case_images: PMC11021098_01
case_images: The patient exhibited multiple subepidermal keratin cysts that appeared as small, firm white papules in varying numbers, consistent with milia.
case_images: SNI-15-89-g001.jpg
case_images: PMC11021098_01_SNI-15-89-g001.jpg
case_images: F1
case_images: On careful inspection, there was no evidence of skin lesions other than diffuse milia [Figure 1].
case_images: First magnetic resonance imaging of the brain showing a huge lesion in the temporal bone. (a) Axial T1-weighted with contrast exhibiting temporal bone mass with peripheral contrast enhancement - right side. (b) Axial T2-weighted image shows hyperintense signal abnormality in the mastoid part of the temporal bone. The occipital bone was invaded. (c) Contrast-enhanced axial T1-weighted showing a large temporal bone tumor on the right side. (d) The mass was predominantly hyperintense on the T2-weighted image.
case_images: SNI-15-89-g002.jpg
case_images: PMC11021098_01_SNI-15-89-g002.jpg
case_images: F2
case_images: The lesion invaded the mastoid, petrous part of the right temporal bone, and squamous part of the occipital bone with no evidence of involvement of the cerebellar tissue [Figure 2].
case_images: Contrast-enhanced axial T1-weighted brain magnetic resonance imaging shows temporal bone tumor invading the cerebellar tissue with dislocation of the IV ventricle.
case_images: SNI-15-89-g003.jpg
case_images: PMC11021098_01_SNI-15-89-g003.jpg
case_images: F3
case_images: Two months after the last surgery, a new brain MRI revealed local recurrence and invasion of the cerebellar tissue [Figure 3].
case_images: Microsurgical resection of the tumor invading the cerebellar tissue. (a) The tumor was identified after the dural opening. (b) Circumferential dissection between the tumor and normal cerebellum parenchyma. (c) Tumor removal using a microdissector.
case_images: SNI-15-89-g004.jpg
case_images: PMC11021098_01_SNI-15-89-g004.jpg
case_images: F4
case_images: Another partial resection was performed [Figure 4].
case_images: Temporal bone tumor samples: (a) Hematoxylin and Eosin (H&E) stain (x200). Squamous epithelium with some maturation, keratin sheets with parakeratosis, sometimes forming horny pearls. (b) H&E stain (x400). Foci of preserved squamous epithelium showing areas with enlarged nuclei, but no signs of stromal invasion. (c) H&E stain (x100). Sample from the cerebellar region. Squamous epithelium presenting poorly cohesive cells with moderate to marked pleomorphism, superficially infiltrating the cerebellar cortex. (d) H&E stain (x400). Sample from the dural region. Squamous epithelium with an enlarged and irregular nucleus, and frequent atypical mitotic figures infiltrating fibroconnective tissue.
case_images: SNI-15-89-g005.jpg
case_images: PMC11021098_01_SNI-15-89-g005.jpg
case_images: F5
case_images: Pathology samples are collected in Figure 5.
case_images: Comparison between the first brain magnetic resonance imaging (MRI) (fluid-attenuated inversion recovery [FLAIR] sequence) and head computed tomography (CT) after symptoms of hydrocephalus. (a) Preoperative MRI-FLAIR shows a normal lateral ventricle without radiological signs of hydrocephalus. Normal anatomical variation is observed: Cavum septum pellucidum. (b) Head CT showing enlargement of the lateral ventricles and transependymal edema: Low-density change on CT around the margins of the ventricles.
case_images: SNI-15-89-g006.jpg
case_images: PMC11021098_01_SNI-15-89-g006.jpg
case_images: F6
case_images: The new MRI revealed infiltration of the mass into the cerebellar region, accompanied by compression of the fourth ventricle and obstructive hydrocephalus [Figure 6].
case_images: Final appearance of the wound after four attempts at tumor resection and adjuvant radiotherapy. The surgical wound is open and the patient was referred for palliative care.
case_images: SNI-15-89-g007.jpg
case_images: PMC11021098_01_SNI-15-89-g007.jpg
case_images: F7
case_images: At present, his surgical wound is open [Figure 7] and he is being monitored by palliative care.