Neurology India Medknow Publications on behalf of the Neurological Society of India ISSN: 0028-3886 EISSN: 1998-4022 Vol. 58, Num. 2, 2010, pp. 330-331

Neurology India, Vol. 58, No. 2, March-April, 2010, pp. 330-331

Letter To Editor

Large colloid cyst of the anterior third ventricle associated with calcification in the cyst wall

Mahadevan Sambasivan, Sanalkumar Padmanabhan, Mahesh Sambasivan

Neuro Surgery Department, Cosmopolitan Hospitals, Murinjapalam, Pattom.P.O., Trivandrum, Kerala-695 004, India

Correspondence Address:
Mahadevan Sambasivan
Neuro Surgery Department, Cosmopolitan Hospitals, Murinjapalam, Pattom.P.O., Trivandrum, Kerala-695 004
India
drmsambasivan@gmail.com

Date of Acceptance: 01-Feb-2010

Code Number: ni10089

PMID: 20508369

DOI: 10.4103/0028-3886.63774

Sir,

A 38-year-old female patient was admitted with complaints of persistent headache, blurring of vision and memory lapses of one year duration. Since two months before admission, the headache was aggravated and she developed recurrent attacks of vomiting. Patient was a known case of diabetes mellitus type 2 and hypothyroidism on oral hypoglycemic drugs and on thyroxin for the past five years. She had under gone hysterectomy in January 2008 for fibroid uterus with adrexal mass. Patient was getting treatment for bilateral groin and axillary hydradenitis suppurativa for the last two years.

On examination, the patient was conscious and intermittent memory lapses were noted. Pupils were equal and reacting to light. Fundi showed bilateral gross papilloedema. Eye movements were full and equal. No evidence of facial asymmetry and no sensory deficit were noted. Deep tendon jerks were brisk on either side and plantars were unequivocal. There was no evidence of ataxia and other cerebellar signs. There were no signs of meningeal irritation. Vitals were normal. Computed tomography (CT) scan of the head revealed a round hyperdense lesion measuring approximately 3.cm in diameter, located in the anterior third ventricle at the level of foramen of Monro with marked dilatation of both lateral ventricles. There was evidence of calcification in the cyst wall and the features were consistent with colloid cyst of the third ventricle with calcification [Figure - 1],[Figure - 2],[Figure - 3].

The patient under went frontal craniotomy under general anesthesia. Through a transcortical incision in the middle frontal gyrus, the frontal horn was entered. The enlarged foramen Monro was identified and the bluish cyst was found to be projecting through the foramen. Aspiration of the cyst revealed thick colloid material. By gentle and careful dissection the cyst wall was excised in toto. The calcified area adhering to the fornix was removed separately. Postoperative period was stormy, patient had mutism. The hydradenitis flared up and the patient developed fulminant lung infection. Subsequently patient went in for septicemia and renal failure. The patient was shifted to dialysis unit and she underwent periodic hemodialysis. Septicemia was managed with appropriate antibiotics and supportive treatment. The patient showed gradual improvement over a period of two weeks. At the time of discharge she was symptom free and was neurologically stable and mutism had disappeared. Histopathological examination showed cyst wall lined by tall columnar/cuboidal epithelium. Cyst wall showed fibrocollagenous tissue with areas of calcification. Histological diagnosis was suggestive of colloid cyst with calcification.

Both computed tomography (CT) and magnetic resonance imaging (MRI) may be used in the diagnosis of colloid cyst. On CT scan, most of the colloid cysts were hyperdense occasionally hypo dense or isodense. Most colloid cysts are round or oval. Contrast administration reveals a thin rim of enhancement around the cyst, indicating the cyst capsule. On MR imaging, about 50% of colloid cyst are hyperintense on T1- weighted image and the remaining 50% are either isointense or hypointense with respect to the brain. Radiographically demonstrable calcification in the cyst wall is extremely rare in a case of colloid cyst. Calcification in a lesion in the anterior third ventricle suggests something other than colloid cyst such as meningioma, xantho granuloma, cavernous angioma, cysticercal cyst or craniopharyngyioma. There were only two case reports of colloid cysts with calcification. Yuceer et al reported a case of huge colloid cyst of third ventricle with calcification in the cyst. ^[1] and Ture et al reported a case of solid calcified colloid cyst of the third ventricle. ^[2] The present case is also a large colloid cyst with calcification in the cyst wall.

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