Malignant transformation of an intramedullary epidermoid cyst in the thoracic region of the spinal cord

Intramedullary Spinal Epidermoid Cyst-A Rare Cause of Spastic Paraparesis

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.

Spinal epidermoid cyst associated with limited dorsal myeloschisis

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.

Brain lymphoma development related to a long lasting epidermoid cyst

INTRODUCTION

Epidermoid cysts (EC) are benign and slow growing lesions. A primary brain lymphoma development related to a EC is presented, second case described in literature.

CASE PRESENTATION

A woman 40 years old, harbouring a EC for more than 20 years, develops a fast growing brain lesion next to the EC. Surgery was performed and diagnosis was primary diffuse B cells lymphoma.

DISCUSSION

Malignant transformation of EC has been described, usually to squamous cells carcinoma, and much less frequently, to another tumours. Inflammatory mechanisms have been advocated to explain this evolution. Chronic inflammation and lymphoma genesis are related, and this could be the mechanism behind this rare evolution of an EC.

CONCLUSIONS

Even being benign lesions, EC can develop malignant tumours due to the chronic inflammation secondary to them.

Brain lymphoma development related to a long lasting epidermoid cyst

INTRODUCTION

Epidermoid cysts (EC) are benign and slow growing lesions. A primary brain lymphoma development related to a EC is presented, second case described in literature.

CASE PRESENTATION

A woman 40 years old, harbouring a EC for more than 20 years, develops a fast growing brain lesion next to the EC. Surgery was performed and diagnosis was primary diffuse B cells lymphoma.

DISCUSSION

Malignant transformation of EC has been described, usually to squamous cells carcinoma, and much less frequently, to another tumours. Inflammatory mechanisms have been advocated to explain this evolution. Chronic inflammation and lymphoma genesis are related, and this could be the mechanism behind this rare evolution of an EC.

CONCLUSIONS

Even being benign lesions, EC can develop malignant tumours due to the chronic inflammation secondary to them.

Intramedullary epidermoid cysts in adults: Case report and updated literature review

Epidermoid cysts are classical tumors in neurosurgery, but spinal locations are rare and intramedullary locations represent only approximately 80 cases in the literature. Intramedullary epidermoid cysts arise from ectodermic tissue inclusion during neural tube closure. Intramedullary epidermoid cysts are more frequent in young patients and in a thoracic location. We report the case of a 61-year-old patient consulting for bilateral asymmetrical progressive paraparesis and proprioceptive ataxia revealing a T3-T4 exophytic medullar epidermoid cyst. The tumor was surgically removed with a favorable outcome. The capsule was partially removed. The authors present an updated literature review of intramedullary epidermoid cyst diagnosis, management and recommendations.