Dermoid and epidermoid cysts

Dermoid and epidermoid cysts are important intracranial developmental lesions. They are commonly derived from retained surface ectoderm trapped by two fusing neuroectodermal surfaces during neural tube closure, and are also termed congenital ectodermal inclusion cysts. Occasionally epidermoid cysts are acquired lesions derived from iatrogenic implantation of surface ectoderm (termed implantation dermoids). Dermoid cysts are rare, usually midline lesions that present early; these include dermoid structures and may rupture, causing meningitis. Epidermoids are usually lateral, slightly more common, and present later. Radiologically these lesions are characterized by restricted diffusion on MRI which distinguishes them from arachnoid cysts. Treatment is usually surgical with complete or subtotal resection of the cyst, the need for long-term follow-up is controversial.

Iatrogenic implantation of myxoid dedifferentiated chondrosarcoma at donor site: A case report and review of literature

Iatrogenic implantation of chondrosarcoma (CS) is not only extremely rare but also technically avoidable and impacts with morbidity, mortality, and quality of life (QoL). We report a similar case of myxoid dedifferentiated CS at remote tissue-graft donor site (left chest-wall pectoralis major myocutaneous flap). Although the exact mechanism of primary tumor cells seeding is not clear, the probable causes are direct contamination from surgical instruments and altered blood circulation at the graft-donor site.

Iatrogenic cerebellar implantation of a vestibular schwannoma

✓ Metastatic seeding or iatrogenic implantation of numerous types of primary central nervous system tumors, typically along cerebrospinal fluid pathways, is a frequently described albeit rare phenomenon and has never been reported in association with vestibular schwannoma (VS). The authors present a case of inadvertent surgical implantation of VS into the cerebellar hemisphere during resection of a recurrent VS in the cerebellopontine angle and internal auditory canal. A 42-year-old man presented with a 2.5-cm right VS that was removed without complication via a retrosigmoid approach. Routine imaging performed 5 years later revealed a 1.5-cm recurrence of the VS that was subsequently removed by reopening the retrosigmoid craniotomy. Five years later—10 years after initial presentation—follow-up imaging revealed a 1-cm recurrence of the VS and a separate 2.2-cm tumor in the inferior cerebellar parenchyma with surrounding edema. Both tumors were removed without complication by reopening the previous retrosigmoid craniotomy. Histological evaluation of these tumors revealed features typical of VS and similar to those of the tissue obtained from the two prior resections. Given the similarities among these tumors in pathological appearance and mitotic index, the presence of the intraparenchymal cerebellar schwannoma was probably due to intraoperative iatrogenic implantation.

Some Additional Questions: A Response to Shaffer & Cozolino, to Gould and Cozolino, and to Friesen

The author reviews and comments on three articles (Shaffer & Cozolino, Gould & Cozolino, and Friesen) featured in the Journal of Psychology & Theology, 1992, 20(3) special issue on satanic ritual abuse. Issues explored include approaches to the factual validity of patient experiences; the diagnosis and treatment of the emotional sequelae of SRA; the existence of criminal satanic cults; basic premises on which observations and hypotheses about SRA are founded; the difficulty in extrapolating MPD data to SRA memories; the possibility of iatrogenic implantation of SRA “memories” through techniques of hypnotic interrogation; and the part transference issues and resistance may play in personality “splits.” The author affirms the importance of raising questions about the nature of the relationship between patients and therapists during psychotherapy, as well as the need for closer scrutiny of the various techniques being used to uncover and explore alleged trauma memories. The vulnerability of dissociative disorder patients to exploitation suggests the need to carefully review the standards of practice of mental health professionals, whatever their level of education and theoretical/technical persuasion.