Presentation
Long term headache.
Patient Data
Large lobulated extra-axial cystic mass located in the pontomedullary junction with projections to the spinal canal and lower right cerebellopontine angle and cisterna magna.
It appears T2 hyperintense and T1 hypointense with thin inner septations. Only a small part shows FLAIR hyperintensity.
No evidence of diffusion restriction on ADC map.
A right located septation displays mild enhancement.
There is considerable mass-effect on the pons, medulla, cranial nerves, and basilar artery.
No evidence of bony remodeling.
At histopathologic analysis, the capsule wall had a single pseudostratified columnar epithelium.
At immunohistochemical analysis, the specimen tested positive for keratin markers, suggesting an endodermal origin.
Post-surgical control displays removal of most of the cyst.
Case Discussion
The mass has the most frequent location of intracranial neurenteric cysts.
The intracranial neurenteric cysts are usually hyperintense on FLAIR1 compared to CSF but in this case, only a small locule has this behavior.
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