Thoracolumbar intradural extramedullary bronchiogenic cyst

Dorsal Intradural Extramedullary Bronchogenic Cysts: A Case Report and Comprehensive Literature Review

Intradural extramedullary bronchogenic cysts (IEBCs) are exceedingly rare congenital entities, composed of respiratory epithelial cells derived from the anomalous development of the embryonic foregut. Due to their exceptionally low morbidity, only limited cases are available. Consequently, the clinical features and optimal therapeutic approach remain poorly understood. We report a very unusual case of a 54-year-old Mexican male who initially presented with paraparesis seven years ago, leading to a significant gait disturbance. Conservative therapy was employed, with notable improvements seen after four months of treatment. No additional ambulation assistance was required over the following six years, reflecting a stable progression of the condition. However, the patient experienced a worsening recurrent paraparesis, along with episodic dorsal pain in the last year. Physical examination revealed a reduction in lower extremity strength, with preservation of sensory function. Magnetic resonance imaging (MRI) showed an intraspinal, intradural extramedullary lesion in the dorsal region, extending for at least 50% of the canal. Areas of hyperintensity on the T2 sequence, with a fusion of vertebral bodies at the T3-T4 levels, were observed. A posterior dorsal approach was performed with T2-T4 laminectomy, durotomy, and resection of the cystic lesion, draining the cyst and removing the capsule. Histopathology from the capsule reported a ciliated cyst morphologically characterized by bronchogenic features; immunohistochemistry revealed positivity for cytokeratin cocktail AE1/AE3. Follow-up MRI showed no residual lesion, without further complications. Surgical resection is the most effective treatment for intraspinal bronchogenic cysts, providing significant symptom relief. Complete removal is ideal, while partial resection may reduce complications in cases with severe adhesions; however, it increases the risk of recurrence. Due to the rarity of the disease, the number of cases is relatively limited. Future studies should strongly consider employing a larger sample size and extending the follow-up period to better understand the spectrum of the disease.

Impact of the Extent of Surgical Resection on Patients With Intradural Extramedullary Bronchogenic Cysts: A Retrospective Institutional Experience and Review of the Literature

Intradural extramedullary bronchogenic cysts (IEBC) are rare congenital cystic lesions. The clinical manifestations, radiological characteristics, especially the optimal treatment regimen are not well-understood. We retrospectively analyzed a series of patients with confirmed IEBC in Tangdu hospital and reviewed the published works to gain a comprehensive understanding of IEBC. In our institution, nine consecutive patients had pathologically confirmed IEBC between 2005 and 2018. We also identified 27 patients from previous studies. The most common presentations on magnetic resonance imaging (MRI) were hypointensity on T1-weighted images (T1WI), hyperintensity on T2-weighted images(T2WI), and no improvement on T1WI contrast-enhanced with gadolinium (94.4%). All patients in our center and the patients we reviewed received surgical resection; gross total resection (GTR) and partial resection (PR) were achieved in 20 (55.6%) and 16 (44.4%) patients, respectively. The symptom remission rate of patients who underwent GTR was 100%, which was similar to those who underwent PR (93.8%) (P = 0.457). The recurrence rate was 12.5% in the group who underwent PR and nil after GTR (P = 0.202). According to our current investigation, the surgical resection degree is irrelevant to the symptom remission rate. Therefore, we suggest that total resection should not be recommended for cases with tight adhesion. For patients with PR, longer follow-up will be necessary to determine the long-term outcome.

Large intramedullary bronchogenic cyst of the cervical spine: illustrative case

BACKGROUND

Spinal bronchogenic cysts are rare entities arising from errors in embryogenesis and consisting of respiratory epithelial cells. To date, there are three other published accounts of intramedullary cysts, which were partially resected and thereby warrant close follow-up and monitoring. The authors present an illustrative case of a patient presenting with Klippel-Feil anomaly and a large intramedullary bronchogenic cyst in the upper cervical spine.

OBSERVATIONS

The authors noted fusion of the C5–6 laminae as they performed the C2–6 laminectomy. After dural opening, an intramedullary lesion with a smooth, fibrous component emerging from the dorsal spinal cord was immediately observed. The dorsal spinal columns were not involved with this cyst wall or the other smaller cysts, which all contained gray fluid. The cyst walls were partially resected and sent for pathological examination.

LESSONS

Spinal developmental cysts are associated with other anatomical anomalies, such as Klippel-Feil anomaly, arising from errors in embryogenesis. For intramedullary lesions such as this patient’s bronchogenic cyst, partial resection and decompression are the goals of surgery because aggressive debulking may lead to neurological compromise. Close imaging follow-up is warranted.

Upper cervical spinal bronchogenic cyst: A rare lesion at an exceptional location

An intraspinal bronchogenic cyst is a rare but important cause of compressive cord myelopathy, commonly seen in the cervicothoracic spine. We report a case of a 30-year-old female, presented with complaints of neck pain and progressive weakness of the extremities. The magnetic resonance imaging of the cervical spine revealed an intradural extramedullary, well-defined, multiloculated, cystic lesion in the upper cervical canal extending from the C2 to C5 vertebral levels. To our knowledge, only 11 cases of spinal bronchogenic cysts have been reported in the literature so far. We discuss the rare location of this unusual lesion, possible embryological reasons, and the overall surgical outcome.

Bronchogenic Cyst: Skull Base Lesions with Extracranial Extension

BACKGROUND

Intracranial bronchogenic cysts (BCs) are extremely rare. To our knowledge, this is the first report of a BC in which lesions involve the middle and posterior cranial fossa, as well as the infratemporal fossa.

CASE DESCRIPTION

We present the case of a 38-year-old woman who suffered from a cranial nerve dysfunction for 2 years. Magnetic resonance imaging showed that there were skull base communication lesions across the middle and posterior fossa. The patient was operated on through an infratemporal fossa approach. The final diagnosis was BC after histopathologic examination and immunohistochemical verification. The patient's neurologic dysfunction was partially ameliorated at the half-year follow-up.

CONCLUSIONS

Intracranial BCs are rare. However, they should be considered in the differential diagnosis for cystic lesions with edge enhancement or extracranial extension.

Intramedullary bronchogenic cyst in the foramen magnum region accompanied with syringomyelia: A case report and literature review

RATIONALE

Bronchogenic cysts refer to congenital anomalies derived from the primitive foregut. Spinal bronchogenic cysts are uncommon entities, and those occurring in the intramedullary sites are extremely rare. Bronchogenic cysts involving the foramen magnum region have only been described in 2 cases; however, intramedullary bronchogenic cysts with syringomyelia have not yet been reported.

PATIENT CONCERNS

A 46-year-old woman presented with a 6-month history of pain in the posterior neck region and a 1-month history of numbness in the upper extremities. Neurological examination revealed a loss of sensation in bilateral upper extremities and sensory dissociation. Magnetic resonance imaging (MRI) showed an intramedullary cystic lesion in the foramen magnum region and syringomyelia.

DIAGNOSIS

Histopathological findings were consistent with a bronchogenic cyst.

INTERVENTIONS AND OUTCOMES

A surgical resection of the cystic lesion was performed via a posterior midline approach. Under neurophysiological monitoring, the cyst was punctured, yielding gelatinous liquid. The dorsal part of the cystic wall was removed. One month postoperatively, the symptoms were resolved completely. Three months after operation, MRI showed no recurrence of the cyst and the syringomyelia disappeared.

LESSONS

Intramedullary bronchogenic cysts with syringomyelia are extremely rare. Preoperative identification is challenging and definitive diagnosis depends on histopathological evidence. Timely surgical resection should be highlighted.

Upper Cervical Bronchogenic Cyst: A Rare Condition at a Rare Location

Intraspinal bronchogenic cyst (SBC) is a rare but important cause of spinal cord compression, commonly seen in the cervicothoracic spine. We report a case of a 43-year-old male, presenting with complaints of neck pain, radiating to right shoulder, with numbness of right hand and fingers. Magnetic resonance imaging of the cervical spine revealed an intradural extramedullary, ventral cystic lesion extending from C2 to C4 vertebral levels. Complete surgical excision was performed, and the patient had a complete relief of symptoms postoperatively. Only 11 cases of SBCs have been reported in literature. We discuss the peculiar location of this lesion, possible embryological reasons and the overall surgical outcome of SBC.

An intradural extramedullary bronchogenic cyst in the thoracolumbar spine: A case report

RATIONALE

We report the symptoms beginning with weakness and the clinical courses of a patient who was diagnosed with an intradural extramedullary bronchogenic cyst.

PATIENT CONCERNS

The patient was a 44-year-old man visited the Department of Physical Medicine and Rehabilitation for walking difficulties characterized by limping due to muscle weakness of left lower extremity for 5 months and atrophy in left calf muscle.

DIAGNOSES

Lumbar spine MRI was repeated, since radiating pain in the left hip and posterior thigh with low back pain developed 16 months later. Intraspinal mass of T12 and L1 levels that was not found in the first MRI was newly found in the follow-up MRI.

INTERVENTIONS

Total tumor removal was conducted with laminectomy. It was finally diagnosed as an intradural extramedullary bronchogenic cyst on the basis of the pathological analysis results.

OUTCOMES

His left calf circumference was increased compared to before surgery the radiating pain also disappeared.

LESSONS

If the patient's MRI findings are not correlated with the electrophysiologic and physical examination findings, additional MRI should be accompanied with other tests for an early detection.

An unusual case of intradural intramedullary dorsal bronchogenic cyst in spine

Bronchogenic cysts are congenital malformations derived from anomalous budding of the embryonic foregut. Intraspinal bronchogenic cysts are extremely rare and most of them are extramedullary. There has been only one case of intramedullary spinal bronchogenic cyst reported. We present an 18-year-old male patient with spastic paraparesis and bowel and bladder involvement. MRI revealed a 2 cm diameter intradural and intramedullary lesion at D2-D3 level which was hyperintense on T1 and hypointense on T2 imaging. Histopathological examination after surgical excision of the lesion revealed a bronchogenic cyst. To our knowledge this is the first case reporting an intramedullary bronchogenic cyst at the upper dorsal level and overall second reported case of intramedullary spinal bronchogenic cyst.

Dual lumbar bronchogenic and arachnoid cyst presenting with sciatica and left foot drop

INTRODUCTION

Spinal bronchogenic cysts are rare findings, with only four cases of lumbar bronchogenic cysts reported in the literature. All of these bronchogenic cysts involved the conus medullaris. We present the first case of a lumbar bronchogenic cyst and arachnoid cyst arising from the cauda equina in a 68-year-old male. Uniquely, this bronchogenic cyst also contained components of an arachnoid cyst.

METHODS

Magnetic resonance imaging (MRI) demonstrated a compressive cystic lesion at the level of the L3 vertebra splaying the cauda equina. An L3/L4 laminectomy was performed with marsupialisation of the cyst.

RESULTS

Histological examination revealed pseudostratified ciliated columnar epithelium confirming the diagnosis of a bronchogenic cyst, as well as a pleated fibrovascular tissue lined by sparsely spaced small monomorphic arachnoidal cells, indicating an arachnoid cyst.

CONCLUSION

We demonstrate that bronchogenic cysts can be successfully treated with marsupialisation.

Intraspinal bronchogenic cyst: Series of case reports and literature review

PURPOSE

Spinal bronchogenic cysts (SBCs) are rare congenital lesions. The clinical and imaging characteristics and treatment of SBCs are not well known. We studied three cases of SBCs retrospectively, which were registered in our department and analyzed eight case reports which were all published in English, focusing on providing a deeper knowledge of SBCs.

METHODS

Three patients with SBCs registered in our department were retrospectively reviewed. Eight reported SBCs cases published from 1992 to 2015 were enrolled in our study. Imaging diagnosis was confirmed by computed tomography (CT), MRI, and computed tomography angiography (CTA). All of our patients and reviewed cases had undergone surgical resection and the final diagnosis was made by pathological examination.

RESULTS

Five lesions were located at the cervical spinal canal. Most patients presented with pain in the limbs and back, which might be related to compression of the spinal cord and the reduced blood supply of the anterior spinal artery. The signal intensity on MRI was correlated with cystic fluid traits to a large extent. Seven lesions were partially removed because of the adhesions to the nearby spinal cord. All reported cases had no recurrence in the later follow-up.

CONCLUSIONS

SBCs can occur anywhere in the spinal canal, but they are more likely to present at the cervical canal and might be present along with some developmental malformations of the spine. We emphasize the role of CT and MRI findings in the disease diagnosis. It is recommended that the lesion should be removed as completely as possible.

Intramedullary and Extramedullary Cervical Neurenteric Cyst Requiring Fixation and Fusion

BACKGROUND

Spinal neurenteric cysts are rare in the literature, described by sporadic case reports and small case series. In the vast majority of cases, these lesions are intradural extramedullary. We report the novel case of a cervical neurenteric cyst that was simultaneously intramedullary and extramedullary.

CASE DESCRIPTION

A 47-year-old man underwent C2 through C7 laminectomies for microsurgical resection of a large cystic intradural mass, with C1 through T1 instrumentation and fusion. Gross total resection was obtained. Fusion was necessary after removal of the posterior elements because the vertebrae were thinned extensively and remodeled around the tumor, a treatment paradigm that has not been described adequately for neurenteric cysts previously.

CONCLUSIONS

A novel case of cervical intramedullary and extramedullary neurenteric cyst is presented with clinical, radiographic, and histologic details. Given the potential for bony remodeling around these developmental tumors, the possibility exists for instability after certain neurenteric cysts are resected. Thus, the present case adds fixation and fusion to the potential treatment paradigm for select spinal neurenteric cysts.

Case Report Series and Review of Rare Intradural Extramedullary Neoplasms-Bronchiogenic Cysts

The congenital malformation known as an intraspinal bronchiogenic cyst is a rare form of endodermal (neurenteric, enterogenous) cyst lined with respiratory tract epithelium. We describe 3 new cases of intradural extramedullary bronchiogenic cyst in the Department of Neurosurgery between the years 2006 and 2014. Three patients were performed resection of intradural extramedullary bronchiogenic cysts and finally symptoms were relieved. Taken together with 10 previous reports identified from a PubMed search, an analysis of 13 cases of intradural bronchiogenic cysts was conducted. The aim of this literature review was to provide information on histopathology, mechanisms of pathogenesis, clinical manifestations, radiographic features, and surgical strategies.Symptoms in spinal bronchiogenic cyst patients primarily depend on the local mass effect of the cyst on the spinal cord. magnetic resonance imaging, together with myelograms and computed tomography scans, is necessary to preoperative evaluation of spinal bronchiogenic cysts. The aim of surgery is total resection, although tight adhesion, ventral and intramedullary locations, and vertebral anomalies make it more challenging.

Solitary cervical neurenteric cyst in an adolescent patient

Spinal neurenteric cysts are uncommon congenital lesions, furthermore solitary neurenteric cysts of the upper cervical spine are very rare. A 15-year-old boy having an intraspinal neurenteric cyst located at cervical spine presented with symptoms of neck pain and both shoulders pain for 2 months. Cervical spine magnetic resonance (MR) imaging demonstrated an intradural extramedullary cystic mass at the C1-3 level without enhancement after gadolinium injection. There was no associated malformation on the MR imaging, computed tomography, and radiography. Hemilaminectomy at the C1-3 levels was performed and the lesion was completely removed through a posterior approach. Histological examination showed the cystic wall lined with ciliated pseudostratified columnar epithelium containing mucinous contents. Neurenteric cyst should be considered in the diagnosis of spinal solitary cystic mass.

Intramedullary bronchogenic cyst of the conus medullaris

Spinal bronchogenic cysts are rare congenital lesions. The authors describe their experience in the treatment of a 17-year-old boy who presented with back pain and paresthesia in both lower extremities. Lumbar MR imaging revealed the presence of an intramedullary cystic lesion at the conus medullaris and histopathological analysis revealed a bronchogenic cyst. To the best of the authors' knowledge, this is the first report of an intramedullary spinal bronchogenic cyst arising at the conus; all previously reported spinal bronchogenic cysts were either intradural extramedullary or not located at the conus.

Thoracic myelopathy secondary to intradural extramedullary bronchogenic cyst

BACKGROUND/OBJECTIVE

To report a case of thoracic myelopathy secondary to intradural extramedullary bronchogenic cyst.

STUDY DESIGN

Case report.

METHODS/FINDINGS

A 20-year-old man presented to the emergency department with increasing back pain and lower-extremity weakness. Magnetic resonance imaging demonstrated a cystic lesion at the T4 level with mass effect on the spinal cord.

RESULTS

The lesion was resected, and histopathologic evaluation showed a cyst lined by respiratory-type epithelium consistent with a bronchogenic cyst.

CONCLUSIONS

Intradural extramedullary bronchogenic cysts of the thoracic spine have been reported previously but are extremely rare. The treatment of choice is surgical resection.

Sacral intraspinal bronchogenic cyst: a case report

Intraspinal bronchogenic cysts are rare congenital cystic lesions. In all the reported cases, the cysts have been located in the cervical, upper thoracic or thoracolumbar segments. We report the case of an intraspinal bronchogenic cyst in the sacral location. We present the case of a 5-month-old female with a skin dimple in the midline over the sacral vertebra. Magnetic resonance image of the lumbar and sacral vertebra revealed a dermal sinus tract and an epidural cystic mass at the S2 level. The patient underwent the removal of the dermal sinus tract and the cyst. The cystic mass was shown to be connected to the subarachnoid space through a slender pedicle from the dura. The cyst was diagnosed to be a bronchogenic cyst based on the results of the histopathological examination. We conclude that intraspinal bronchogenic cysts may appear in the sacral location.

Lumbar Intradural Extramedullary Bronchiogenic Cyst

The pathological findings of an intradural and extramedullary cyst at the L1 level of the spinal canal are described in a 28-year-old male who presented with chronic lumbago and progressive weakness and numbness in both lower limbs. Histopathological examination revealed the diagnosis of bronchiogenic cyst. Bronchiogenic cysts in the spinal canal are uncommon, and cysts at the L1 level are extremely rare. Their pathogenesis is still poorly understood. They are thought to be a malformation arising from a split notochordal syndrome. We conclude that intradural extramedullary bronchiogenic cysts may appear also at lumbar levels. Surgical resection can be achieved with good outcome.