Epithelial Cysts of the CNS

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Epithelial Cystic Masses of the CNS *

Name	Location	Epithelium	Gross Pathology	CT	MR
Epidermoid	CPA >> middle fossa	Squamous only	Dry flaky waxy lamellar keratin, pearly	Homogeneous water-like attenuation	Lamellar, do not suppress on FLAIR or DWI
Dermoid	Retroclival suprasellar	Squamous, hair follicles, sebaceous gland, sweat glands	Mixture of hair, sebaceous grummus, buttery or cheesy	Fluid-fluid level, lipid top layer, hair-ball	Lipid layer bright on T1W
Colloid	Ant. 3^rd ventricle	Ciliated Cuboidal, low columnar, Goblet cells	Gelatinous, hyaline	Round sharply demarcated, some hyperdense	Round sharply demarcated some bright on T1W, some bright on T2W, some with "black hole" on T2W
Arachnoid	Middle fossa	Arachnoid	CSF	CSF Isodense	CSF Isointense FLAIR - Dark DWI - Dark
Rathke Cleft	Intrasellar, Suprasellar, Behind pituitary stalk	Ciliated Cuboidal - Columnar, Goblet cells		Water like	Bright on T1W and dark on T2W Rim enhancement in residual pituitary
Craniopharyngioma - child	Suprasellar above and anterior to stalk	Squamous (stratified and palisading) and adamantinomatous tissue w/connective tissue rim and reactive astrogliosis	Wet nodular keratin, "machine oil" with cholesterol	Ca++, mixed cystic and solid, solid enhances	May be bright on T1W, solid regions enhance
Craniopharyngioma - adult	Suprasellar above and anterior to stalk	Squamous (sheets, no palisading) and forming (pseudo) papillary structures	Solid masses without cholesterol, no wet keratin, no Ca++	Solid mass	Solid regions enhance

Modified from Smirniotopoulos, JG: "Extraaxial Neoplasms of the CNS", RSNA 2000 Categorical Course

* Data compiled from ^[41,45-49^]

^{41. Kallmes DF, Provenzale
JM, Cloft HJ, McClendon RE. Typical and atypical MR imaging features of
intracranial epidermoid tumors. AJR Am J Roentgenol 1997; 169:883-887.}

^{45. Sumida M, Uozumi
T, Yamanaka M, Mukada K, Arita K, Kurisu K, et al. Displacement of the
normal pituitary gland by sellar and juxtasellar tumours: surgical-MRI
correlation and use in differential diagnosis. Neuroradiology 1994; 36:372-375.}

^{46. Sumida M, Uozumi
T, Mukada K, Arita K, Kurisu K, Eguchi K. Rathke cleft cysts: correlation
of enhanced MR and surgical findings. AJNR Am J Neuroradiol 1994; 15:525-532.}

^{47. Kleinschmidt-DeMasters
BK, Lillehei KO, Stears JC. The pathologic, surgical, and MR spectrum of
Rathke cleft cysts. Surg Neurol 1995; 44:19-26; discussion 26-7.}

^{48. Naylor MF, Scheithauer
BW, Forbes GS, Tomlinson FH, Young WF. Rathke cleft cyst: CT, MR, and pathology
of 23 cases [published erratum appears in J Comput Assist Tomogr 1996 Jan-Feb;20(1):171].
J Comput Assist Tomogr 1995; 19:853-859.}

^{49. Sartoretti-Schefer
S, Wichmann W, Aguzzi A, Valavanis A. MR differentiation of adamantinous
and squamous-papillary craniopharyngiomas. AJNR Am J Neuroradiol 1997;
18:77-87.}