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      Role of intraoperative squash smear cytology as a diagnostic modality in lipoma of quadrigeminal cistern

      case-report

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          Abstract

          Quadrigeminal lipoma is a rare tumor that has been categorized as developmental malformation rather than a hamartoma or true neoplasm, due to its origin from abnormal persistence and mal-differentiation of meninx primitiva during the development of the subarachnoid cisterns. Reported admixture of adipose tissue with heterotopic elements also supports a developmental origin. Quadrigeminal lipomas are frequently asymptomatic and detected incidentally. Though a favorable clinical course is usually expected, recurrences may occur due to partial removal of lesions in close relation to vital structure. We describe the role of intraoperative squash smear cytology as a diagnostic aid in quadrigeminal cistern lipoma and an alternative to frozen sections that are technically difficult to obtain due to presence of lobules of fibro-adipose tissue. With radiological correlation, squash cytology can be an economical method for intraoperative diagnosis, pending subsequent histopathological confirmation.

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          Most cited references 10

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          Pathogenesis of intracranial lipoma: an MR study in 42 patients.

          Intracranial lipomas are uncommon lesions whose development remains poorly understood. To clarify the anatomic and embryologic features of intracranial lipomas, we retrospectively reviewed the MR scans of 42 patients with 44 intracranial lipomas. Interhemispheric lipomas were the most common, accounting for 45% of cases. The remainder of the lesions were clustered in the quadrigeminal/superior cerebellar (25%), suprasellar/interpeduncular (14%), cerebellopontine angle (9%), and sylvian (5%) cisterns. Fifty-five percent of the lesions were associated with brain malformations of varying degrees. Intracranial vessels and nerves were noted to course through 16 (36%) of the lesions. The relative frequencies of the locations of the lipomas correspond to the temporal sequence of dissolution of the meninx primitiva, the mesenchymal anlage of the meninges. This finding supports the concept of lipoma formation as a result of abnormal persistence and maldifferentiation of the meninx. This embryologic concept of the development of intracranial lipomas explains the high frequency of callosal and other brain hypoplasias. Intracranial lipomas are neither hamartomas nor true neoplasms; rather, they are congenital malformations.
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            Pathogenesis of intracranial lipoma: an MR study in 42 patients.

             C Truwit,  A Barkovich (2015)
            Intracranial lipomas are uncommon lesions whose development remains poorly understood. To clarify the anatomic and embryologic features of intracranial lipomas, we retrospectively reviewed the MR scans of 42 patients with 44 intracranial lipomas. Interhemispheric lipomas were the most common, accounting for 45% of cases. The remainder of the lesions were clustered in the quadrigeminal/superior cerebellar (25%), suprasellar/interpeduncular (14%), cerebellopontine angle (9%), and sylvian (5%) cisterns. Fifty-five percent of the lesions were associated with brain malformations of varying degrees. Intracranial vessels and nerves were noted to course through 16 (36%) of the lesions. The relative frequencies of the locations of the lipomas correspond to the temporal sequence of dissolution of the meninx primitiva, the mesenchymal anlage of the meninges. This finding supports the concept of lipoma formation as a result of abnormal persistence and maldifferentiation of the meninx. This embryologic concept of the development of intracranial lipomas explains the high frequency of callosal and other brain hypoplasias. Intracranial lipomas are neither hamartomas nor true neoplasms; rather, they are congenital malformations.
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              Intracranial lipoma of the quadrigeminal region associated with complex partial seizures.

              A 7-year-old Japanese boy with an intracranial lipoma of the quadrigeminal region and complex partial seizures is reported. Among 28 published patients with lipoma originating in the quadrigeminal plate and ambient cistern, 6 suffered from seizures and 3 were mentally retarded. Our patient's seizures were controlled with carbamazepine.
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                Author and article information

                Journal
                J Neurosci Rural Pract
                J Neurosci Rural Pract
                JNRP
                Journal of Neurosciences in Rural Practice
                Medknow Publications & Media Pvt Ltd (India )
                0976-3147
                0976-3155
                Jan-Mar 2013
                : 4
                : 1
                : 59-62
                Affiliations
                Department of Pathology, G B Pant Hospital, Jawaharlal Nehru Marg, New Delhi, India
                [1 ] Department of Neurosurgery, G B Pant Hospital, Jawaharlal Nehru Marg, New Delhi, India
                Author notes
                Address for correspondence: Prof. Ravindra K Saran, Department of Pathology, Academic Block, G B Pant Hospital, Jawaharlal Nehru Marg, New Delhi - 110 002, India. E-mail: ravindraksaran@ 123456hotmail.com
                Article
                JNRP-4-59
                10.4103/0976-3147.105617
                3579050
                23546355
                Copyright: © Journal of Neurosciences in Rural Practice

                This is an open-access article distributed under the terms of the Creative Commons Attribution-Noncommercial-Share Alike 3.0 Unported, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                Categories
                Case Report

                Neurosciences

                cytology, lipoma, quadrigeminal, squash

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