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      Endodermal Cysts of the Central Nervous System: Review of the Literature and a Case Report

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          Abstract

          Context:

          Endodermal cysts are rare benign developmental cysts lined by mucin-secreting and/or ciliated, cuboidal, or columnar epithelium of probably endodermal origin.

          Aims:

          Endodermal cysts are rarely intracranial, frequently located in the posterior fossa. Supratentorial location is the most infrequent and only few cases are reported in the literature, included our case.

          Settings and Design:

          The authors report a case of intracranial supratentorial endodermal cyst with a review of the literature.

          Subjects and Methods:

          A 40-year-old woman was admitted to our department because of progressive gait disorder for 3 months due to right brachial and crural motor deficit associated to right crural sensory disorder (tactile hypesthesia) and right Babinski response at neurological examination due to an endodermal cyst located in the left frontoparietal convexity.

          Discussion:

          Total resection of endodermal cysts is recommended, despite their location and adhesion to the surrounding structures, due to its high risk of recurrence. Fenestration of the cystic content into the subarachnoid cistern may cause obstructive hydrocephalus or chemical meningism.

          Results:

          Although rare, surgeons should be aware that these lesions must be differentiated clinically, radiologically, and histologically from other supratentorial cystic lesions.

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          Most cited references81

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          Imaging of cystic masses of the mediastinum.

          Cystic masses of the mediastinum are well-marginated round lesions that contain fluid and are lined with epithelium. Major cystic masses include congenital benign cysts (ie, bronchogenic, esophageal duplication, neurenteric, pericardial, and thymic cysts), meningocele, mature cystic teratoma, and lymphangioma. Many tumors (eg, thymomas, Hodgkin disease, germ cell tumors, mediastinal carcinomas, metastases to lymph nodes, nerve root tumors) can undergo cystic degeneration-especially after radiation therapy or chemotherapy-and demonstrate mixed solid and cystic elements at computed tomography (CT) or magnetic resonance (MR) imaging. If degeneration is extensive, such tumors may be virtually indistinguishable from congenital cysts. A mediastinal abscess or pancreatic pseudocyst also appears as a fluid-containing mediastinal cystic mass. However, clinical history and manifestations, anatomic position, and certain details seen at CT or MR imaging allow correct diagnosis in many cases. Familiarity with the radiologic features of mediastinal cystic masses facilitates accurate diagnosis, differentiation from other cystlike lesions, and, thus, optimal patient treatment. Copyright RSNA, 2002
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            Retroclival ecchordosis physaliphora: MR imaging and review of the literature.

            Ecchordosis physaliphora (EP), found in about 2% of autopsies, is a clinically inconspicuous notochordal remnant appearing at the dorsal wall of the clivus. To our knowledge, a systematic review of its MR features does not exist. The aim of this study was to describe the MR imaging findings of incidentally found retroclival EP with special respect to its differentiation from intradural chordomas. We reviewed 300 consecutive 1.5-T MR imaging studies that included thin-section transverse T2-weighted images of the skull base for the presence of a retroclival EP. In cases in which an EP was identified, two neuroradiologists observed MR signal intensity characteristics, contrast enhancement, size, form, stalk of EP, and signal intensity changes of the adjacent clivus. Five cases with retroclival EP were found (incidence, 1.7%). In all cases, the ecchordoses was hyperintense on T2-weighted images and hypointense on T1-weighted images. Contrary to the reported findings in chordomas, none of the lesions showed contrast enhancement. In four cases, there were signal intensity changes in the adjacent clivus. A stalklike connection between clivus and EP was seen in three patients. Because of the benign character of EP and the difficulties in its histopathologic differentiation from chordomas, precise knowledge of the radiologic characteristics of EP is important. On the basis of these five cases and a review of literature, contrast enhancement and the presence of clinical symptoms seem to be highly reliable parameters in the differential diagnosis of intradural chordoma and EP.
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              Intracranial neuroenteric cysts: a concise review including an illustrative patient.

              Neuroenteric cysts (NC) are rare, benign lesions lined by mucin-secreting cuboidal or columnar epithelium of an intestinal or respiratory type. They are regarded as ectopic endodermal cysts, and tend to be found in the spine rather than an intracranial location. Advances in neuroimaging have led to an increased frequency of diagnosis of NC, especially as an incidental finding, although such cysts may be confused radiologically with other lesions such as epidermoid and arachnoid cysts. We undertook a PubMed search of the literature using the search terms "neuroenteric cyst" and its many pseudonyms, including "endodermal cyst", "enterogenous cyst", "neurenteric cyst", "epithelial cyst", "intestinome", "teratomatous cyst", "gastrocytoma", and also "enterogenic", "foregut", "respiratory", and "bronchogenic cyst". Only reports in English and those containing histopathologically-confirmed NC were considered for this review. In total, 140 patients with intracranial NC were found, including the patient reported in the present review. This review describes the classification, epidemiology, embryology, clinical presentation, radiology, histopathology, and surgical treatment of NC, and includes an illustrative patient.
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                Author and article information

                Journal
                Asian J Neurosurg
                Asian J Neurosurg
                AJNS
                Asian Journal of Neurosurgery
                Wolters Kluwer - Medknow (India )
                1793-5482
                2248-9614
                Oct-Dec 2020
                21 December 2020
                : 15
                : 4
                : 989-996
                Affiliations
                [1 ] Department of Neurosurgery Padua University Hospital, Padua, Italy
                [2 ] Department of Neurosurgery and Gamma Knife Radiosurgery, IRCCS San Raffaele Scientific Institute, Vita-Salute University, Milan, Italy
                [3 ] Department of Neurological Surgery, Galliera Hospitals, Genova, Italy
                Author notes
                Address for correspondence: Dr. Fotios Kalfas, Department of Neurosurgery Padua University Hospital, Padua, Italy. E-mail: fkalfas@ 123456tiscali.it Dr. Claudia Scudieri, Department of Neurosurgery and Gamma Knife Radiosurgery, IRCCS San Raffaele Scientific Institute, Vita-Salute University, Milan, Italy. E-mail: claudiascudieri@ 123456gmail.com
                Article
                AJNS-15-989
                10.4103/ajns.AJNS_322_19
                7869303
                33708675
                fb09b695-02fe-40b4-8114-a6269597242d
                Copyright: © 2020 Asian Journal of Neurosurgery

                This is an open access journal, and articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms.

                History
                : 28 October 2019
                : 30 March 2020
                : 13 August 2020
                Categories
                Original Article

                Surgery
                central nervous system,endodermal cyst,enterogenous cyst,epithelial cyst,neurenteric cyst,neuroenteric cyst,supratentorial extra-axial cystic lesion

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