Apparent diffusion coefficient of subcutaneous epidermal cysts in the head and neck comparison with intracranial epidermoid cysts.

RATIONALE AND OBJECTIVES: Subcutaneous epidermal cysts and intracranial epidermoid cysts are pathologically identical. Although diffusion-weighted imaging (DWI) studies of intracranial epidermoid cysts have been numerously reported, those of subcutaneous epidermal cysts have not been sufficiently investigated. Our hypothesis for this study is that the apparent diffusion coefficient (ADC) values of subcutaneous epidermal cysts and intracranial epidermoid cysts are not different. This study was intended to evaluate the ADC of subcutaneous epidermal cysts of the head and neck in comparison with that of intracranial epidermoid cysts. MATERIALS AND METHODS: The MR studies were performed in 14 patients with head and neck subcutaneous epidermal cysts and 10 patients with intracranial epidermoid cysts using line scan DWI (LSDWI). The ADC was measured and compared between the two types of cyst. RESULTS: The ADC values (mean +/- SD) were 0.81 +/- 0.14 x 10(-3) mm(2)/s in subcutaneous epidermal cysts and 1.06 +/- 0.12 x 10(-3) mm(2)/s in intracranial epidermoid cysts. A significant difference was found in ADC values between the two types (P = .0019). CONCLUSION: Our preliminary study has shown that the ADC provides useful information regarding tissue characterization of subcutaneous epidermal cysts. However, the ADC of subcutaneous epidermal cysts was significantly lower than that of intracranial epidermoid cysts.

Slowly progressive type 1 diabetes mellitus associated with vitiligo vulgaris, chronic thyroiditis, and pernicious anemia.

A 81-year-old woman was diagnosed as having diabetes mellitus (DM) at 58 years of age. She started insulin therapy the following year, but her blood sugar levels were poorly controlled. At the age of 75, she tested positive for the anti-GAD antibody (7.8 U/ml) and was diagnosed as having slowly progressive type 1 DM (SPIDDM), as well as vitiligo vulgaris. At 78 years of age, chronic thyroiditis was diagnosed after positive tests for anti-thyroid peroxidase antibody and anti-thyroglobulin antibody. At the age of 81, general fatigue and jaundice appeared concomitantly with severe anemia, with Hb levels at 5.2 g/dl. Low serum vitamin B12 levels and the finding of erythroblastic hyperplasia with megaloblasts in bone marrow led to the diagnosis of pernicious anemia. Anemia was alleviated by intramuscular injections of vitamin B12. The patient developed chronic thyroiditis, vitiligo vulgaris, and pernicious anemia concomitantly with SPIDDM, and was diagnosed as having polyglandular autoimmune syndrome type III. Attention should be paid to these potentially associated autoimmune diseases in daily practice during the follow-up of SPIDDM patients.