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Supratentorial neurenteric cyst with spontaneous repetitive intracystic hemorrhage mimicking brain abscess: a case report

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Abstract

Neurenteric cyst (NC) is a benign epithelial cyst (BEC) of endodermal origin that mostly occurs in the spinal subdural space or posterior cranial fossa. A 28-year-old male presented with a left frontal lobe NC associated with spontaneous repetitive intracystic hemorrhage, which was initially diagnosed and treated as a brain abscess. He presented with headache and disorientation, without underlying diseases. A cystic tumor was suspected because of a hypointense signal on diffusion-weighted magnetic resonance imaging (MRI). One day after admission, his condition deteriorated rapidly and emergency cyst aspiration was performed. A brown viscous liquid like bloody pus comprising many neutrophils and macrophages was obtained. Although culture was negative, we initially started antibiotic treatment because of cyst content characteristics and rapid clinical course compatible with brain abscess. He was discharged without neurological deficits, but occasionally complained of intense headache. Computed tomography/MRI showed repetitive intracystic hemorrhage and gradual re-enlargement of the lesion. He underwent radical cyst excision by frontal craniotomy 34 months after aspiration. The pathological diagnosis was NC. We believe this is the first report of a supratentorial NC with spontaneous repetitive intracystic hemorrhage. BECs, especially with intracystic hemorrhage, are difficult to be distinguished from brain abscesses. In cases of cystic lesions or presumed brain abscesses refractory to treatment with aspiration and/or antibiotics, BECs should be considered, and radical cyst wall removal should be considered a treatment option.

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References

  1. Abou-Samra M, Marlin AE, Story JL, Brown WE Jr (1980) Cranial epidermoid tumor associated with subacute extradural hematoma. Case report. J Neurosurg 53(4):574–575. doi:10.3171/jns.1980.53.4.0574

    Article  CAS  PubMed  Google Scholar 

  2. Arai Y, Yamauchi Y, Tsuji T, Fukasaku S, Yokota R, Kudo T (1992) Spinal neurenteric cyst. Report of two cases and review of forty-one cases reported in Japan. Spine (Phila Pa 1976) 17(11):1421–1424

    Article  CAS  Google Scholar 

  3. Beems T, Menovsky T, Lammens M (2006) Hemorrhagic colloid cyst: case report and review of the literature. Surg Neurol 65(1):84–86. doi:10.1016/j.surneu.2005.03.034

    Article  PubMed  Google Scholar 

  4. Binning MJ, Liu JK, Gannon J, Osborn AG, Couldwell WT (2008) Hemorrhagic and nonhemorrhagic Rathke cleft cysts mimicking pituitary apoplexy. J Neurosurg 108(1):3–8. doi:10.3171/JNS/2008/108/01/0003

    Article  PubMed  Google Scholar 

  5. Chen CY, Wong JS, Hsieh SC, Chu JS, Chan WP (2006) Intracranial epidermoid cyst with hemorrhage: MR imaging findings. AJNR Am J Neuroradiol 27(2):427–429

    CAS  PubMed  Google Scholar 

  6. Cummings TJ, Chu CT, Hulette CM (1999) December 1998—16 year old female with headaches, lethargy and a sellar/suprasellar mass. Brain Pathol 9(2):425–426

    CAS  PubMed  Google Scholar 

  7. Ellison D, Love S, Chimelli L, Harding BN, Lowe J, Vinters HV (2004) Neuropathology: a reference text of CNS pathology, 2nd edn. Mosby, London

    Google Scholar 

  8. Emmerson AM, Mills F (1978) Recurrent meningitis and brain abscess caused by Eikenella corrodens. Postgrad Med J 54(631):343–345

    Article  CAS  PubMed  Google Scholar 

  9. Farooq MU, Bhatt A, Chang HT (2008) Hemorrhagic colloid cyst in a 9-year-old girl. Pediatr Neurol 38(6):443–444. doi:10.1016/j.pediatrneurol.2008.02.004

    Article  PubMed  Google Scholar 

  10. Favre J, Curty B, Steel T, Baltuch G, Genne D, Kernan J, Fankhauser H (1998) Recurrent nocardial brain abscesses treated by repeated stereotactic aspirations. J Clin Neurosci 5(1):97–100

    Article  CAS  PubMed  Google Scholar 

  11. Fox BD, Smitherman SM, Amhaz H, Ruiz MI, Rouah E, Radaideh M, Ehni BL (2009) A supratentorial, hemorrhagic, intraparenchymal epidermoid cyst. J Clin Neurosci 16(8):1101–1105. doi:10.1016/j.jocn.2008.04.033

    Article  PubMed  Google Scholar 

  12. Godano U, Ferrai R, Meleddu V, Bellinzona M (2010) Hemorrhagic colloid cyst with sudden coma. Minim Invasive Neurosurg 53(5–6):273–274. doi:10.1055/s-0030-1267232

    Article  CAS  PubMed  Google Scholar 

  13. Hadar EJ, Schmunk GA, Salamat MS (1999) Hemorrhagic colloid cyst in a patient with leukemia. Case illustration. J Neurosurg 91(3):516

    Article  CAS  PubMed  Google Scholar 

  14. Hasegawa H, Bitoh S, Nakata M, Fujiwara M, Yasuda H (1981) Intracranial epidermoid mimicking meningioma. Surg Neurol 15(5):372–374

    Article  CAS  PubMed  Google Scholar 

  15. Ho NC, Wu HY (2009) Ependymal cyst with hemorrhage in the cerebellopontine angle. J Clin Neurosci 16(1):127–129. doi:10.1016/j.jocn.2008.02.019

    Article  PubMed  Google Scholar 

  16. Inoue Y, Ohata K, Nakayama K, Haba T, Shakudo M (2001) An unusual middle fossa interdural epidermoid tumor. Case report. J Neurosurg 95(5):902–904. doi:10.3171/jns.2001.95.5.0902

    Article  CAS  PubMed  Google Scholar 

  17. Kachur E, Ang LC, Megyesi JF (2004) Intraparenchymal supratentorial neurenteric cyst. Can J Neurol Sci 31(3):412–416

    PubMed  Google Scholar 

  18. Kawamura T, Ikeda H, Nakasato N, Ogawa A, Yoshimoto T (1992) A case of intracerebral epidermoid associated with aspergillosis. No Shinkei Geka 20(4):463–467

    CAS  PubMed  Google Scholar 

  19. Keiner D, Gaab MR, Ostertag H, Sommer C, Oertel J (2009) Brain abscess formation within an endodermal cyst of the frontal lobe: case report. Minim Invasive Neurosurg 52(5–6):242–245. doi:10.1055/s-0029-1239502

    Article  CAS  PubMed  Google Scholar 

  20. Khalatbari MR, Moharamzad Y (2011) Spontaneous hemorrhage into a neurenteric cyst of the cerebellar vermis. Neuropediatrics 42(3):116–118. doi:10.1055/s-0031-1279786

    Article  CAS  PubMed  Google Scholar 

  21. Kimura H, Nagatomi A, Ochi M, Kurisu K (2006) Intracranial neurenteric cyst with recurrence and extensive craniospinal dissemination. Acta Neurochir (Wien) 148(3):347–352. doi:10.1007/s00701-005-0714-0, discussion 352

    Article  CAS  Google Scholar 

  22. Kocherry XG, Hegde T, Sastry KV, Mohanty A (2008) Efficacy of stereotactic aspiration in deep-seated and eloquent-region intracranial pyogenic abscesses. Neurosurg Focus 24(6):E13. doi:10.3171/FOC/2008/24/6/E13

    Article  PubMed  Google Scholar 

  23. Kohno K, Sakaki S, Nakano K, Yano M, Matsuoka K (1984) Brain abscess secondary to intracranial extradural epidermoid cyst. Surg Neurol 22(6):541–546

    Article  CAS  PubMed  Google Scholar 

  24. Komatsu F, Tsugu H, Komatsu M, Sakamoto S, Oshiro S, Fukushima T, Nabeshima K, Inoue T (2010) Clinicopathological characteristics in patients presenting with acute onset of symptoms caused by Rathke’s cleft cysts. Acta Neurochir (Wien) 152(10):1673–1678. doi:10.1007/s00701-010-0687-5

    Article  Google Scholar 

  25. Kurisaka M, Fukui N, Sakamoto T, Mori K, Okada T, Sogabe K (1998) A case of Rathke’s cleft cyst with apoplexy. Childs Nerv Syst 14(7):343–347

    Article  CAS  PubMed  Google Scholar 

  26. Little MW, Guilfoyle MR, Bulters DO, Scoffings DJ, O’Donovan DG, Kirkpatrick PJ (2011) Neurenteric cyst of the anterior cranial fossa: case report and literature review. Acta Neurochir (Wien) 153(7):1519–1525. doi:10.1007/s00701-011-1041-2

    Article  Google Scholar 

  27. Love S, Louis DN, Ellison DW (2008) Greenfield’s Neuropathology, vol 2, 8th edn. Oxford University Press, New York

    Google Scholar 

  28. Lunardi P, Rizzo A, Guidetti G (1988) Unusual CT-dense transtentorial epidermoid cyst. Neurochirurgia 31(6):219–221. doi:10.1055/s-2008-1053941

    CAS  PubMed  Google Scholar 

  29. Malcolm GP, Symon L, Kendall B, Pires M (1991) Intracranial neurenteric cysts. Report of two cases. J Neurosurg 75(1):115–120. doi:10.3171/jns.1991.75.1.0115

    Article  CAS  PubMed  Google Scholar 

  30. Malik GM, Horoupian DS, Boulos RS (1980) Hemorrhagic (colloid) cyst of the third ventricle and episodic neurologic deficits. Surg Neurol 13(1):73–77

    CAS  PubMed  Google Scholar 

  31. Mamelak AN, Obana WG, Flaherty JF, Rosenblum ML (1994) Nocardial brain abscess: treatment strategies and factors influencing outcome. Neurosurgery 35(4):622–631

    Article  CAS  PubMed  Google Scholar 

  32. Marshman LA, Connor S, Chandler CL (2004) Persistent absence of ring-enhancement on CT with an encapsulated brain abscess. Br J Neurosurg 18(4):377–382

    Article  CAS  PubMed  Google Scholar 

  33. Mathiesen T, Grane P, Lindgren L, Lindquist C (1997) Third ventricle colloid cysts: a consecutive 12-year series. J Neurosurg 86(1):5–12. doi:10.3171/jns.1997.86.1.0005

    Article  CAS  PubMed  Google Scholar 

  34. Mittal S, Petrecca K, Sabbagh AJ, Rayes M, Melancon D, Guiot MC, Olivier A (2010) Supratentorial neurenteric cysts—a fascinating entity of uncertain embryopathogenesis. Clin Neurol Neurosurg 112(2):89–97. doi:10.1016/j.clineuro.2009.11.001

    Article  PubMed  Google Scholar 

  35. Morishita T, Watanabe T, Ohta T, Fukushima M, Katayama Y (2009) Atypical epidermoid cyst with repetitive hemorrhages in the supracallosal region: case report. Neurol Med Chir (Tokyo) 49(10):492–494

    Article  Google Scholar 

  36. Nishioka H, Ito H, Miki T, Hashimoto T, Nojima H, Matsumura H (1999) Rathke’s cleft cyst with pituitary apoplexy: case report. Neuroradiology 41(11):832–834

    Article  CAS  PubMed  Google Scholar 

  37. Onesti ST, Wisniewski T, Post KD (1990) Pituitary hemorrhage into a Rathke’s cleft cyst. Neurosurgery 27(4):644–646

    Article  CAS  PubMed  Google Scholar 

  38. Pandey P, Umesh S, Bhat D, Srinivas D, Abraham R, Pillai S, Balasubramaniam A, Devi I, Sampath S, Chandramouli BA (2008) Cerebellar abscesses in children: excision or aspiration? J Neurosurg Pediatr 1(1):31–34. doi:10.3171/PED-08/01/031

    Article  PubMed  Google Scholar 

  39. Pawar SJ, Sharma RR, Lad SD, Dev E, Devadas RV (2002) Rathke’s cleft cyst presenting as pituitary apoplexy. J Clin Neurosci 9(1):76–79. doi:10.1054/jocn.2001.0974

    Article  PubMed  Google Scholar 

  40. Ranjan R, Handa A, Choudhary A, Kumar S (2009) Acanthamoeba infection in an interhemispheric ependymal cyst: a case report. Surg Neurol 72(2):185–189. doi:10.1016/j.surneu.2008.04.008

    Article  PubMed  Google Scholar 

  41. Reddy JS, Mishra AM, Behari S, Husain M, Gupta V, Rastogi M, Gupta RK (2006) The role of diffusion-weighted imaging in the differential diagnosis of intracranial cystic mass lesions: a report of 147 lesions. Surg Neurol 66(3):246–250. doi:10.1016/j.surneu.2006.03.032, discussion 250–241

    Article  PubMed  Google Scholar 

  42. Reddy RS, Vijayasaradhi M, Uppin MS, Challa S (2010) A rare case of extradural neurenteric cyst with supratentorial and infratentorial extension. Acta Neurochir (Wien) 152(11):1957–1959. doi:10.1007/s00701-010-0791-6

    Article  Google Scholar 

  43. Rosales MY, Smith TW, Safran M (2004) Hemorrhagic Rathke’s cleft cyst presenting as diplopia. Endocr pract: Off J Am Coll Endocrinol Am Assoc Clin Endocrinol 10(2):129–134

    Article  Google Scholar 

  44. Scarone P, Boissonnet H, Heran F, Gray F, Robert G (2009) Neurenteric cyst of the posterior fossa. Case report and review of the literature. Neurochirurgie 55(1):45–52. doi:10.1016/j.neuchi.2008.03.006

    Article  CAS  PubMed  Google Scholar 

  45. Shenoy SN, Raja A (2004) Spinal neurenteric cyst. Report of four cases and review of the literature. Pediatr Neurosurg 40(6):284–292. doi:10.1159/000083741

    Article  CAS  PubMed  Google Scholar 

  46. Shuangshoti S (2000) Hemorrhagic colloid cyst. J Neurosurg 93(2):369–370

    CAS  PubMed  Google Scholar 

  47. Takeshita M, Kagawa M, Yato S, Izawa M, Onda H, Takakura K, Momma K (1997) Current treatment of brain abscess in patients with congenital cyanotic heart disease. Neurosurgery 41(6):1270–1278, discussion 1278–1279

    Article  CAS  PubMed  Google Scholar 

  48. Takumi I, Mori O, Mizutani N, Akimoto M, Kobayashi S, Teramoto A (2008) Expansile neurenteric cyst arising in the frontal lobe associated with status epilepticus: report of a case and discussion of epileptogenesis. Brain Tumor Pathol 25(2):97–101. doi:10.1007/s10014-008-0238-4

    Article  PubMed  Google Scholar 

  49. Tokumitsu N, Sako K, Kunimoto M, Nakai H, Yonemasu Y (1997) Glial cyst in the thalamus with intracystic hemorrhage—case report. Neurol Med Chir (Tokyo) 37(3):284–287

    Article  CAS  Google Scholar 

  50. Torbiak CW, Mazagri R, Tchang SP, Clein LJ (1995) Parasellar epidermoid cyst presenting with subarachnoid hemorrhage. Can Assoc Radiol J 46(5):392–394

    CAS  PubMed  Google Scholar 

  51. Tsurushima H, Kamezaki T, Tomono Y, Nose T (1997) Intracranial epidermoid cyst including elements of old hematoma. Neurol Med Chir (Tokyo) 37(11):861–864

    Article  CAS  Google Scholar 

  52. Tucker A, Miyake H, Tsuji M, Ukita T, Ito S, Matsuda N, Ohmura T (2010) Neurenteric cyst of the lower clivus. Neurosurgery 66(1):E224–E225. doi:10.1227/01.NEU.0000361998.93841.C3

    Article  PubMed  Google Scholar 

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Conflict of interest

The authors have no personal, financial, or institutional interest in any of the drugs, materials, or devices described in this article.

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Authors and Affiliations

  1. Department of Neurosurgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan

    Yohei Kitamura, Hikaru Sasaki, Satoka Shidoh & Kazunari Yoshida

  2. Department of Pathology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan

    Akinori Hashiguchi

  3. Department of Diagnostic Radiology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan

    Suketaka Momoshima

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  1. Yohei Kitamura
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  2. Hikaru Sasaki
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  3. Akinori Hashiguchi
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  5. Satoka Shidoh
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Correspondence to Yohei Kitamura.

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Comments

William T. Couldwell, Salt Lake City, USA

Kitamura and colleagues report a very unusual case of a neurenteric cyst of the frontal lobe in a young man that presented with recurrent hemorrhage. The lesion was initially aspirated and treated as presumptive abscess. Ultimately, the lesion was resected and pathological analysis revealed a benign epithelial cyst with hemorrhage.

In retrospect, the only keys that this lesion was not infectious in etiology were the diffusion-weighted MR imaging pattern and the very long protracted period of evolution, some 34 months, prior to definitive surgical management. Another very interesting question to be answered is what the pathological basis of hemorrhage is from a benign epithelial cyst, whether in the supratentorial space, posterior fossa, or sella turcica. I thank the authors for bringing this very rare case to our attention.

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Kitamura, Y., Sasaki, H., Hashiguchi, A. et al. Supratentorial neurenteric cyst with spontaneous repetitive intracystic hemorrhage mimicking brain abscess: a case report. Neurosurg Rev 37, 153–159 (2014). https://doi.org/10.1007/s10143-013-0476-8

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