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Intraparenchymal epithelial (enterogenous) cyst of the medulla oblongata
1Division of Anatomical Pathology (Neuropathology), Ottawa Civic Hospital, Ontario, Canada.
Abstract:
Intraparenchymal solitary cyst of the medulla oblongata was diagnosed on MRI examination in a 66-year-old woman with a nine year history of progressive brainstem dysfunction and three negative CT scan examinations. Craniotomy and drainage of the cyst to the IVth ventricle led to remarkable clinical recovery. Biopsy of the wall of the cyst revealed an epithelial lining with tonofilaments, desmosomes and surface coating on ultrastructural examination. Immunohistochemistry demonstrated positive reactions of epithelium for keratins, cytokeratins, epithelial membrane antigen and Ulex Europeus lectin, indicating endodermal origin of the cyst.
Insights
A solitary cyst in the medulla oblongata was diagnosed using MRI, leading to surgical drainage and significant recovery. Biopsy confirmed an epithelial lining, suggesting an endodermal origin for this rare brainstem cyst.
Area of Science:
- Neuroscience
- Pathology
- Surgical Neurology
Background:
- Brainstem dysfunction can arise from various pathologies, including rare cystic lesions.
- Magnetic Resonance Imaging (MRI) is crucial for diagnosing subtle neurological abnormalities.
- Computed Tomography (CT) scans may not always detect small or specific types of brain lesions.
Observation:
- A 66-year-old woman presented with a nine-year history of progressive brainstem dysfunction.
- Initial CT scans were negative, but MRI revealed an intraparenchymal solitary cyst in the medulla oblongata.
- Surgical intervention involved craniotomy and cyst drainage into the fourth ventricle.
Findings:
- The cyst was successfully drained, resulting in a remarkable clinical recovery for the patient.
- Histopathological examination of the cyst wall showed an epithelial lining.
- Ultrastructural analysis revealed tonofilaments, desmosomes, and surface coating.
- Immunohistochemistry demonstrated positive staining for keratins, cytokeratins, epithelial membrane antigen, and Ulex Europeus lectin.
Implications:
- The histological and immunohistochemical findings strongly indicate an endodermal origin for the cyst.
- This case highlights the diagnostic value of MRI in identifying rare brainstem lesions.
- Surgical cyst drainage can be an effective treatment for symptomatic intraparenchymal medulla oblongata cysts.