Supratentorial neurenteric cyst mimicking hydatid cyst: A case report and literature review
A 67-year-old Mediterranean male who had episodes of seizures with altered consciousness. He was subsequently placed on keppra and became seizure-free. Magnetic resonance imaging (MRI) of the brain with and without gadolinium revealed a large well-defined left frontal cystic mass measuring 4.8 cm × 4.0 cm × 4.8 cm. The mass displays cerebrospinal fluid (CSF) intensity with low signal on T1-weighted and fluid-attenuated inversion recovery (FLAIR) images [] and high signal on T2-weighted (T2W) images []. The lesion contained sausage-shaped debris of high FLAIR signal in its dependent portion with an internal septation. On post contrast imaging, there is no discernible enhancement of the mass or any surrounding capsule. The diffusion tensor imaging (DTI) and diffusion weighted imaging exhibits presence of a high T2 signal wall surrounded by a low signal capsule. On the functional MRI, the left-sided primary motor cortex is seen along the posterior and lateral margin of the left frontal cyst []. The activated supplemental motor area is seen along the medial margin of the cyst. The DTI revealed that the white matter tracks of centrum semiovale are cleaved and displaced rather than infiltrated and destroyed []. The patient also underwent a computed tomography (CT) scan of the thorax and abdomen, as part of the patient's workup for suspected hydatid cyst disease, which revealed a mesenteric cystic lesion.\nBased on the pre-operative imaging findings, the patient was started on albendazole for treatment of the presumed hydatid cyst.\nLater, the patient underwent a stealth-guided left frontoparietal craniotomy for resection of cyst. The lesion was adherent to the cerebral pial surface and contained proteinaceous gelatinous yellowish discolored material. The lesion was irrigated several times with hypertonic saline to kill any hydatid ova. The patient's post-operative course was uncomplicated and albendazole was resumed. Histologically, the lesion showed a fibrous cyst wall lined by cuboidal to columnar, single to multilayered epithelium, which focally shows surface cilia and mucin production that is positive on alcian blue special histochemical stain. The cystic lining is immunoreactive for pan-cytokeratin and epithelial membrane antigen (EMA) and negative for glial fibrillary acidic protein (GFAP) and CK20 []. The histological features are consistent with an enterogenous/epithelial cyst. There is no evidence of hydatid cyst, scolex or other abnormal parasitic structure. Based on the final pathologic diagnosis, albendazole was discontinued.