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Case of the Week 10

A 6-month-old patient with soft tissue swelling of the fontanelle.

What is the most likely diagnosis?

1.Lipoma
2.Neurofibroma
3.Abscess
4.Keratinous cyst

Answer

Case Discussion:

MRI shows a well circumscribed mass overlying anterior fontanelle which is of low signal on T1, high signal on T2, demonstrates diffusion restriction and does not enhance. Features are consistent with keratinous cyst (Pathologically proven).

A keratinous cyst (also called sebaceous cyst, epidermal inclusion cyst) is common cutaneous lesion including keratin arising from the epidermis, frequently from a hair follicle. They generally arise as a result of traumatic/surgical implantation, occlusion of the pilosebaceous unit (1)

References:
1. Hong SH, Chung HW, Choi JY et-al. MRI findings of subcutaneous epidermal cysts: emphasis on the presence of rupture. AJR Am J Roentgenol.