Primary lumbar epidermoid tumor mimicking schwannoma

Intraspinal Epidermoid Tumor of the Cauda Equina Region

“…Progressive desquamation and breakdown of keratin from the epithelial lining into the center of the mass produces a soft white bulk, rich in cholesterol crystals, and often described as waxy and forming concentric lamellae. 8 Alvord studied the growth rate of epidermoid tumors and noted that they grow linearly at a rate similar to normal human skin. 9 This pattern of growth is very different from that of neoplasms, in which the most common pattern is an exponential increase in size.…”

Chronic cystic lesion of the sacrum: characterisation with diffusion-weighted MR imaging

“…However, at the lumbosacral level, other expansile slow-growth lesions can lead to a similar bone remodelling [4][5][6] and seem analogous in CT scans and conventional MRI sequences (T1-and T2-weighted images) to be examples of giant sacral neurofibroma and epidermoid cysts [2,6,[9][10][11][12][13][14]. The use of contrast material is not helpful insofar as both Tarlov and epidermoid cysts do not show enhancement.…”

“…A tale livello però altre lesioni espansive a lenta crescita possono causare un simile rimodellamento osseo [4][5][6] e possono presentare caratteristiche analoghe in TC e nelle sequenze convenzionali di RM (T1 e T2), tra le quali il neurofibroma gigante del sacro e le cisti epidermoidi [2,6,[9][10][11][12][13][14]. .…”

“…Similar bone remodelling, however, can also be caused by slow-growth lesions (e.g. giant sacrum neurinoma, neurofibroma and epidermoid cysts) that on CT and conventional MRI present a signal similar to that of CSF [4][5][6]. Unfortunately, the clinical picture is rather nonspecific.…”

“…Un rimodellamento osseo simile, peraltro, può essere determinato da formazioni espansive a crescita lenta (p.e. neurinomi giganti del sacro, neurofibromi e cisti epidermoidi), che sia in TC che nelle sequenze RM convenzionali (T2, T1 senza e con MdC) possono presentare caratteristiche di segnale simili al liquor [4][5][6]. In questo caso, purtroppo, anche il quadro clinico è aspecifico e di scarso aiuto nella diagnosi differenziale.…”