) shows a mixed signal mass with a focus of profound hypointensity. FLAIR sequence (D) shows the cyst does not suppress. There was no restriction in DWI (E)
A
B
C
D
ESlide7
A 48-year-old man presented to the emergency department, with a 2 day history of frontal headache and nausea associated with an episode of vomiting.
He was neurologically intact, with no signs of meningism.Patient 2Slide8
NECT shows a small, Well-demarcated round,
hyperdense foramen of Monro mass with obstructive hydrocephalus.There was no enhancement after injection.Slide9
MRI imaging shows a colloid cyst at the foramen of
Monro (A). The cyst is hyperintense on T1 WI (B) and is causing moderate hydrocephalus with transependymal CSF flow (C). T1WI with gadolinium revealed no enhancement (D).
A
B
C
DSlide10
Colloid cyst or
paraphyseal cyst is the most common tumours in the 3rd ventricle.It’s wedged into foramen of Monro in over 99% of cases.Rare reports describe other locations including the
leptomeninges
, cerebellum, lateral and 4th ventricles. CC, like neurenteric and Rathke cysts, is derived from embryonic endoderm.
DiscussionSlide11
Age : 3
rd to 4th decadeRare in children40-50% asymptomatic, discovered incidentallyThe most common sign is a headache (50-60%)Acute foramen of
Monro
obstruction may lead to rapid onset hydrocephalus, herniation and deathDiscussionSlide12
Prognosis is variable:
90% of CC are stable 10% can expand rapidly, causing coma and death.Criteria of poor prognosis are: Younger patients
Larger cyst, hydrocephalus
Iso/hypodense on NECT, often hyperintense on T2WIDiscussionSlide13
CC is a smooth, spherical, well-delineated cysts.
The content is composed of a viscous gelatinous material (colloid) with variable viscosity. Histologically, CC is characterized by a simple or
pseudostratified
epithelial lining with interspersed goblet cells and scattered ciliated cells.The cyst contents is PAS positive and composed of.It may contain necrotic leucocytes and cholesterol clefts.
Pathologic findingsSlide14
Either
CT or MRI may help in diagnosing a CC, although MRI has a few advantages. The multiplanar capabilities of MRI optimally demonstrate the classical location of the cyst, and typical signal intensities in the cyst help helpful in the early and correct diagnosis of this entity.
Imaging Slide15
On NECT, approximately 2/3 of CC are slightly
hyperdense. It may occasionally be hypodense or isodense.The density is correlated inversely with
hydratation
state.Calcification or hemorrhage are rare.After administration of iodinated contrast material, no enhancement of the mass lesion or a thin rim of enhancement may be present.Imaging : CTSlide16
On T1WI, the signal of CC is correlates with cholesterol concentration:
2/3 are hyperintense1/3 are isointenseOn T2 WI, the signal is more variable:
the majority are
isointense to brain.¼ are mixed “black hole” effectOn FLAIR sequence; the signal cyst is not suppressedThere are not restriction on DWIImaging : MRISlide17
The imaging appearance of a colloid cyst is almost pathognomonic.
The most common “lesion” mistaken for a colloid cyst is CSF flow artifact (MR pseudocyst) caused by pulsatile turbulent CSF flow around the foramen of Monro. Multiplanar
technique confirms artifact.Differential diagnosisSlide18
Occasionally, a
neurocysticus cyst may occur at the foramen of Monro. However, multiple lesions within parenchyma and cisterns are usually shown in n
eurocysticercosis
. Neoplasms such as subependymoma or choroid plexus papilloma that may occur at the foramen of Monro are much less common and typically enhanced.
Differential diagnosisSlide19
Prophylactic surgery for asymptomatic CC of the 3
rd ventricle remains controversial. However, the possibility of spontaneous rupture of these cysts should also be kept in mind.The most common treatment consist on complete surgical resection.Recurrence is rare, if resection is complete
Treatement