Adult Intramedullary Teratoma of the Spinal Cord: A Case Report and Review of Literature

Mature Teratoma at the Lumbar Spinal Cord: A Case Report and Literature Review

Mature spinal teratoma is a rare type of germ cell tumor that arises from any of the three germ cell layers (ectoderm, mesoderm, and endoderm) and consists of differentiated tissues and structures that reflect the cellular organization and morphology of normal adult tissues. It has the ability to grow independently and cause compressive symptoms when found in this rare location. In this article, we present the case of a 29-year-old male patient with the onset of neurological symptoms beginning with pelvic limb paresthesias and progressing to back pain. Magnetic resonance imaging (MRI) revealed a tumor at L1-L4, which was resected by laminotomy, and histopathology revealed a mature intradural teratoma. Fortunately, this histologic type had a good prognosis for our patient, who had a significant clinical improvement. A systematic review was performed using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) methodology with PubMed and Google Scholar to find similar case reports and to summarize the main features of this disease, which contributes to the understanding of its diagnostic presentation, treatment, and prognosis, improving clinical practice in the management of similar cases. The rarity of this condition, together with its wide clinical heterogeneity and prognosis, underscores the importance of a thorough evaluation of cases of intramedullary lesions, where the consideration of uncommon diseases in the differential diagnosis should be highlighted.

Mature teratoma of conus medullaris: A case report and review of literature

In conus medullaris, mature teratomas are rare. We report a case of a 40-year-old man who presented with urinary incontinence, low back pain, and muscle weakness. Magnetic resonance imaging revealed a mass in conus medullaris (T11-L1), further confirmed as a mature teratoma by pathological examination. We identified 63 cases of conus medullaris teratoma over the past two decades by systematically analyzing the case reports. Findings demonstrated that most cases were diagnosed in the fourth decade of life, with the majority of cases (57.6%) being male. Lower back pain, radiating pain in the extremities, hypoesthesia, and urinary dysfunction are the most common clinical presentations among patients with teratoma of conus medullaris. Mature teratoma is the dominant pathologic subtype of teratomas in this region, comprising more than 95% of cases. Our case highlights the importance of considering spinal teratoma as a differential diagnosis in patients presenting with urinary incontinence and lumbar pain.

Ossified upper thoracic intradural mature teratoma in a teenager - A technical case report with special emphasis on surgical strategy

Spinal teratomas are heterogeneous neoplasms and are extremely rare in the upper thoracic spine. They are sub-classified as mature, immature, or malignant. They may be calcified or rarely ossified; the latter posing a major surgical challenge due to surgical difficulties in safe removal. Clinicoradiologico-pathological and operative experience of ossified spinal intradural mature teratomas is extremely rare. We present a case of ossified upper thoracic intradural mature teratoma managed by microsurgical drilling and resection under neuromonitoring.

Pediatric Extramedullary Epidural Spinal Teratomas: A Case Report and Review of the Literature

Background

Teratomas in the pediatric population are most commonly found in the sacrococcygeal region. Pediatric intraspinal teratomas, however, are an exceedingly rare central nervous system (CNS) neoplasm. The clinical presentation of these intraspinal neoplasms can vary significantly and thus can be difficult to identify in infants less than one year of age where verbal expression and motor development are still lacking. Case Description. A 7-month-old, previously healthy male presented with a thoracic scoliosis and an asymptomatic right midupper thoracic spinal prominence present since birth. MRI revealed an extensive heterogenous mass in the right epidural space from T5-T6 and the right paravertebral space, resulting in severe spinal stenosis. Outcome. Complete resection of the tumor, including a three-level neurotomy, was achieved by posterior decompression/laminectomy. The final tumor was consistent with a mature teratoma. The surgical resection was performed without any immediate complications.

Conclusions

Extramedullary epidural teratomas are exceptionally rare tumors in the pediatric population. Clinical presentation can be ambiguous, particularly in an infant. MRI was useful in suggesting a teratoma as a potential diagnosis and for postoperative surveillance for recurrence. However, histopathological analysis remains the gold standard for definitive diagnosis. Surgical resection is the mainstay of treatment, especially in the setting of cord compression and progressive loss of motor function. Close follow-up is crucial to monitor for progressive spinal deformity or recurrence.

Intramedullary cervical spinal cord teratoma

BACKGROUND

Intramedullary cervical spinal cord teratomas (ICTs) are extremely rare, and diagnosis and treatment are challenging. We conducted a systematic review of the literature on the diagnosis and treatment of ICT.

METHOD

The presentation, imaging manifestations, diagnosis, management, surgery findings, prognosis and histology were reviewed following Preferred Reporting Items for Systematic Reviews and Meta Analyses guidelines. English-language studies and case reports published from inception to 2018 were retrieved. Data on presentation, imaging characteristics, diagnosis, management, surgery findings, outcomes, and histopathology were extracted.

RESULTS

Ten articles involving 10 patients were selected. The lesions were located in the upper cervical vertebrae in 4 cases, whereas in the lower cervical vertebrae in the remaining 6 cases. In 5 cases, the lesions were located on the dorsal side of the spinal cord, and in the center of the spinal cord in the remaining 5 cases. Quadriparesis (60%), paraplegia (30%), monoplegia (10%), and neck pain (50%) were the main presentations. The lesion appeared as a intramedullary heterogeneous signal during an MRI scan, and the lesion signal would be partially enhanced after the contrast medium was applied. All patients underwent surgical intervention through a posterior approach. Neurological function improved postoperatively in all patients. Two patients with pathology confirmed to be immature teratomas experienced recurrence.

CONCLUSION

ICTs are extremely rare entities that are mainly located in the center or dorsal part of the spinal cord which mainly manifest as quadriplegia and neck pain. MRI is a useful modality that provides diagnostic clues. Surgery from a posterior approach is the primary treatment, and the effect of adjuvant therapy remains uncertain. The prognosis is mainly related to the pathological nature of the tumor and not the method of resection.

Spinal Intradural Extramedullary Dermoid Cyst

BACKGROUND

Dermoid cysts are benign congenital tumors that develop early in life. These tumors are classified by the presence of all 3 germ layers. Spinal intradural extramedullary teratoma is a rare disease, which is more common in children under 5 years of age than in adults.

CASE DESCRIPTION

A 12-year-old girl with a dermoid cyst at the lower lumbar level presented with 2-month low back pain and intermittent lower extremity radicular symptoms on the right side. Magnetic resonance imaging scan of the spine revealed an intradural extramedullary mass lesion at L4-5. Surgical excision of the cyst was successfully performed. Surgical and histopathologic findings confirmed extramedullary ruptured matured teratoma. Postoperatively, the patient had remarkable clinical improvement.

CONCLUSIONS

Although dermoid cysts are uncommon, they should be considered in the differential diagnosis of spinal lesions in patients with lower back pain. It can be successfully treated with surgical excision.

A comprehensive review of adult onset spinal teratomas: analysis of factors related to outcomes and recurrences

PURPOSE

Spinal teratomas are rare tumours noted in adults and are commonly located in the thoracolumbar region. Currently, there appears to be a lack of clear consensus regarding the management and prognosis of these lesions. A comprehensive review along with an illustrative case managed at the author's institute has been presented.

MATERIALS AND METHODS

Online database search was performed for literature review.

RESULTS

A 26-year-old male presented with acute onset neurological deficits and imaging revealed features of conus teratoma. Subtotal resection was performed and patient achieved fair recovery. Including the present one, a total of 146 cases have been reported and were analysed. Mean age was 39.6 years (range 18-85 years) and males predominated. Limb weakness and backache were the commonest symptoms. Majority of the lesions were intramedullary and located in the thoracolumbar region. Complete resection (CR) was achieved in 45% of cases. All, except one, were mature teratomas. Recurrences were noted in nine (6.1%) cases. Outcome was good/excellent in 86 (60%) and fair/poor in 26 (18%) cases. The presence of pain, absence of limb weakness and CR were significantly associated with good outcomes. Furthermore, subtotal resection (STR) had significantly higher recurrence rates than CR. Four deaths (2.7%) were noted.

CONCLUSIONS

Total surgical resection is the standard treatment and appears to be beneficial both in terms of outcomes and recurrences. Overall, recurrences are rare and may be managed by re-surgery. In addition, the present report is the eighth case of adult spinal teratoma with an acute onset presentation. These slides can be retrieved under Electronic Supplementary Material.