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Datta D, Chatterjee D, Tiwari M, Das S, Basu A. Intramedullary Spinal Epidermoid Cyst-A Rare Cause of Spastic Paraparesis. Asian J Neurosurg 2024; 19:309-311. [PMID: 38974452 PMCID: PMC11226243 DOI: 10.1055/s-0044-1787049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/09/2024] Open
Abstract
Spinal intramedullary epidermoids are rare intramedullary lesions of the spinal cord. They may be congenital or acquired with the congenital type often associated with spinal dysraphism and other spinal anomalies. The clinical presentation depends on the level of the involvement of the spinal cord. Management of these lesions is surgical excision. We report a case of intramedullary spinal epidermoid who presented with spastic paraparesis.
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Affiliation(s)
- Debajyoti Datta
- Department of Neurosurgery, Institute of Neurosciences, Kolkata, West Bengal, India
| | - Debarshi Chatterjee
- Department of Neurosurgery, Institute of Neurosciences, Kolkata, West Bengal, India
| | - Mona Tiwari
- Department of Radiology, Institute of Neurosciences, Kolkata, West Bengal, India
| | - Soutrik Das
- Department of Radiology, Institute of Neurosciences, Kolkata, West Bengal, India
| | - Anindya Basu
- Department of Neurosurgery, Institute of Neurosciences, Kolkata, West Bengal, India
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2
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Hammoud M, Cisse D, Chakour K, Chaoui MEF. Spinal epidermoid cyst associated with limited dorsal myeloschisis. Surg Neurol Int 2024; 15:169. [PMID: 38840610 PMCID: PMC11152525 DOI: 10.25259/sni_291_2024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2024] [Accepted: 04/29/2024] [Indexed: 06/07/2024] Open
Abstract
Background Epidermoid cysts (ECs) are rare benign tumors arising from epidermal cells, associated with congenital abnormalities or acquired through trauma, surgery, or lumbar punctures. They represent <1% of all intraspinal tumors and may be associated with limited dorsal myeloschisis (LDM). Case Description A 7-year-old neurologically intact male had a dorsal skin mass since birth located posteriorly in the midline of the inferior thoracic spine. The mass was palpable, painless, mobile, vascularized, and could be transilluminated. Thoracic magnetic resonance imaging showed an extensive intradural extramedullary cystic lesion extending from D6 to D8 that did not enhance with contrast, accompanied by a subcutaneous fluid collection at D8-D9 communicating with the subarachnoid space. The patient underwent gross total resection of the lesion, pathologically confirmed as an EC. The postoperative course was uneventful, with no recurrence 1 year postoperatively. Conclusion LDM may be associated with ECs. Early diagnosis and surgical resection of these lesions are essential for favorable outcomes.
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Affiliation(s)
- Marouane Hammoud
- Department of Neurosurgery, Medical School, University Sidi Mohammed Ben Abdellah, Hassan II University Hospital of Fez, Fez, Morocco
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3
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Alsulami FN, Alotaibi FM, Alfraidi LS, Alotaibi NF, Alnami RE, Alotaibi MF, Musllet RM, Alharbi A. A Pediatric Case of Spinal Intradural Epidermoid Cyst: A Rare Encounter. Cureus 2023; 15:e49970. [PMID: 38179394 PMCID: PMC10766006 DOI: 10.7759/cureus.49970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/30/2023] [Indexed: 01/06/2024] Open
Abstract
Intradural epidermoid cysts of the spine are rare congenital lesions. Their etiology is thought to stem from ectodermal remnants during embryonic development. They result in a diverse clinical presentation, often marked by an insidious onset and variable neurological deficits. Timely diagnosis is crucial for optimizing patient outcomes. We present the case of a 10-year-old male child presenting a six-month history of worsening back pain, intermittent leg weakness, and urinary incontinence. The physical examination revealed tenderness over the lower thoracic and lumbar spine, lower limb weakness, hyperreflexia, and sensory deficits. The diagnostic work-up, including cerebrospinal fluid analysis and magnetic resonance imaging, confirmed the presence of an intradural epidermoid cyst in the lumbosacral region. Surgical excision resulted in complete resection, with subsequent improvement in neurological deficits. This pediatric case underscores the importance of maintaining a high index of suspicion for unexplained neurological deficits. Characteristic imaging findings played a pivotal role in the diagnosis, guiding successful surgical intervention and achieving favorable outcomes.
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Affiliation(s)
| | | | | | | | | | | | - Reema M Musllet
- General Practice, Princess Nourah Bint Abdul Rahman University, Riyadh, SAU
| | - Ahlam Alharbi
- Family Medicine, Primary Health Care Center, Riyadh, SAU
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4
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Elnoamany H, Salim M. Idiopathic lumbar epidermoid: review of literature and case report. EGYPTIAN JOURNAL OF NEUROSURGERY 2023. [DOI: 10.1186/s41984-023-00188-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/29/2023] Open
Abstract
Abstract
Background
Spinal epidermoid tumors are rare, comprising of less than 1% of tumors involving the spine. These tumors arise from pathological displacement of epidermal cells into the spinal canal. Therefore, these tumors can be congenital, when there is improper closure of the neural tube; or acquired, in patients who have had prior lumbar punctures, trauma, or surgery. Spinal epidermoids are typically found in the lumbosacral region but can be found in other locations as well.
Case presentation
We report an original case of a 50 year old. He presented with 1 year with back pain and bilateral sciatica. The patient was neurological intact with no sphincter incompetence. The magnetic resonance image of the lumbosacral spine showed a 12 × 3 cm well-circumscribed intradural mass at the L3–S1 level. The patient was operated on with posterior lumbar laminectomy for tumor removal. Postoperation, the patient had improved pain and numbness. The motor power was intact as preoperative.
Conclusions
MRI with DWI is especially useful to confirm the diagnosis with the lesions appearing hyperintense. The most conventional approach to resection involved laminectomies and intradural tumor resection. GTR provided better outcomes in most cases even when the tumor was adherent to the nearby spinal cord or nerve roots.
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Saekhu M, Susanto E, Handryastuti S, Ashari S, Nugroho S. Spinal dermal sinus coinciding with an infected giant epidermoid cyst in an infant presenting with constipation: a case report. PAEDIATRICA INDONESIANA 2022. [DOI: 10.14238/pi62.5.2022.357-63] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Early diagnosis of spinal tumors is a prerequisite for achieving satisfactory neurological recovery. However, rare diseases tend to have a long diagnostic course.1 In addition, the clinical presentation of spinal tumors in most children is not apparent, moreover, spinal tumors may not show clinical symptoms if they are located in the lumbar spine and sized no more than one vertebra.2,3 Clinical presentations caused by tumors in the lumbar spine may include weakness of both limbs, impaired urination, and constipation.
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6
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Sarhan FM, Daqour AM, Abu-Harb ZH, Al-Darawish A, Ganaim FZ. Recurrent lumbar intraspinal epidermoid cyst presenting as lower back pain, a case report. Int J Surg Case Rep 2022; 97:107420. [PMID: 35853283 PMCID: PMC9403204 DOI: 10.1016/j.ijscr.2022.107420] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 07/12/2022] [Accepted: 07/12/2022] [Indexed: 02/07/2023] Open
Abstract
INTRODUCTION Intraspinal Epidermoid Cyst (IEC) is a very-rare, yet one of the most benign tumors of the Central Nervous System (CNS). Very few cases of IEC were reported world-wide. Presentations depend on the location of the tumor with pain being the most common presenting symptom. CASE PRESENTATION A-35-year-old patient presented to the neurosurgical department for a regular follow up. Her history dates back to four years ago, when she first presented with back pain, which was later accompanied with fecal and urinary incontinence. Magnetic Resonance Imaging (MRI) showed a tumor at the level of L4-L5 which was surgically removed. Three years later, the patient presented to the clinic with similar symptoms. A repeat MRI showed a mass at L4-L5, which was surgically removed. Histological findings of both surgeries showed findings consistent with IEC. Currently the patient has no complaints. CLINICAL DISCUSSION IEC has various presentations. Our case presented with back pain, and urinary and fecal incontinence. Diagnosis depends on imaging and histology. MRI is the imaging modality of choice for those tumors in the CNS. Surgical removal is associated with high recurrence as a result of the suboptimal resection due to the strong adhesions between the capsule and the spinal cord. CONCLUSION Pain is the most common presenting symptom for IEC. Adjuvant radiotherapy, which should be implemented in the standard of care, is associated with a lesser degree of recurrence, in addition to regular follow-ups.
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Affiliation(s)
- Fajr M.A. Sarhan
- Al-Quds University-School of Medicine, Abu-Dis, East Jerusalem-West Bank, Palestine,Corresponding author.
| | | | - Zahra Hosam Abu-Harb
- Al-Quds University-School of Medicine, Abu-Dis, East Jerusalem-West Bank, Palestine
| | - Asaad Al-Darawish
- Al-Makassed Islamic Charitable Hospital, East-Jerusalem, West Bank, Palestine
| | - Fidaa Zakaria Ganaim
- Al-Quds University-School of Medicine, Abu-Dis, East Jerusalem-West Bank, Palestine
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7
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Miller M, Chahlavi A. Intradural intramedullary dermoid cyst in a 42-year-old man at the L1-L2 region. NORTH AMERICAN SPINE SOCIETY JOURNAL (NASSJ) 2022; 10:100124. [PMID: 35634129 PMCID: PMC9136178 DOI: 10.1016/j.xnsj.2022.100124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Revised: 04/25/2022] [Accepted: 05/09/2022] [Indexed: 12/04/2022]
Abstract
Background Intramedullary dermoid cysts within the spine are a rare benign tumor. We present this case, which has atypical presenting symptoms, in order to increase awareness of intradural dermoid cysts. Clinical presentation We present here a case of a 42 year old man with a 12-month history of lumbar spinal pain as well progressive left lower extremity loss of strength, as well as numbness and paresthesia radiating into the left foot. Magnetic resonance imaging scan revealed a 4 × 1 × 1.3cm intradural mass at the cauda equina L1-L2 region and was hyperintense in both T1 and T2 causing cord compression. L1-L2 laminectomy and intradural micro resection were performed with successful excision of the suspicious mass. Histopathological review revealed keratinaceous debris and adnexal structures consistent with a dermoid cyst. Conclusions Our case is unusual with the other reported cases of dermoid cysts due to superior involvement in the lumbar region compared to other case reports with predominantly lumbosacral involvement. This location of the cyst lead to radicular symptoms, rather than lumbosacral pain and sphincter incompetence that is more commonly represented in the literature
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Affiliation(s)
- Mark Miller
- Lake Erie College of Osteopathic Medicine, Bradenton FL, USA
| | - Ali Chahlavi
- Ascension Health St Vincent Hospital, Department of Neurosurgery, Jacksonville FL, USA
- Corresponding author at: Department of Neurological Surgery, Ascension Health St Vincent Hospital, 4205 Belfort Rd # 1100, Jacksonville, FL 32216, USA
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8
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Devathasan D, Murakami M, Miller MA, Thomovsky SA, Lewis MJ. Case Report: Recurrence of an Extradural Spinal Epidermoid Cyst Following Surgical Excision in a Dog. Front Vet Sci 2022; 9:871023. [PMID: 35498737 PMCID: PMC9051319 DOI: 10.3389/fvets.2022.871023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 03/23/2022] [Indexed: 11/13/2022] Open
Abstract
Congenital epidermoid cysts are slow-growing, mass lesions caused by the abnormal inclusion of neuroectodermal tissue within the developing central nervous system. Subtotal excision of epidermoid cysts increases the risk of early recurrence of clinical signs. A 4-year-old female spayed boxer was presented with a 4-month history of ambulatory paraparesis and proprioceptive ataxia. Neurological examination localized a T3-L3 myelopathy. MRI revealed a T1 iso- to hypointense, T2 and FLAIR hyperintense, rim-enhancing mass at the level of the T9-T10 vertebrae resulting in extradural compression of the spinal cord. This was histopathologically confirmed as an extradural epidermoid cyst following subtotal excision. MRI performed 2 months post-operatively revealed a significant decrease of the lesion volume. The dog was neurologically normal following the surgery however re-presented 28 months later with recurrence of clinical signs. A 28-month post-operative MRI revealed substantial enlargement of the epidermoid cyst. The dog was subsequently taken for repeat decompressive surgery. At 6 months from the repeat surgery, the dog was neurologically static with mild proprioceptive deficits. The case report highlights the clinical and MRI features of a recurrent extradural spinal epidermoid cyst treated by subtotal excision.
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Affiliation(s)
- Dillon Devathasan
- Department of Clinical Sciences, College of Veterinary Medicine, Auburn University, Auburn, AL, United States
- *Correspondence: Dillon Devathasan
| | - Masahiro Murakami
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Purdue University, West Lafayette, IN, United States
| | - Margaret A. Miller
- Department of Comparative Pathobiology, College of Veterinary Medicine, Purdue University, West Lafayette, IN, United States
| | - Stephanie A. Thomovsky
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Purdue University, West Lafayette, IN, United States
| | - Melissa J. Lewis
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Purdue University, West Lafayette, IN, United States
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9
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Nishimura Y, Hara M, Awaya T, Ando R, Eguchi K, Nagashima Y, Wakabayashi T, Ginsberg HJ. Possible Double Crush Syndrome Caused by Iatrogenic Acquired Lumbosacral Epidermoid Tumor and Concomitant Sacral Tarlov Cyst. NMC Case Rep J 2020; 7:195-199. [PMID: 33062568 PMCID: PMC7538451 DOI: 10.2176/nmccrj.cr.2019-0236] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Accepted: 03/04/2020] [Indexed: 11/24/2022] Open
Abstract
We describe a rare case of 42-year-old female who had possible double crush syndrome caused by iatrogenic spinal epidermoid tumor (ET) associated with lumbar puncture as well as concomitant sacral Tarlov cyst in close proximity. She presented with progressive left-sided perianal pain. She had a history of a Caesarean section with lumbar spinal anesthesia. Magnetic resonance imaging (MRI) demonstrated a relatively small intradural extramedullary solid lesion at L5/S1 level and cystic lesion at S2 level. We considered there were two different lesions, such as a tumor and Tarlov cyst; however, we could not rule out the possibility of a single lesion with two different components. Furthermore, there was a distinct compression at more than one locations along the course of the left S2 nerve root and we suspected possible double crush syndrome. We conducted tumor removal and the lesion turned out to be two different pathologies, such as an ET and Tarlov cyst. Both lesions were intraopertively pinching the left S2 nerve root at different sites as expected. The tumor was successfully removed and the cyst wall was imbricated and sutured. We need to take the possibility of ET into consideration if the patient underwent invasive spinal procedure previously. We also have to pay attention to the possibility of double crush syndrome if the nerve root possibly holding the responsibility for symptoms is compressed at two or more sites. This is the first report of possible double crush syndrome caused by acquired spinal tumor and congenital Tarlov cyst.
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Affiliation(s)
- Yusuke Nishimura
- Department of Neurosurgery, Nagoya University, Nagoya, Aichi, Japan
| | - Masahito Hara
- Department of Neurosurgery, Nagoya University, Nagoya, Aichi, Japan
| | - Takayuki Awaya
- Department of Neurosurgery, Nagoya University, Nagoya, Aichi, Japan
| | - Ryo Ando
- Department of Neurosurgery, Nagoya University, Nagoya, Aichi, Japan
| | - Kaoru Eguchi
- Department of Neurosurgery, Nagoya University, Nagoya, Aichi, Japan
| | | | | | - Howard J Ginsberg
- Division of Neurosurgery, St. Michael's Hospital, University of Toronto, Toronto, Canada
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10
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Hernandez JJC, Anokwute M, Martinez SJH, Olivas JR. Intradural iatrogenic epidermoid cyst at cauda equina: A case report. Surg Neurol Int 2020; 11:299. [PMID: 33093976 PMCID: PMC7568090 DOI: 10.25259/sni_417_2020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Accepted: 09/03/2020] [Indexed: 11/20/2022] Open
Abstract
Background: Spinal epidermoid accounts for <1% of all primary spinal cord tumors. They occur due to the invagination of epidermal elements into the neural tube during the embryonic period. Even more infrequent are spinal epidermoid cysts that occur without attendant spinal dysraphism (e.g., as occurs with the iatrogenic inoculation of epithelial cells in the subarachnoid space following a lumbar puncture). Case Description: A 38-year-old female with a history of epidural spinal blocks at L2-3 for two previous pregnancies presented with low back pain, right lower extremity weakness (4/5 level), hyporeflexia, and tingling/ numbness in the right L3-5 distribution. The lumbar MR demonstrated an intradural extramedullary lesion at the L2-L3 level that compressed the cauda equina/nerve roots. MR findings were compatible with an epidermoid cyst, this was histologically confirmed following a microsurgical L2-3 laminectomy for lesion resection. Pathologically, the lesion demonstrated a keratinized stratified squamous epithelium with keratin content without cutaneous attachments, thus confirming the diagnosis of an epidermoid cyst. Postoperatively, her sensory complains improved and her motor strength fully recovered to the 5/5 level. Conclusion: Patients with spinal epidermoid cysts typically present with underlying spinal dysraphism, but only rarely do iatrogenic cases arise. Here, we presented a patient who developed a spinal lumbar epidermoid cyst in a female patient after undergoing spinal epidural anesthesia during pregnancy. Notably, this was successfully treated a with decompressive laminectomy and microsurgical resection.
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Affiliation(s)
| | - Miracle Anokwute
- Department of Neurosurgery, Indiana University School of Medicine, Indianapolis, Indiana, United States
| | | | - Jose Ramon Olivas
- Departments of Neurosurgery, Northeast National Medical Center, Monterrey, Nuevo Leon, Mexico
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11
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Sîrbu OM, Chirteş AV, Mitricã M, Sîrbu CA. Spinal Intramedullary Epidermoid Cyst: Case Report and Updated Literature Review. World Neurosurg 2020; 139:39-50. [DOI: 10.1016/j.wneu.2020.03.207] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2020] [Revised: 03/27/2020] [Accepted: 03/29/2020] [Indexed: 11/17/2022]
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12
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Dodson V, Majmundar N, Sharer LR, Gillick JL. Epidermoid Cyst of the Lumbar Spine After Lumbar Puncture: A Clinical, Radiographic, and Pathologic Correlation. World Neurosurg 2020; 137:363-366. [PMID: 32058114 DOI: 10.1016/j.wneu.2020.02.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2019] [Accepted: 02/01/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Epidermoid cysts can rarely arise as a late complication of lumbar puncture. We describe a young man who had a remote history of a lumbar puncture and who was subsequently found to have a lumbar spinal epidermoid cyst on imaging, after presenting with lower extremity radicular pain. CASE DESCRIPTION A 24-year-old man with a remote history of lumbar puncture presented with lower back pain and radicular leg pain which had been ongoing for over a year. Despite conservative management, the patient's symptoms progressed to worsening back pain and left L4 radiculopathy. Magnetic resonance imaging of the lumbar spine demonstrated a peripherally enhancing, intradural, extramedullary lesion at L4-5. Diffusion-weighted imaging revealed diffusion restriction within the lesion, characteristic of an epidermoid cyst. The patient underwent an L4-5 laminectomy for resection of the intradural tumor. The lesion was noted to contain pearly white granules consistent with the appearance of an epidermoid cyst. Histopathology confirmed the diagnosis. On follow-up examination, the patient demonstrated improvement of his back pain and resolution of radicular symptoms. CONCLUSIONS Lumbar spinal epidermoid cysts may be either congenital or secondary to an iatrogenic cause. This patient had a remote history of lumbar puncture during workup for meningitis as a child. As a complication of a lumbar puncture, the formation of an epidermoid cyst can occur and is thought to be the result of implanted cutaneous tissue. This case provides a comprehensive illustration of the clinical, radiographic, intraoperative, and pathologic findings consistent with an iatrogenic epidermoid cyst.
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Affiliation(s)
- Vincent Dodson
- Departments of Neurological Surgery and Pathology, Immunology and Laboratory Medicine, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Neil Majmundar
- Departments of Neurological Surgery and Pathology, Immunology and Laboratory Medicine, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Leroy R Sharer
- Departments of Neurological Surgery and Pathology, Immunology and Laboratory Medicine, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - John L Gillick
- Departments of Neurological Surgery and Pathology, Immunology and Laboratory Medicine, Rutgers New Jersey Medical School, Newark, New Jersey, USA.
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13
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Hao D, Zhu J, Wang X, Chang Z. A Case of Scheuermann’s Disease Co-Occurrence with Idiopathic Scoliosis and Intradural-Extramedullary Epidermoid Cyst: The First Case Report in Literature. Surg Case Rep 2019. [DOI: 10.31487/j.scr.2019.04.12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background and importance: Scheuermann’s disease (SD), intradural-extramedullary epidermoid cysts and idiopathic scoliosis (IS) are all rare conditions. The co-occurrence of the three condition on one case has not been reported in literature before. We describe an extremely rare case of SD co-occurrence with IS and intradural-extramedullary epidermoid cyst, which is the first in the literature.
Clinical presentation: A 13-year old boy and his parents presented at Honghui Hospital complaining of progressive hyperkyphosis for 5 years and back pain for 2 months. Thorough medical examination and radiology confirmed the diagnosis of SD kyphosis, IS, and intradural-extramedullary epidermoid cyst. Medical panel with spine surgeons, oncologists, neurosurgeons, histopathologists and radiologists were consulted. Tumor excise, kyphosis recorrection and spine reconstruction surgery was conducted. Postoperative histological examination detected desquamation of keratin from the epithelial lining and stratified squamous epithelium without skin adnexa. The boy was ambulant 2 days postoperative with walking aids.
Conclusion: This is the first case report of Scheuermann’s disease (SD) co-occurrence with idiopathic scoliosis (IS) and intradural-extramedullary epidermoid cyst. The co-occurrence of intradural epidermoid cyst, SD and IS might not be a coincidence, indicating a kind of genetic etiology need to be illuminated.
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14
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Mangraviti A, Mazzucchi E, Izzo A, Sturdà C, Albanese A, Marchese E, Olivi A, Puca A, Sturiale CL. Surgical Management of Intracranial Giant Epidermoid Cysts in Adult: A Case-Based Update. Asian J Neurosurg 2018; 13:1288-1291. [PMID: 30459920 PMCID: PMC6208223 DOI: 10.4103/ajns.ajns_91_18] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Epidermoid cysts (ECs) are benign and slow-growing lesions that account for about 0.2%-2% of all intracranial tumors. Symptoms appear slowly and tumors may have already grown to giant proportions when patients receive their first diagnosis. The optimal treatment for ECs is surgical removal, which includes the total resection of the entire capsule of the lesion in order to minimize the risk of malignant transformation associated with partial removal. However, considering the giant size that the ECs can reach at the time of the diagnosis, and their adherence to the surrounding structures, the risks and benefits of total versus subtotal resections in the short- and long-term patients' outcome are still under debate. Here, we report a case of an extensive giant EC and offer a discussion of its characteristics, surgical management, and postoperative outcome, taking a cue to argue about the recent literature based in the latest case studies.
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Affiliation(s)
- Antonella Mangraviti
- Institute of Neurosurgery, Fondazione Policlinico Universitario A. Gemelli – IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Edoardo Mazzucchi
- Institute of Neurosurgery, Fondazione Policlinico Universitario A. Gemelli – IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Alessandro Izzo
- Institute of Neurosurgery, Fondazione Policlinico Universitario A. Gemelli – IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Cosimo Sturdà
- Institute of Neurosurgery, Fondazione Policlinico Universitario A. Gemelli – IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Alessio Albanese
- Institute of Neurosurgery, Fondazione Policlinico Universitario A. Gemelli – IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Enrico Marchese
- Institute of Neurosurgery, Fondazione Policlinico Universitario A. Gemelli – IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Alessandro Olivi
- Institute of Neurosurgery, Fondazione Policlinico Universitario A. Gemelli – IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Alfredo Puca
- Institute of Neurosurgery, Fondazione Policlinico Universitario A. Gemelli – IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Carmelo Lucio Sturiale
- Institute of Neurosurgery, Fondazione Policlinico Universitario A. Gemelli – IRCCS, Rome, Italy
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15
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Beechar VB, Zinn PO, Heck KA, Fuller GN, Han I, Patel AJ, Ropper AE. Spinal Epidermoid Tumors: Case Report and Review of the Literature. Neurospine 2018; 15:117-122. [PMID: 29991240 PMCID: PMC6104727 DOI: 10.14245/ns.1836014.007] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Accepted: 04/23/2018] [Indexed: 11/19/2022] Open
Abstract
Spinal epidermoid tumors are rare, benign tumors that are either acquired from trauma, surgery, or lumbar puncture or arise as congenital lesions, particularly spinal dysraphisms. We report a case of a massive spinal epidermoid tumor and review the literature with a focus on the surgical outcomes. A 71-year-old female patient presented after a fall with subsequent symptoms of severe back and hip pain, as well as loss of motor strength in the left leg. Her magnetic resonance imaging demonstrated a T2/short tau inversion recovery hyperintense mass extending from the level of the T10–11 disc caudally through S2. A biopsy was recommended to determine whether the tumor was radio- or chemo-sensitive. The patient underwent a L4 laminectomy and a pearly-white tumor was encountered, with a subsequent biopsy confirming it to be an epidermoid tumor. The following conclusions can be drawn from a review of the literature. Spinal epidermoid tumors are more common in women and tend to present in younger patients (median age of 23). The majority of patients had acquired lesions (46%). In terms of surgical outcomes for adherent tumors, gross total resection was found to provide optimal outcomes, with 90% of patients improving clinically after surgery.
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Affiliation(s)
- Vivek B Beechar
- Department of Neurosurgery, Baylor College of Medicine, Houston, TX, USA
| | - Pascal O Zinn
- Department of Neurosurgery, Baylor College of Medicine, Houston, TX, USA
| | - Kent A Heck
- Department of Pathology, Baylor College of Medicine, Houston, TX, USA
| | - Gregory N Fuller
- Department of Pathology, MD Anderson Cancer Center, Houston, TX, USA
| | - Inbo Han
- Department of Neurosurgery, CHA University, CHA Bundang Medical Center, Seongnam, Korea
| | - Akash J Patel
- Department of Neurosurgery, Baylor College of Medicine, Houston, TX, USA
| | - Alexander E Ropper
- Department of Neurosurgery, Baylor College of Medicine, Houston, TX, USA
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16
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Li J, Qian M, Huang X, Zhao L, Yang X, Xiao J. Repeated recurrent epidermoid cyst with atypical hyperplasia: A case report and literature review. Medicine (Baltimore) 2017; 96:e8950. [PMID: 29245264 PMCID: PMC5728879 DOI: 10.1097/md.0000000000008950] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
RATIONALE Epidermoid cysts are slow-growing, benign tumor which account for less than 1% of all intraspinal tumors and epidermoid cyst with Atypical Hyperplasia is very rare. Surgical resection is the standard treatment of the tumor, but recurrence is not uncommon after incomplete resection. Inappropriate treatment can lead to repeated recurrent. Here, we reported a case of repeated recurrent epidermoid cyst with atypical hyperplasia treated with radiotherapy after surgery. PRESENTING CONCERNS A 40-year-old female presenting with intraspinal epidermoid cyst showed incomplete paraplegia in lower limbs. DIAGNOSIS Back pain reappeared 19 months later after surgical treatment. The patient suffered marked weakness in both limbs, along with obvious muscle atrophy and sensation deficiency of warmth and pain in left lower limb. MRI demonstrated a cystic mass with solid content and peripheral strengthen in enhanced scan. INTERVENTIONS Extended excision with intraoperative local chemotherapy and postoperative radiotherapy was performed and a dramatic reversal of symptoms was gained 4 weeks after surgery, with a total dose of 46 Gy. Postoperative pathological examination revealed epidermoid cyst with mild to moderate atypical hyperplasia. OUTCOMES No acute side effects of the treatment were reported. Back pain obviously alleviated within 48 hours after surgery, while weakness and numbness of the lower limbs gradually improved and nearly disappeared in the 3-monthly follow-up visit. Until now, no recurrence is found during the 5-years follow-up. LESSONS Our study highlights that incomplete excision has led to repeated recurrent epidermoid cyst, but its complete removal with adjuvant radiotherapy has achieved remission of symptoms. Atypical hyperplasia discovered by pathological examination reminds us the possibility of malignant transformation and ensures the necessity of adequate treatment.
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Affiliation(s)
- Jialin Li
- Department of Orthopedics Oncology, Changzheng Hospital
| | - Ming Qian
- Department of Orthopedics Oncology, Changzheng Hospital
| | | | - Li Zhao
- Nursing School, Second Military Medical University, Shanghai, China
| | - Xinghai Yang
- Department of Orthopedics Oncology, Changzheng Hospital
| | - Jianru Xiao
- Department of Orthopedics Oncology, Changzheng Hospital
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Funao H, Isogai N, Daimon K, Mima Y, Sugiura H, Koyanagi T, Nakamura M, Matsumoto M, Ishii K. A rare case of intradural and extramedullary epidermoid cyst after repetitive epidural anesthesia: case report and review of the literature. World J Surg Oncol 2017; 15:131. [PMID: 28716031 PMCID: PMC5513138 DOI: 10.1186/s12957-017-1186-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2016] [Accepted: 06/22/2017] [Indexed: 11/10/2022] Open
Abstract
Background Spinal epidermoid cysts are benign tumors, which are rarely seen as an intradural extramedullary spinal cord tumor in the conus medullaris region. Acquired spinal epidermoid cysts are mostly caused by iatrogenic procedures, such as lumbar puncture, and the majority of acquired spinal epidermoid cysts have been reported below the L1 level, because lumbar puncture is usually performed around the iliac crest. Here, we report an extremely rare case of an epidermoid cyst that occurred as an intradural and extramedullary spinal cord tumor attached to the conus medullaris after repetitive epidural anesthesia. Case presentation A 67-year-old female presented with a low back pain and left sciatica. Although the patient had experienced occasional mild low back pain for several years, her low back pain markedly worsened 2 months before her visit, as well as newly developed left sciatica resulting in intermittent claudication. She had a history of several abdominal surgeries. All abdominal procedures were performed under general anesthesia with epidural anesthesia in her thoracolumbar spine. Magnetic resonance imaging of her lumbar spine demonstrated an intradural extramedullary spinal cord tumor at the T12–L1 level. Because her symptoms deteriorated, the tumor excision was performed using microscopy. Histological examination of the specimens demonstrated that the cyst walls lined with stratified squamous keratinizing epithelium surrounded by the outer layer of collagenous tissue with the absence of skin adnexa. A diagnosis of epidermoid cysts was confirmed. Her MRI showed complete resection of the tumor, and there was no recurrence at 2-year follow-up. Conclusions In this case report, epidermoid cells might be contaminated into the spinal canal during repetitive epidural anesthesia. The patient was successfully treated by complete resection, and there was no recurrence at 2-year follow-up with a good clinical outcome. However, long-term follow-up is required for a potential risk of tumor recurrence.
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Affiliation(s)
- Haruki Funao
- Department of Orthopaedic Surgery, School of Medicine, International University of Health and Welfare Mita Hospital, Minato, Japan. .,Spine and Spinal Cord Center, International University of Health and Welfare Mita Hospital, Minato, Japan. .,Department of Orthopaedic Surgery, Kawasaki Municipal Kawasaki Hospital, Kawasaki, Japan.
| | - Norihiro Isogai
- Department of Orthopaedic Surgery, School of Medicine, International University of Health and Welfare Mita Hospital, Minato, Japan.,Spine and Spinal Cord Center, International University of Health and Welfare Mita Hospital, Minato, Japan
| | - Kenshi Daimon
- Department of Orthopaedic Surgery, Kawasaki Municipal Kawasaki Hospital, Kawasaki, Japan
| | - Yuichiro Mima
- Department of Orthopaedic Surgery, Kawasaki Municipal Kawasaki Hospital, Kawasaki, Japan
| | - Hitoshi Sugiura
- Department of Pathology, Kawasaki Municipal Kawasaki Hospital, Kawasaki, Japan
| | - Takahiro Koyanagi
- Department of Orthopaedic Surgery, Kawasaki Municipal Kawasaki Hospital, Kawasaki, Japan
| | - Masaya Nakamura
- Department of Orthopaedic Surgery, Keio University School of Medicine, Shinjuku, Japan
| | - Morio Matsumoto
- Department of Orthopaedic Surgery, Keio University School of Medicine, Shinjuku, Japan
| | - Ken Ishii
- Department of Orthopaedic Surgery, School of Medicine, International University of Health and Welfare Mita Hospital, Minato, Japan.,Spine and Spinal Cord Center, International University of Health and Welfare Mita Hospital, Minato, Japan.,Department of Orthopaedic Surgery, Keio University School of Medicine, Shinjuku, Japan
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Sivaraju L, Thakar S, Ghosal N, Hegde AS. Primary intradural sacral epidermoid in a nondysraphic spine: Case report and review of literature. JOURNAL OF CRANIOVERTEBRAL JUNCTION AND SPINE 2016; 7:105-8. [PMID: 27217657 PMCID: PMC4872558 DOI: 10.4103/0974-8237.181866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
The occurrence of epidermoids within the spinal canal is uncommon. Most of the reported spinal epidermoids (SEs) have been described in the thoracic or lumbar regions. They occur either following trauma or in the setting of coexistent spinal dysraphism. The authors describe an unusual case of a 28-year-old lady who presented with long-standing back pain and urinary incontinence. Magnetic resonance imaging (MRI) of her spine demonstrated a sacral SE without any coexistent spinal dysraphism. The diagnosis of an epidermoid was confirmed by histopathological examination following laminectomy and excision. To the authors’ best knowledge, this is the third case of a sacral SE occurring in a non-dysraphic spine. The case is discussed in the light of a relevant literature review.
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Affiliation(s)
- Laxminadh Sivaraju
- Department of Neurosurgery, Sri Sathya Sai Institute of Higher Medical Sciences, Bengaluru, Karnataka, India
| | - Sumit Thakar
- Department of Neurosurgery, Sri Sathya Sai Institute of Higher Medical Sciences, Bengaluru, Karnataka, India
| | - Nandita Ghosal
- Department of Pathology, Sri Sathya Sai Institute of Higher Medical Sciences, Bengaluru, Karnataka, India
| | - Alangar S Hegde
- Department of Neurosurgery, Sri Sathya Sai Institute of Higher Medical Sciences, Bengaluru, Karnataka, India
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