1
|
Wu X, Cheng XL, Kang MY, Dong RP, Qu Y, Zhao JW. Intradural extramedullary spinal choristoma: A case report. Medicine (Baltimore) 2023; 102:e36672. [PMID: 38115260 PMCID: PMC10727637 DOI: 10.1097/md.0000000000036672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 11/23/2023] [Indexed: 12/21/2023] Open
Abstract
RATIONALE A choristoma is a rare and benign neoplasm characterized by the presence of normal tissue in an anomalous anatomical location. In contrast, choristoma tend to occur in other body regions rather than within the spinal canal. Before our findings, only 4 cases of intraspinal choristoma had been recorded. Because its composition is complex and very rare, routine examinations, such as magnetic resonance imaging, are difficult to diagnose, and the possibility of its occurrence is often missed in clinical diagnosis. If there is no specificity in its components, such as in this case, even pathological examinations can only confirm the diagnosis as choristoma after eliminating other possibilities. Therefore, in clinical practice, when encountering patients with intraspinal tumors, it is essential to consider the possibility of choristoma. In this case, the choristoma lack of specific constituent composition sets it apart from previously reported intraspinal choristoma, significantly raising the diagnostic challenge, which offers valuable insights for clinical diagnosis. PATIENT CONCERNS A female patient aged 48 years was admitted to our medical center due to experiencing persistent lower back pain accompanied by radiating pain in both legs for 5 months. Based on the findings from the neurological physical examination and magnetic resonance imaging, the patient was diagnosed with an intradural space-occupying lesion located at the level of the first lumbar vertebral body. We performed an enhanced magnetic resonance neurography examination to further determine the positional relationship between the occupation and nerves in preparation for surgery. Postoperative pathological biopsy showed that the mass was an intraspinal choristoma. DIAGNOSIS Intradural extramedullary spinal choristoma. INTERVENTION Occupied lesion is removed surgically. OUTCOMES After surgery, all symptoms were significantly relieved, and when the patient was discharged, all symptoms disappeared completely. There was no sign of recurrence after 1 year of follow-up. LESSONS Intraspinal choristomas are not specific and need to be diagnosed by pathologic examination. Early detection of and intervention for intraspinal tumors can mitigate nerve dysfunction.
Collapse
Affiliation(s)
- XueRui Wu
- Department of Orthopedics, The Second Hospital of Jilin University, Changchun, Jilin Province, China
| | - Xue-Liang Cheng
- Department of Orthopedics, The Second Hospital of Jilin University, Changchun, Jilin Province, China
| | - Ming-Yang Kang
- Department of Orthopedics, The Second Hospital of Jilin University, Changchun, Jilin Province, China
| | - Rong-Peng Dong
- Department of Orthopedics, The Second Hospital of Jilin University, Changchun, Jilin Province, China
| | - Yang Qu
- Department of Orthopedics, The Second Hospital of Jilin University, Changchun, Jilin Province, China
| | - Jian-Wu Zhao
- Department of Orthopedics, The Second Hospital of Jilin University, Changchun, Jilin Province, China
| |
Collapse
|
2
|
Raj S, Chouksey P, Shrivastava A, Mishra R, Tandon A, Prakash M, Agrawal A. Non-dysraphic extramedullary intradural spinal lipoma with neurocutaneous melanocytosis. Br J Neurosurg 2023; 37:1824-1828. [PMID: 34148439 DOI: 10.1080/02688697.2021.1937518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Accepted: 05/28/2021] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Intradural spinal lipomas are very rare and constitute less than 1% of all spinal tumors. Such tumors are usually associated with spinal dysraphism and occur mostly in the lumbosacral or cervical region. Intradural spinal lipomas tends to be intramedullary or subpial. Meningeal melanocytoma is further rarer cases that comprise less than 0.1% of cases. These usually occur in the fifth or fifth decade and chances of malignant transformation are high. CASE REPORT Here, we report an extremely rare case (first to the best of our knowledge) of a 9 years female child who presented to us with rapid progressing paraparesis. She was operated and found to have an intradural purely extramedullary spinal lipoma without spinal dysraphism. Moreover, she had melanin pigment deposits all over her meninges which is further rare. On presentation, the patient was bedridden but after surgery, the patient improved and could walk without support. CONCLUSIONS To the best of our knowledge, this is the first case of spinal cord lipoma in dorsal location along with melanin pigments in the meninges. We discuss the pathogenesis, presentation and management of intradural extramedullary spinal lipomas.
Collapse
Affiliation(s)
- Sumit Raj
- Department of Neurosurgery, All India Institute of Medical Sciences, Bhopal, India
| | - Pradeep Chouksey
- Department of Neurosurgery, All India Institute of Medical Sciences, Bhopal, India
| | - Adesh Shrivastava
- Department of Neurosurgery, All India Institute of Medical Sciences, Bhopal, India
| | - Rakesh Mishra
- Department of Neurosurgery, All India Institute of Medical Sciences, Bhopal, India
| | - Ashwani Tandon
- Department of Pathology, All India Institute of Medical Sciences, Bhopal, India
| | - Manas Prakash
- Department of Neurosurgery, All India Institute of Medical Sciences, Bhopal, India
| | - Amit Agrawal
- Department of Neurosurgery, All India Institute of Medical Sciences, Bhopal, India
| |
Collapse
|
3
|
Hazneci J, Bastacı F, Börekci A, Öztürk ÖÇ, İş M, Somay A, Ekşi MŞ, Çelikoğlu E. Split cord malformation concomitant with spinal teratoma without open spinal dysraphism. Childs Nerv Syst 2022; 38:1977-1986. [PMID: 35687168 DOI: 10.1007/s00381-022-05578-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Accepted: 05/24/2022] [Indexed: 11/26/2022]
Abstract
PURPOSE Split cord malformation (SCM) presenting concomitant with spinal teratoma without any open spinal dysraphism has rarely been reported in the literature. We aimed to make a systematic review and qualitative analysis of the literature about the topic and present the first case of SCM concomitant with spinal teratoma harboring papillary thyroid carcinoma (PTC) component. METHODS Two big search tools (Pubmed/MEDLINE) and Scopus were used. The search strategy was compatible to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). An exemplary case of ours was also presented. RESULTS There were 30 patients (15 pediatric and 15 adult). Female and male distribution was even. Median age of the patients was 18 years (range = 0-66 years). The most common presenting symptoms were back pain and lower limb weakness. Spinal teratoma and SCM mostly presented at thoracic/thoracolumbar region in children and lumbar region in adults. Surgical outcome was better in the children compared to the adults. CONCLUSION Thoracolumbar region is the most common location for such entity in children, whereas lumbar region for the adults. Surgical resection should be done as much as possible under neuromonitorization. The resected material should be evaluated thoroughly not to miss any malign pathology. Surgical outcome is better when it is done at an early age.
Collapse
Affiliation(s)
- Jülide Hazneci
- FSM Training and Research Hospital, Neurosurgery Clinic, Istanbul, Turkey
| | - Feryal Bastacı
- FSM Training and Research Hospital, Neurosurgery Clinic, Istanbul, Turkey
| | - Ali Börekci
- FSM Training and Research Hospital, Neurosurgery Clinic, Istanbul, Turkey
| | | | - Merih İş
- Private Practice, Neurosurgery, Istanbul, Turkey
| | - Adnan Somay
- FSM Training and Research Hospital, Pathology Clinic, Istanbul, Turkey
| | - Murat Şakir Ekşi
- FSM Training and Research Hospital, Neurosurgery Clinic, Istanbul, Turkey.
- School of Medicine, Neurosurgery Research Laboratory, Yeditepe University, Istanbul, Turkey.
- , Istanbul, Turkey.
| | - Erhan Çelikoğlu
- FSM Training and Research Hospital, Neurosurgery Clinic, Istanbul, Turkey
| |
Collapse
|
4
|
Thompson DNP, Spoor J, Schotman M, Maestri S, Craven CL, Desai D. Does conus morphology have implications for outcome in lumbosacral lipoma? Childs Nerv Syst 2021; 37:2025-2031. [PMID: 33604718 DOI: 10.1007/s00381-021-05081-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 02/08/2021] [Indexed: 12/01/2022]
Abstract
OBJECTIVE Lumbosacral lipomas (LSL) of the 'dorsal' type have been associated with more favourable outcomes compared with other conus region lipomas. We hypothesised that integrity of the conus on MRI underpins the improved prognosis in this subgroup of LSL patients. METHODS The definition of 'dorsal lipomas' included lipomas with attachment to the conus, but where the conus could be delineated on MRI (Morota type 1) as reported by Morota et al. (J Neurosurg Pediatr 19:428-439, 2017). Additional inclusion criteria included asymptomatic status at presentation, age >3 years at follow-up, and neurological and urological evaluation at presentation and at last follow-up. Lipoma extent and conus level were recorded. Outcome measures were the need for untethering surgery and neuro-urological status at last follow-up. Urological outcomes were defined by continence and efficacy of bladder emptying. RESULTS Twenty-six children were included (median age 8.7 years). Conus level was low (at or below L2) in 92%. Nine required untethering surgery: 5 prophylactic, 4 because of clinical deterioration. Twenty-five children were continent at last follow-up, one had stress incontinence, and none required catheterisation. One had persisting ankle weakness after surgery requiring orthotic support. CONCLUSIONS In LSL of the conus, visualisation of the conus on MRI is associated with good urological and motor outcomes. The integrity of the conus appears to be a more important prognostic factor than anatomical level. An observational approach to this group of LSL patients does not appear to compromise outcomes. These findings support a selective approach to untethering surgery.
Collapse
Affiliation(s)
- Dominic N P Thompson
- Department of Paediatric Neurosurgery, Great Ormond Street Hospital for Children NHS Trust, London, UK.
| | - Jochem Spoor
- Department of Paediatric Neurosurgery, Great Ormond Street Hospital for Children NHS Trust, London, UK.,Department of Paediatric Neurosurgery, Erasmus MC Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Martje Schotman
- Department of Paediatric Neurosurgery, Great Ormond Street Hospital for Children NHS Trust, London, UK.,Department of Urology, Haga Hospitals, The Hague, The Netherlands
| | - Susan Maestri
- Department of Paediatric Urology, Great Ormond Street Hospital for Children NHS Trust, London, UK
| | - Claudia L Craven
- Department of Paediatric Neurosurgery, Great Ormond Street Hospital for Children NHS Trust, London, UK
| | - Divyesh Desai
- Department of Paediatric Urology, Great Ormond Street Hospital for Children NHS Trust, London, UK
| |
Collapse
|
5
|
Expression Patterns of Hypoxia-Inducible Factors, Proinflammatory, and Neuroprotective Cytokines in Neuroepithelial Tissues of Lumbar Spinal Lipomas-A Pilot Study. World Neurosurg 2020; 141:e633-e644. [PMID: 32522652 DOI: 10.1016/j.wneu.2020.05.256] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2020] [Revised: 05/27/2020] [Accepted: 05/28/2020] [Indexed: 01/03/2023]
Abstract
OBJECTIVE Lumbosacral lipomas (LSLs), one form of closed spinal dysraphism, are congenital disorders of the terminal spinal cord (SC). Delayed neurologic deterioration often occurs in the subsequent developmental course of the patient. Identifying the cellular and molecular factors underlying the progressive damage to neural structures is a prerequisite for developing treatment strategies for LSLs. METHODS Nine LSL specimens obtained from the SC/lipoma interface during surgical resection were examined. Normal SC tissue served as a control. Clinical characteristics were obtained, and spinal magnetic resonance imaging was re-evaluated. Cellular marker profiles were established. Immunoreactivity (IR) of hypoxia-inducible factor 1α (HIF-1α/-2α), erythropoietin (Epo)/erythropoietin receptor (EpoR), interleukin-1β (IL-1β)/IL-1R1, and tumor necrosis factor α/tumor necrosis factor receptor type 1 were analyzed qualitatively and semiquantitatively by densitometry. Colabeling with cellular markers was determined by multifluorescence labeling. Cytokines were further analyzed by real-time reverse transcription polymerase chain reaction. RESULTS LSL specimens showed significant gliosis. HIF-1α/HIF-2α-IR and Epo/Epo-IR were found at significantly higher levels in the LSL specimens, as were IL-1β-/IL-1β receptor type 1 (IL1-R1) and tumor necrosis factor α/tumor necrosis factor receptor type 1 (P < 0.001), than were the controls. At the messenger RNA level, cytokines appeared partially induced. Double immunofluorescence labeling confirmed the costaining of these factors with inflammatory and glial markers. CONCLUSIONS The expression of hypoxia-related and inflammatory mediators was shown for the first time in LSL specimens. These factors might play a role in multifactorial secondary lesion cascades underlying further damage to the neural placode in closed dysraphism.
Collapse
|
6
|
Rhodes RH. Congenital Spinal Lipomatous Malformations. Part 1. Spinal Lipomas, Lipomyeloceles, and Lipomyelomeningoceles. Fetal Pediatr Pathol 2020; 39:194-245. [PMID: 31342816 DOI: 10.1080/15513815.2019.1641859] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Background: Lumbosacral spinal lipomas and lipomyeloceles are usually identified in early childhood. Terminology, histopathology, and diagnosis for these malformations can be confusing. Materials and Methods: This is a PubMed review with comparison of embryology, gross, and histopathology, and reporting requisites for these and related closed spinal malformations. Results: The spinal lipoma group (congenital spinal lipomatous malformations) includes subcutaneous, transdural, intradural, and noncontiguous malformations stretching through the entire lower spinal region. This lipomyelocele trajectory overlaps the embryonic tail's caudal eminence. Histopathologically, the lipomyelocele spectrum is a heterogeneous, stereotypical set of findings encountered from dermis to spinal cord. Diagnosis requires detailed correlation of images, intraoperative inspection, and histopathology. Conclusions: Appropriate terminology and clinicopathologic correlation to arrive at a diagnosis is a critical activity shared by pathologist and clinician. Prognostic and management differences depend on specific diagnoses. Familial and genetic influences play little if any role in patient management in closed spinal malformations.
Collapse
Affiliation(s)
- Roy H Rhodes
- LSUHSC, Pathology, New Orleans, Louisiana, USA.,Rutgers Robert Wood Johnson Medical School, Pathology, New Brunswick, New Jersey, USA
| |
Collapse
|
7
|
Enlargement of sacral subcutaneous meningocele associated with retained medullary cord. Childs Nerv Syst 2018; 34:1785-1790. [PMID: 29704125 DOI: 10.1007/s00381-018-3812-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Accepted: 04/17/2018] [Indexed: 10/17/2022]
Abstract
BACKGROUND A retained medullary cord (RMC) is a rare closed spinal dysraphism with a robust elongated neural structure continuous from the conus and extending to the dural cul-de-sac. Four cases of RMC extending down to the base of an associated subcutaneous meningocele at the sacral level have been reported. CLINICAL PRESENTATION We report an additional case of RMC, in whom serial MRI examination revealed an enlargement of the meningocele associated with RMC over a 3-month period between 8 and 11 months of age, when he began to stand. At the age of 12 months, untethering of the cord was performed. Histologically, the presence of ependyma-lined central canals in the dense neuroglial cores was noted in all cord-like structures in the intradural and intrameningocele sacs and at the attachment to the meningocele. CONCLUSION It is conceivable that the hydrodynamic pressure with standing position and the check valve phenomenon were involved in meningocele enlargement. We should be mindful of these potential morphological changes.
Collapse
|
8
|
Jones V, Wykes V, Cohen N, Thompson D, Jacques TS. The pathology of lumbosacral lipomas: macroscopic and microscopic disparity have implications for embryogenesis and mode of clinical deterioration. Histopathology 2018; 72:1136-1144. [PMID: 29350777 PMCID: PMC5969216 DOI: 10.1111/his.13469] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2017] [Accepted: 01/15/2018] [Indexed: 01/22/2023]
Abstract
AIMS Lumbosacral lipomas (LSL) are congenital disorders of the terminal spinal cord region that have the potential to cause significant spinal cord dysfunction in children. They are of unknown embryogenesis with variable clinical presentation and natural history. It is unclear whether the spinal cord dysfunction reflects a primary developmental dysplasia or whether it occurs secondarily to mechanical traction (spinal cord tethering) with growth. While different anatomical subtypes are recognised and classified according to radiological criteria, these subtypes correlate poorly with clinical prognosis. We have undertaken an analysis of surgical specimens in order to describe the spectrum of histological changes that occur and have correlated the histology with the anatomical type of LSL to determine if there are distinct histological subtypes. METHODS AND RESULTS The histopathology was reviewed of 64 patients who had undergone surgical resection of LSL. The presence of additional tissues and cell types were recorded. LSLs were classified from pre-operative magnetic resonance imaging (MRI) scans according to Chapman classification. Ninety-five per cent of the specimens consisted predominantly of mature adipocytes with all containing thickened bands of connective tissue and peripheral nerve fibres, 91% of samples contained ectatic blood vessels with thickened walls, while 22% contained central nervous system (CNS) glial tissue. Additional tissue was identified of both mesodermal and neuroectodermal origin. CONCLUSIONS Our analysis highlights the heterogeneity of tissue types within all samples, not reflected in the nomenclature. The diversity of tissue types, consistent across all subtypes, challenges currently held notions regarding the embryogenesis of LSLs and the assumption that clinical deterioration is due simply to tethering.
Collapse
Affiliation(s)
- Victoria Jones
- Developmental Biology and Cancer ProgrammeUCL Institute of Child HealthLondonUK
- Department of NeurosurgeryGreat Ormond Street Hospital NHS TrustLondonUK
| | - Victoria Wykes
- Department of NeurosurgeryGreat Ormond Street Hospital NHS TrustLondonUK
| | - Nicki Cohen
- Department of HistopathologyGreat Ormond Street Hospital NHS TrustLondonUK
- Department of HistopathologyKings College LondonLondonUK
| | - Dominic Thompson
- Department of NeurosurgeryGreat Ormond Street Hospital NHS TrustLondonUK
| | - Tom S Jacques
- Developmental Biology and Cancer ProgrammeUCL Institute of Child HealthLondonUK
- Department of HistopathologyGreat Ormond Street Hospital NHS TrustLondonUK
| |
Collapse
|
9
|
Retained medullary cord extending to a sacral subcutaneous meningocele. Childs Nerv Syst 2018; 34:527-533. [PMID: 29101613 DOI: 10.1007/s00381-017-3644-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2017] [Accepted: 10/18/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND A retained medullary cord (RMC) is a rare closed spinal dysraphism with a robust elongated neural structure continuous from the conus and extending to the dural cul-de-sac. One case extending down to the base of a subcutaneous meningocele at the sacral level has been reported. CLINICAL PRESENTATION We report on three cases of closed spinal dysraphism, in which a spinal cord-like tethering structure extended out from the dural cul-de-sac and terminated at a skin-covered meningocele sac in the sacrococcygeal region, which was well delineated in curvilinear coronal reconstructed images of 3D-heavily T2-weighted images (3D-hT2WI). Intraoperative neurophysiology revealed the spinal cord-like tethering structure was nonfunctional, and histopathology showed that it consisted of central nervous system tissue, consistent with RMC. The tethering structure histologically contained a glioneuronal core with an ependymal-like lumen and smooth muscle, which may indicate developmental failure during secondary neurulation. CONCLUSIONS When the RMC extending to a meningocele is demonstrated with the detailed magnet resonance imaging including 3D-hT2WI, decision to cut the cord-like structure for untethering of the nervous tissue should be made under careful intraoperative neurophysiological monitoring.
Collapse
|
10
|
Jones V, Thompson D. Placode rotation in transitional lumbosacral lipomas: are there implications for origin and mechanism of deterioration? Childs Nerv Syst 2018; 34:1557-1562. [PMID: 29594462 PMCID: PMC6060810 DOI: 10.1007/s00381-018-3782-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Accepted: 03/16/2018] [Indexed: 01/07/2023]
Abstract
PURPOSE Rotation of the lipoma-neural placode has been noted in transitional lumbosacral lipomas. The purpose of this study was to confirm this rotation; that this rotation occurs with a preference to the left, and correlates with clinical symptoms. In addition, this study tests the hypothesis that this rotation occurs through local mechanical forces rather than intrinsic congenital malformation. METHODS Lipomas were classified as per the Chapman classification. Degree of rotation of the placode from the coronal plane was recorded along with the presence of herniation outside of the vertebral canal. Abnormalities on urodynamic testing were recorded, along with neuro-orthopaedic signs picked up on formal neuro-physiotherapy assessment. RESULTS Placode rotation occurs more frequently in the transitional group. Regardless of lipoma classification, rotation was much more common to the left. Furthermore, when lateralisation of symptoms was present, this strongly correlated with the direct of rotation. There was no difference in rotation of the placode whether it was within (lipomyelocoele) or without the vertebral canal (lipomyelomeningocoele). CONCLUSIONS Placode rotation is a feature of transitional lumbosacral lipomas and may account for the increase in symptoms amongst this subgroup. Herniation of the placode outside the vertebral canal does not increase the risk of rotation suggesting a congenital cause for this finding rather than a purely mechanical explanation.
Collapse
Affiliation(s)
- Victoria Jones
- Great Ormond Street Institute of Child Health, 30 Guildford Street, London, WC1N 1EH, UK.
| | - Dominic Thompson
- Great Ormond Street Institute of Child Health, 30 Guildford Street, London, WC1N 1EH, UK
| |
Collapse
|
11
|
Murakami N, Morioka T, Shimogawa T, Mukae N, Inoha S, Sasaguri T, Suzuki SO, Iihara K. Ependyma-Lined Canal with Surrounding Neuroglial Tissues in Lumbosacral Lipomatous Malformations: Relationship with Retained Medullary Cord. Pediatr Neurosurg 2018; 53:387-394. [PMID: 30391938 DOI: 10.1159/000494029] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Accepted: 09/23/2018] [Indexed: 11/19/2022]
Abstract
BACKGROUND An ependyma-lined canal with surrounding neuroglial tissues can be present in lumbosacral lipomatous malformations; however, the precise embryological significance is still unclear. METHOD Six out of 50 patients with lipomatous malformations had ependymal structures. We retrospectively analyzed the clinical, neuroradiological, and histological findings of these patients to demonstrate the relationship with the embryological background of the retained medullary cord (RMC), which normally regresses, but was retained here because of late arrest of secondary neurulation. RESULTS Five (13.9%) of 36 patients with filar and caudal types and 1 of 3 lipomyelomeningoceles had ependymal structures, while none with dorsal and transitional types had these tissues. Histologically, the ependymal structures surrounded by neuroglial tissue and containing various amounts of adipose tissue bear a striking resemblance to the ependymal structures in RMC. CONCLUSION The 13.9% incidence of association between the ependymal structures and filar and caudal types is thought to be because of second ary neurulation failure with the same embryological background as that of RMC. Dorsal and transitional types, resulting from primary neurulation failure, therefore, did not have ependymal structures.
Collapse
Affiliation(s)
- Nobuya Murakami
- Department of Neurosurgery, Fukuoka Children's Hospital, Fukuoka, Japan,
| | - Takato Morioka
- Department of Neurosurgery, Fukuoka Children's Hospital, Fukuoka, Japan
| | - Takafumi Shimogawa
- Department of Neurosurgery, Fukuoka Children's Hospital, Fukuoka, Japan.,Department of Neurosurgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Nobutaka Mukae
- Department of Neurosurgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Satoshi Inoha
- Department of Neurosurgery, Japan Community Health Care Organization (JCHO), Kyushu Hospital, Kitakyushu, Japan
| | - Takakazu Sasaguri
- Department of Pathology, Japan Community Health Care Organization (JCHO), Kyushu Hospital, Kitakyushu, Japan
| | - Satoshi O Suzuki
- Department of Neuropathology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Koji Iihara
- Department of Neurosurgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| |
Collapse
|
12
|
Tirumani SB, Raghavendra Prasad, Mudunoor VK, Aemjal SC, Tirumani H, Rohatgi S. Ossified dysraphic hamartoma with lipomyelocoele/lipomyelomeningocoele—A rare radiological entity. Clin Imaging 2017; 43:60-63. [DOI: 10.1016/j.clinimag.2017.01.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2016] [Revised: 01/17/2017] [Accepted: 01/24/2017] [Indexed: 10/20/2022]
|
13
|
Morioka T, Murakami N, Shimogawa T, Mukae N, Hashiguchi K, Suzuki SO, Iihara K. Neurosurgical management and pathology of lumbosacral lipomas with tethered cord. Neuropathology 2017; 37:385-392. [DOI: 10.1111/neup.12382] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Revised: 03/05/2017] [Accepted: 03/05/2017] [Indexed: 11/29/2022]
Affiliation(s)
- Takato Morioka
- Department of Neurosurgery; Fukuoka Children's Hospital; Fukuoka Japan
| | - Nobuya Murakami
- Department of Neurosurgery; Fukuoka Children's Hospital; Fukuoka Japan
| | - Takafumi Shimogawa
- Department of Neurosurgery; Fukuoka Children's Hospital; Fukuoka Japan
- Department of Neurosurgery; Kyushu University; Fukuoka Japan
| | - Nobutaka Mukae
- Department of Neurosurgery; Kyushu University; Fukuoka Japan
| | | | - Satoshi O. Suzuki
- Department of Neuropathology, Graduate School of Medical Sciences; Kyushu University; Fukuoka Japan
| | - Koji Iihara
- Department of Neurosurgery; Kyushu University; Fukuoka Japan
| |
Collapse
|
14
|
Accogli A, Pavanello M, Accorsi P, De Marco P, Merello E, Pacetti M, Nozza P, Fiorillo C, Pinelli L, Cama A, Rossi A, Catala M, Capra V. Spinal lipoma as a dysembryogenetic anomaly: Four unusual cases of ectopic iliac rib within the spinal lipoma. ACTA ACUST UNITED AC 2016; 106:530-5. [DOI: 10.1002/bdra.23489] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2015] [Revised: 12/29/2015] [Accepted: 01/06/2016] [Indexed: 11/09/2022]
Affiliation(s)
| | | | - Patrizia Accorsi
- U.O. Neuropsichiatria dell'Infanzia e dell'Adolescenza, Spedali Civili; Brescia Italy
| | | | | | | | | | | | | | | | | | - Martin Catala
- Fédération de Neurologie; Groupe hospitalier Pitié-Salpêtrière APHP; Paris France
- Sorbonne Universités; UPMC Université Paris 06; UMR7622 Paris France
- CNRS; Institut de Biologie Paris Seine (IBPS) - Developmental Biology Laboratory; UMR7622 Paris France
| | | |
Collapse
|
15
|
Mottet N, Saada J, Jani J, Martin A, Riethmuller D, Zerah M, Benachi A. Sonographic Evaluation of Fetal Conus Medullaris and Filum Terminale. Fetal Diagn Ther 2016; 40:224-230. [DOI: 10.1159/000443731] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2015] [Accepted: 12/28/2015] [Indexed: 11/19/2022]
Abstract
Background: Sonographic evaluation of the fetal conus medullaris (CM) level is not reproducible. The objectives of this study were to determine the normal position of the fetal CM during pregnancy as well as the normal intradural filum terminale (FT) length and to evaluate their use in detecting tethered cord. Methods: This is a prospective evaluation of normal singleton pregnancies examined by sonography from 17 weeks of gestation to term. Each sonographer had to identify the top of the first sacral vertebra (S1) to measure the distance between it and the conus extremity (CM-S1 distance). The intradural FT distance was measured with 5- to 8-MHz probes. Results: 194 consecutive pregnant women were included. The CM and intradural FT were demonstrated clearly in 164 (84%) cases. The mean CM-S1 distance was 20.6 mm (range 0.5-42). The mean intradural FT distance was 27.9 mm (range 6.6-49.3). Linear regression analysis showed a significant association between both those distances and gestational age (p < 0.05). In cases of tethered cord, the mean CM-S1 distance and the mean intradural FT distance were both below the 5th percentile. Conclusion: Prenatal evaluation of the CM and the intradural FT is feasible and reproducible and seems useful in detecting tethered cord.
Collapse
|
16
|
Lipomatous Lumbar Mass with an Attached Digit and Associated Split Cord Malformation. Can J Neurol Sci 2014; 35:250-4. [DOI: 10.1017/s0317167100008738] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Background:A male infant was born with a digit attached to a skin-covered lumbar lipomatous mass and an underlying split cord malformation.Methods:Surgical removal of the mass was performed at four months-of-age. By this time the digit had grown a nail and imaging and histology showed ongoing development of articulated phalanges.Results:The lipomatous mass contained a long bone, a clavicle-and scapula-like structure and a variety of other mature germ layer derivatives. These features raised a number of diagnostic considerations, including: mature teratoma, hamartoma, rudimentary parasitic twin, lipomyelomeningocele and dorsal accessory limb.Conclusions:Based on review of the literature, the authors hypothesize that there is a pathogenetically related spectrum of skin-covered dorsal mass lesions, often associated with spinal dysraphism. These consist of a major lipomatous component and a variety of mature germ layer derivatives that can vary widely in their degree of anatomical organization from case to case.
Collapse
|
17
|
Nasal septal lipoma in a child: Pai syndrome or not? Int J Pediatr Otorhinolaryngol 2014; 78:697-700. [PMID: 24560239 DOI: 10.1016/j.ijporl.2014.01.027] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2013] [Revised: 01/18/2014] [Accepted: 01/22/2014] [Indexed: 12/24/2022]
Abstract
Lipoma is the most common soft tissue mass in adults but it is uncommon in children. Nasal septal lipoma is an even more rare entity. In this report, a 12-year-old girl was presented with congenital nasal septal lipoma. She had permanent partial nasal obstruction on her right side and disfigurement of her right upper lip. CT scan revealed a lipoma-like mass in the septum plus an additional incidental finding of an intracranial lipoma. Further workup with MRI demonstrated corpus callosum agenesis with interhemispheric lipoma. To remove the mass, septoplasty, nasal lipoma excision and nasal vestibule V-Y advancement flap were performed. To close the lip a rotational advancement flap was required. Our case seemed to be a variety of Pai syndrome. We recommend imaging of the central nervous system in newborns with congenital lipomas located in the craniofacial midline to rule out the Pai syndrome.
Collapse
|
18
|
Abstract
At 7 months, an infant born with a third limb attached to a lumbosacral mass with an associated lipomyelomeningocele underwent removal of the limb and spinal cord detethering. Depending on the complexity of the pathology and proximity of the limb to viscera, consultation with neurosurgical and surgical colleagues is recommended.
Collapse
|
19
|
Spinal cord malformations. HANDBOOK OF CLINICAL NEUROLOGY 2013; 112:975-91. [PMID: 23622306 DOI: 10.1016/b978-0-444-52910-7.00018-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/05/2023]
Abstract
Malformations of the spinal cord are one of the most frequent malformations. They should be clearly divided into two completely different families of malformations: open dysraphisms and occult dysraphisms. Open dysraphism mostly consists in myelomeningocele (MMC). Its incidence is 1/1000 live births with a wide variation. Folic acid supplementation has been shown to reduce its risk. In most cases, the diagnosis is done prenatally by serum screening and ultrasound and may lead to termination of pregnancy. In case of decision to continue pregnancy, surgical treatment must be achieved during the first days of life, and in 50 to 90% of cases, a ventricular shunt must be installed. The follow-up of these children must be continued throughout life looking for late complications (Chiari II and syringomyelia, vertebral problems, neuropathic bladder, tethered cord). Occult dysraphisms are a heterogeneous group of malformations. Lipomas (filum and conus) are the most frequent and their treatment remains controversial. Diastematomyelia, neurenteric cysts, dermal sinus, and more complex forms (Currarino syndrome) belong to this group. Most of them can and must be diagnosed prenatally or at birth by careful examination of the lower back for the cutaneous stigmata of the disease to decrease the risk of neurological, urological, or orthopedic permanent handicap.
Collapse
|
20
|
Gessi M, Messing-Jünger M, Röhrig A, Gielen GH, Pietsch T, van Landeghem FKH. Incidental neuropathological findings in a child with cervical meningoradiculocele. Brain Pathol 2012; 22:737-40. [PMID: 22925085 DOI: 10.1111/j.1750-3639.2012.00622.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
|
21
|
Abstract
The authors describe a case in which an intradural lipoma, causing tethering of the cord, was found on histological examination to exhibit fully differentiated mature pacinian corpuscles throughout. There are only 3 reports in the literature describing this rare tumor, and the authors use the term "paciniolipoma" to refer to it.
Collapse
Affiliation(s)
- Samantha Hettige
- Department of Neurosurgery, Atkinson Morley Wing, St George’s Hospital, London, United Kingdom.
| | | | | | | |
Collapse
|
22
|
Abstract
To review the clinical features and current understanding of spina bifida with an emphasis on the Indian Scenario. Selected articles and current English language texts were reviewed. The authors experience was also reviewed and analysed. Spina bifida is a common congenital anomaly encompassing a wide spectrum of neural tube defects.It is broadly classified as spina bifida aperta and occulta. With the prenatal screening, the incidence of aperta is gradually declining, whereas the detection of occulta has increased with the advent of magnetic resonance imaging. Over the years, the understanding of pathophysiology has made a significant changein the management of these anomalies. Early detection and complete correction can significantly reduce the neurological disability. This article is an overview of spina bifida with a special emphasis on Indian scenario.
Collapse
Affiliation(s)
- N. K. Venkataramana
- Department of Neurosurgery, Advanced Neuroscience Institute, BGS Global Hospital, Bangalore, India
| |
Collapse
|
23
|
Chen X, Harter J, Iskandar BJ, Salamat MS. Growing mammary choristoma masquerading as a lumbosacral lipomyelomeningocele in a pubertal girl. J Neurosurg Pediatr 2011; 8:321-4. [PMID: 21882926 DOI: 10.3171/2011.6.peds10480] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The authors report, to the best of their knowledge, the first case of lumbosacral choristoma of breast origin, presenting in a young girl with lumbosacral lipomyelomeningocele. Although choristomas are considered to be benign, the regrowth of this mass when the patient was 15 and 16 years of age, and its involvement in the conus medullaris and cauda equina, warranted 2 additional resections with spinal cordotomy resulting in cessation of any further growth. The authors describe the case and provide a review of pertinent literature and a discussion of the mechanisms involving the development and growth of this lesion.
Collapse
Affiliation(s)
- Xueyan Chen
- Department of Pathology and Laboratory Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin 53792, USA
| | | | | | | |
Collapse
|
24
|
Abstract
BACKGROUND Lipomyelomeningocele (LMM) is a common and severe closed neural tube defect in children. Because of the complex anatomy of LMM and the difficulty in assessing the value of surgery, the management of patients with LMM is controversial. This study was undertaken to evaluate effective techniques and procedures in surgical treatment of LMM and to assess the value of early neurosurgical intervention. METHODS Twenty-five children with LMM aged from 2 months to 6 years underwent surgery between January 2004 and December 2006. Magnetic resonance imaging (MRI) of the spine and electromyography (EMG) of the lower limbs was conducted in all patients preoperatively. Urodynamic studies were appropriate even in asymptomatic patients. Hoffman's functional grading was used to assess the pre and postoperative status of the patients. The operation was composed of subtotal excision of lipoma, suturing of the spinal pia mater, and section of the filum terminale. Suturing of the spinal pia mater was performed in a wide process of reconstruction of meningeal layers including the dura. Follow-up lasted 1-4 years (mean 2.1 years), in which all children underwent neurological examination, EMG and MRI. RESULTS After surgery a temporary neurological deterioration was found in two patients including slight weakness of a leg in one patient and urinary retention in the other, but it recovered completely a few days later. No postoperative complications were encountered. During the follow-up, 20 asymptomatic patients remained symptom-free. Symptoms disappeared totally in 2 of the 5 patients with neurological deficits, improved in one patient and stabilized in the remaining 2. MRI showed no tethered cord in all patients who underwent surgical procedures. CONCLUSIONS Early operation for LMM patients, even asymptomatic ones, should be performed to prevent the development of neurological deficits. Subtotal excision of lipoma, suturing of the spinal pia mater, and section of the filum terminale are recommended in the surgical treatment of LMM. The longitudinal cut of the filum terminale, a technique we have established in our surgical practice, is a simple and practical way to identify the filum terminale by visual inspection. And suturing the spinal pia mater is of extreme importance in preventing postoperative tethering.
Collapse
|
25
|
Fat-forming solitary fibrous tumour (lipomatous haemangiopericytoma) of the spine: case report and literature review. Skeletal Radiol 2010; 39:1039-42. [PMID: 20628877 DOI: 10.1007/s00256-010-0991-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2009] [Revised: 06/07/2010] [Accepted: 06/11/2010] [Indexed: 02/02/2023]
Abstract
Solitary fibrous tumour (SFT) is a rare soft tissue tumour of uncertain histogenesis and unpredictable biological behaviour, which was first described in the pleura and subsequently in many extra-pleural locations. Fat-forming SFT is a sub-type of SFT and only a handful of cases have been reported in the literature. We present the clinical, radiological and histological features of a case of intraspinal fat-forming SFT, along with a literature review. This is the first known report of a fat-forming SFT in the spine.
Collapse
|
26
|
De Wals P, Van Allen MI, Lowry RB, Evans JA, Van den Hof MC, Crowley M, Tairou F, Uh SH, Sibbald B, Zimmer P, Fernandez B, Lee NS, Niyonsenga T. Impact of folic acid food fortification on the birth prevalence of lipomyelomeningocele in Canada. ACTA ACUST UNITED AC 2008; 82:106-9. [DOI: 10.1002/bdra.20418] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
|
27
|
Takeyama J, Hayashi T, Saito M, Shimanuki Y, Watanabe M, Sasano H, Shirane R. Spinal hamartoma associated with spinal dysraphism. Childs Nerv Syst 2006; 22:1098-102. [PMID: 16328392 DOI: 10.1007/s00381-005-0016-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2004] [Indexed: 10/25/2022]
Abstract
OBJECTS The aims of the study were (1) to review the pathological findings of spinal lipomatous masses associated with congenital spinal dysraphism and (2) to discuss the pathological diagnosis. METHODS The pathological records of 47 patients at our institution were reviewed, and three illustrative cases were presented. CONCLUSION Spinal tumorous lesions associated with spinal dysraphism have been traditionally described as lipoma since they are composed mostly of fatty tissue. However, they are different from lipomas arising in other part of the body in that they often contain various tissues of ecto- and mesodermal origin. In our study, we detected such heterotopic components in 24 out of 47 cases. Although they are also similar to teratoma, it is generally accepted that they are malformative lesions which lack neoplastic potential. We therefore should diagnose them as hamartoma rather than lipoma or teratoma.
Collapse
Affiliation(s)
- Junji Takeyama
- Department of Pathology, Miyagi Children's Hospital, 4-3-17 Ochiai, Aoba-ku, Sendai 989-3126, Japan.
| | | | | | | | | | | | | |
Collapse
|
28
|
|
29
|
Abstract
Lipomas of the spinal cord are among the most fascinating lesions encountered by the pediatric neurosurgeon. An understanding of spinal lipomas may, however, be difficult because the terminology used to describe the accumulations of spinal fat is confusing, inconsistently applied, and at times contradictory. An anatomical characterization of lipomas may assist in understanding these lesions. Lipomas of the spinal cord are very rare and cause symptoms related to mass effect and secondary compressive myelopathy. Lipomas of the conus medullaris (or lipomyelomeningocele) are the most common form of fatty masses in the spine and can be divided into dorsal, caudal, and transitional forms. These lesions are a manifestation of occult spinal dysraphism and a common cause of the tethered cord syndrome (TCS). The natural history of untreated lipomyelomeningocele, although incompletely understood, appears to be progressive neurological deterioration with loss of bladder control. Timely, careful surgical intervention may prevent significant neurological deterioration and progressive disability in the majority of children harboring these lesions. In surgical intervention the surgeon seeks to disrupt the connection between the fibrofatty mass and underlying cord as well as to reestablish normal anatomical planes. Several intraoperative video segments illustrating lipomyelomeningocele resection are included in this paper. Lipomas of the terminal filum (fatty filum) are truly occult and are also associated with TCS. Surgical treatment of filum lipomas carries significantly lower risk than that for lipomas of the conus medullaris. Again, the goal of surgery is to disrupt the connection between the abnormal fibrofatty tissue and the underlying spinal cord.
Collapse
Affiliation(s)
- J P Blount
- Division of Neurosurgery, University of Alabama at Birmingham, Children's Hospital of Alabama, Birmingham, Alabama 35233, USA.
| | | |
Collapse
|