Xanthogranulomatous colloid cyst: Radiologic- pathologic correlation and diagnostic difficulties

Area of Science:

• Neuropathology
• Neurosurgery
• Neuroimaging

Background:

• Colloid cysts in the third ventricle commonly cause hydrocephalus.
• Xanthogranulomatous variant colloid cysts are rare and challenging differential diagnoses.
• Craniopharyngioma is a key differential diagnosis for third ventricular lesions.

Observation:

• A 77-year-old woman presented with obstructive hydrocephalus due to a third ventricular lesion.
• MRI revealed a complex solid-cystic lesion with specific T1/T2 signal characteristics.
• The lesion caused obstructive hydrocephalus, leading to symptoms like headaches and memory loss.

Findings:

• Xanthogranulomatous reaction in colloid cysts results from epithelial desquamation, lipid accumulation, and inflammation.
• These lesions present diagnostic challenges due to their rarity and inflammatory nature.
• Adhesions to adjacent structures complicate complete microsurgical excision.

Implications:

• Early and accurate diagnosis is crucial for appropriate management of xanthogranulomatous colloid cysts.
• Microsurgical resection remains the treatment of choice.
• Techniques like aspiration of cystic contents are vital for maximal resection and minimizing complications.