Abstract
A 64-year-old male presented with spontaneous intracerebral hemorrhage and obstructive hydrocephalus without evidence of a third ventricular mass in 2019. The patient was lost to follow-up and re-admitted one year later for hydrocephalus secondary to a third ventricular mass. Imaging characteristics were consistent with a colloid cyst, which was the presumptive diagnosis. A transcallosal transchoroidal approach was utilized for cyst resection. The cyst wall was carefully incised, releasing flakey, partially solid contents which were grossly inconsistent with a colloid cyst. Due to the concern of iatrogenic cyst rupture in the setting of unknown diagnosis, the patient was placed on steroids post-operatively. Surgical specimens sent at the time of surgery were consistent with dermoid cyst. We present the first reported case of a third ventricular dermoid cyst in an adult initially misdiagnosed as a colloid cyst based on imaging characteristics.
Highlights
Dermoid cysts are benign lesions that represent around 0.04-0.7% of intracranial tumors [1,2]
When found within the ventricular system, dermoid cysts are typically located in the fourth ventricle [4,5]
Colloid cysts often top the differential diagnoses for round third ventricular tumors
Summary
Dermoid cysts are benign lesions that represent around 0.04-0.7% of intracranial tumors [1,2]. There was no mention in the radiology report of an underlying third ventricular lesion; upon review of the imaging, there appears to be evidence of a spherical mass at the foramen of Monro (Figure 1c). The patient was readmitted in November 2020 after experiencing altered mental status for several days He was found to be in diabetic ketoacidosis (DKA) and a CTH demonstrated obstructive hydrocephalus secondary to a round, hyperdense third ventricular mass (Figure 1d). The lesion’s features were consistent with those of a dermoid cyst It contained keratin debris, stratified squamous lining, acute inflammatory cells, and a focal area with a granular layer (Figure 3). Immediate post-operative course was unremarkable and he was discharged to a nursing home
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