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

          C Truwit, A. Barkovich (1990)
          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.
          Article 0 comments Cited 37 times – based on 0 reviews     Review now
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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.
            Article 0 comments Cited 11 times – based on 0 reviews     Review now
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              MRI findings in 32 consecutive lipomas using conventional and advanced sequences.

              Z Shaikh, Sonal Bakshi, S. Kamran … (1999)
              Intracranial lipomas are histologically benign and usually incidental magnetic resonance imaging findings that must be differentiated from ominous lesions. The authors describe 32 lipomas in 30 patients using conventional spin-echo (CSE) T1-weighted images (T1WI), CSE proton density (PDWI), CSE T2-weighted images (T2WI), fast spin-echo (FSE) T2WI, and FSE fluid-attenuated inversion recovery (FLAIR). Lipomas occurred most commonly in the trigonal choroid plexus, cerebral convexity, pericallosal, and quadrigeminal cistern regions. Lipomas were hyperintense on CSE T1WI and of variable appearance on CSE PDWI and CSE T2WI. Lipomas were isointense to hyperintense on FSE T2WI and hyperintense on FLAIR. Chemical shift artifact (CSA) usually was present on either CSE PDWI or CSE T2WI but was not seen on FSE images. One patient had intracranial hypotension associated with a large convexity lipoma. The authors conclude that lipomas appear different on CSE T2WI than on FSE T2WI. CSE PDWI and CSE T2WI are complementary in detecting CSA. The lack of CSA being detected in lipomas on FSE images most likely relates to inherent bandwidth differences compared with those of CSE. The hyperintense appearance of lipomas on FSE FLAIR and FSE T2WI may be confused with subacute hematomas. The authors recommend that if CSE technique by itself is used to exclude lipomas (in centers that are not using FSE), then T1WI, PDWI, and T2WI usually are sufficient. For centers using FSE routinely, fat saturation or CSE sequences also may be needed to exclude lipomas. Finally, the authors' series suggests that intracranial lipomas may occur in lateral locations more frequently than reported previously.
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                Author and article information

                Journal
                Journal ID (nlm-ta): J Neurosci Rural Pract
                Journal ID (iso-abbrev): J Neurosci Rural Pract
                Journal ID (publisher-id): JNRP
                Title: Journal of Neurosciences in Rural Practice
                Publisher: Medknow Publications & Media Pvt Ltd (India )
                ISSN (Print): 0976-3147
                ISSN (Electronic): 0976-3155
                Publication date (Print): Jan-Mar 2013
                Volume: 4
                Issue: 1
                Pages: 59-62
                Affiliations
                [1] 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
                Publisher ID: JNRP-4-59
                DOI: 10.4103/0976-3147.105617
                PMC ID: 3579050
                PubMed ID: 23546355
                SO-VID: 682025c1-56ea-4ff4-ae77-b04cb2d1ae94
                Copyright © Copyright: © Journal of Neurosciences in Rural Practice
                License:

                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.

                History
                Categories
                Subject: Case Report

                ScienceOpen disciplines: Neurosciences
                Keywords: cytology,lipoma,quadrigeminal,squash
                Data availability:
                ScienceOpen disciplines: Neurosciences
                Keywords: cytology, lipoma, quadrigeminal, squash

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