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LETTER TO EDITOR
Year : 2012  |  Volume : 1  |  Issue : 1  |  Page : 51-52

Lipoma of the quadrigeminal plate


1 Department of Radiology, Narayana Medical College Hospital, Chinthareddypalem, Nellore, Andhra Pradesh, India
2 Department of Neurosurgery, Narayana Medical College Hospital, Chinthareddypalem, Nellore, Andhra Pradesh, India

Date of Submission25-Jun-2012
Date of Acceptance02-Aug-2012
Date of Web Publication16-Oct-2012

Correspondence Address:
B E Panil Kumar
Department of Radiology, Narayana Medical College Hospital, Chinthareddypalem, Nellore-524003, Andhra Pradesh
India
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DOI: 10.4103/2278-9588.102530

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How to cite this article:
Panil Kumar B E, Hegde KV, Agrawal A. Lipoma of the quadrigeminal plate. J Cranio Max Dis 2012;1:51-2

How to cite this URL:
Panil Kumar B E, Hegde KV, Agrawal A. Lipoma of the quadrigeminal plate. J Cranio Max Dis [serial online] 2012 [cited 2014 Nov 26];1:51-2. Available from: http://www.craniomaxillary.com/text.asp?2012/1/1/51/102530

Sir,

Intracranial lipomas are rare slow growing benign congenital lesions accounting for 0.1-0.5% of all primary brain tumors and are usually detected as incidental findings. [1] A 32-year-old man presented with headache of 1-year duration with on and off seizures of 1 month duration. A cranial computed tomography (CT) revealed a normal cranial vault as well as cerebral and cerebellar hemispheres. A CT scan showed a hypodense lesion (-80 Hounsfield units) with arc like calcification in left half of quadrigeminal plate cistern. Magnetic resonance imaging (MRI) brain showed hyperintense lesion on T1-weighted images and relatively high intensity on T2-weighted images and hyopinetnse on fluid attenuated inversion recovery (FLAIR) images [Figure 1] and c. The findings were consistent with fat and a diagnosis of quadrigeminal plate cistern lipoma was made. The patient was managed conservatively and the patient's headaches subsided and seizures were under control with conservative management.
Figure 1: (a) CT scan brain showing fat-density lesion (-80 Hounsfield units) in the left quadrigeminal cistern (black arrow), (b) MRI axial T1W image showing well defined hyperintense lesion in left quadrigeminal plate cistern, and (c) fat suppressed images showing the suppression of fat lesion in left quadrigeminal cistern

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The most common sites are the corpus callosum, quadrigeminal/superior cerebellar cistern, suprasellar/interpeduncular cistern, cerebellopontine angle cistern, and sylvian cistern. [2] Lipoma in the quadrigeminal region has previously recognized as lipoma in the quadrigeminal cistern, the quadrigeminal plate, the ambient cistern, the superior vermis, or the superior medullary velum. [3],[4] Lipomas of the quadrigeminal plate are usually asymptomatic, [1],[2],[5],[6] but may cause significant symptoms of mass effect in about 20% of patients. [2] Pressure on the ventricular system can result in consequent neurologic deficits, obstructive hydrocephalus, or raised intracranial pressure. [1],[6] Radiological characteristics of quadrigeminal cistern lipoma is always definitive on imaging, hence histopathological confirmation is almost never required. [6],[7] On CT scan the lipoma is characterized by attenuation values of fat density (-50 to -100 Hounsfield units) and absence of postcontrast enhancement. [8],[9] On MRI the lipoma has short T1 and T2 and therefore, a hyperintense signal is present on T1-weighted images and a relatively low to moderate intensity signal on T2-weighted images [Figure 1]. [6] The differential diagnoses of lipomas in the quadrigeminal cistern include: Arachnoid cysts, tectal plate cyst, tectal masses (gliomas), supracerebellar abscess, dermoid and epidermoid cysts, ruptured P4 segment aneurysm of the posterior cerebral artery, and rarely pineal region mass. [6],[7] The lipoma can be differentiated with other negative attenuation value lesions (epidermoid or dermoid tumors) that two tumors will demonstrate heterogeneous attenuation values. [8] Intracranial lipomas rarely become symptomatic and surgery is seldom required. The usual neurological symptoms are intracranial hypertension and hydrocephalus, which can be treated by shunt procedure. [6] Incidental and asymptomatic lipoma of the quadrigeminal region do not require surgical intervention, [3] as our patient also, presented with headaches and seizures, but it appeared to be unrelated to the lipoma, as no compressive, obstructive, or evidence of raised intracranial pressure were seen, hence the patient was managed conservatively.

 
  References Top

1.Yilmazlar S, Kocaeli H, Aksoy K. Quadrigeminal cistern lipoma. J Clin Neurosci 2005;12:596-9.  Back to cited text no. 1
    
2.Ono J, Ikeda T, Imai K, Mano T, Matsuoka T, Nagai T, et al. Intracranial lipoma of the quadrigeminal region associated with complex partial seizures. Pediatr Radiol 1998;28:729-31.  Back to cited text no. 2
    
3.Senoglu M, Altun I. Lipoma of the quadrigeminal plate cistern. Internet J Radiol 2009;10.  Back to cited text no. 3
    
4.Yildiz H, Hakyemez B, Koroglu M, Yesildag A, Baykal B. Intracranial lipomas: Importance of localization. Neuroradiology 2006;48:1-7.  Back to cited text no. 4
    
5.Yilmaz N, Unal O, Kiymaz N, Yilmaz C, Etlik O. Intracranial lipomas: A clinical study. Clin Neurol Neurosur 2006;108: 363-8.  Back to cited text no. 5
    
6.Nikaido Y, Imanishi M, Monobe T. Lipoma in the quadrigeminal cistern-case report. Neurol Med Chir (Tokyo) 1995;35:175-8.  Back to cited text no. 6
    
7.Ogbole G, Kazaure I, Anas I. Quadrigeminal plate cistern lipoma. BMJ Case Rep 2009;2009.  Back to cited text no. 7
    
8.Kazner E, Stochdorph O, Wende S, Grumme T. Intracranial lipoma. Diagnostic and therapeutic considerations. J Neurosurg 1980;52:234-45.  Back to cited text no. 8
    
9.Zimmerman RA, Bilaniuk LT, Dolinskas C. Cranial computed tomography of epidermoid and congenital fatty tumors of maldevelopmental origin. J Comput Tomogr 1979;3:40-50.  Back to cited text no. 9
    


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