Cerebellar dermoid cyst with contrast enhancement mural nodule: case report

Typical dermoid cysts are well-circumscribed fat-density masses with no associated contrast enhancement; rarely, they may appear hyperattenuating on CT scan. CT hyperattenuating dermoid cyst (CHADC) is very uncommon, with only nine case reports in the literature update, which occurs exclusively in the posterior fossa. CHADC with mural nodule is extremely rare and, to the best of our knowledge, only two cases have been documented previously in the literature. A 49-year-old farmer had a 2-month history of occipital headaches, which were not suggestive of raised intracranial pressure. During the last month, he experienced loss of balance, frequent falls, anorexia and loss of weight. Magnetic resonance imaging (MRI) showed a huge mass from the tentorium to the foramen occipitale magnum with obliteration of the fourth ventricle; the lesion was well circumscribed. We completely removed the tumor and postoperative MRI showed no residual tumor. Epidermoid tumors with enhancing mural nodule on MRI and with hyperattenuating lesion on CT are extremely rare. Dermoid cysts are never associated with edema and extremely rarely cause obstructive hydrocephalus. MRI investigations are mandatory to diagnose these cases. The best curative treatment is total removal of the lesion.