Supratentorial intracerebral epithelial (ependymal) cysts: review, case reports, and fine structure

The paper concerns the rare supratentorial, intracerebral or convexity cysts in adults having a wall lined with an epithelium resembling ependyma. The clincopathological aspects of such cysts are reviewed from 15 published cases and two specimens of the authors which could be examined with the electronmicroscope. These cysts manifest at a median age of 46 years as progressive, space occupying lesions with a fairly rapid clinical course of about one to two years. Twelve of 17 cysts were located in the frontal lobes, most were unequivocally intracerebral and none communicated with the lateral ventricle. Microscopic examination of the cyst wall disclosed some variance in structure, the most common feature being a monolayer of ciliated cells sitting on a very thin collagen membrane. One of the present cases was unique in that the compression by the cyst had caused a shell of infarction in the encompassing tissue. The fine structure of the cysts is described and compared with that of potential host tissues from which such cysts may originate. It is concluded that the cysts arise from displaced segments of the wall of the neural tube which correspond to the sites from which the tela chorioidea forms.