Neurenteric Cyst in the Cerebellopontine Angle with Xanthogranulomatous Changes: Serial MR Findings with Pathologic Correlation
Ji Hoon Shina,
Bark Jang Byunb,
Dong Won Kimc and
Deuk Lin Choia
a Department of Radiology, Soonchunhyang University Hospital, Soonchunhyang University College of Medicine, Seoul, Korea
b Department of Neurosurgery, Soonchunhyang University Hospital, Soonchunhyang University College of Medicine, Seoul, Korea
c Department of Pathology, Soonchunhyang University Hospital, Soonchunhyang University College of Medicine, Seoul, Korea
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FIG 1. Initial MR images in a 35-year-old woman with headache.
A, Axial T1-weighted (520/20) image shows a well-circumscribed mass in the left cerebellopontine angle cistern. It is hyperintense to CSF; this finding suggests a high-protein-content cystic mass. Several hypointense areas are present in the mass, with a large solid area (arrows) in the anterior portion of the mass.
B and C, Coronal T1-weighed (B) and contrast-enhanced T1-weighted (C) images (520/20) show homogeneous, strong enhancement of the solid nodule (arrows) surrounded by a thin low-signal-intensity rim (arrowhead).
D, On this coronal T2-weighed (3600/105) image, the center of the solid nodule is hypointense (short arrows), whereas the peripheral portion of the solid nodule is hyperintense. A thin low-signal-intensity rim (arrowhead) is also depicted. The mass displaced the basilar artery (long arrow) to the right side.
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FIG 2. Follow-up MR images obtained 6 months after the initial MR images and a pathologic photomicrograph.
A, Axial T1-weighted (520/20) MR image shows a marked increase in the size of the mass. However, the solid nodule (arrow) has decreased in size.
B, Coronal contrast-enhanced T1-weighted (520/20) MR image shows a decrease in size as well as subtle enhancement of the solid nodule (arrow).
C, Photomicrograph demonstrates ciliated columnar epithelium. Squamous metaplasia (arrows) lining the wall of the cyst (hematoxylin-eosin, original magnification x100). Inset: High-power photomicrograph clearly demonstrates ciliation (arrowhead) (original magnification x200).
D, Photomicrograph of the solid nodule demonstrates xanthogranulomatous change, with foamy macrophages, chronic inflammatory cells, multinucleated giant cells (arrow), and a cholesterol cleft (arrowhead) (hematoxylin-eosin stain, original magnification x100).
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