Atypical myelomeningocele with associated anomalies. Case report

Lumbar lipomyelomeningocele and sacrococcygeal teratoma in siblings: support for an alternative theory of spinal teratoma formation

Sacrococcygeal teratomas may arise in association with regional developmental errors affecting the caudal embryonic segments and may originate within lumbosacral lipomas. It is therefore possible that sacrococcygeal teratomas and lumbosacral lipomas represent related disorders of embryogenesis. Accordingly, the authors report the cases of 2 siblings. The first child (female) was born with a mature Altman Type III sacrococcygeal teratoma that was resected when she was a neonate. Subsequently, a younger brother was found soon after birth to have an L-4-level lipomyelomeningocele and underwent partial resection and spinal cord untethering at 4 months of age. Although familial forms of each of these conditions have been reported, this is, to the authors' knowledge, the first reported occurrence of lipomyelomeningocele and sacrococcygeal teratoma in siblings. They propose that an inherited regional tendency to developmental error affecting the caudal embryonic segments was shared by these siblings and resulted in spinal teratoma formation in one of them.

Human tail and myelomeningocele

The human tail is rarely reported and is usually associated with underlying spina bifida occulta. A male newborn presenting a caudal appendage (human tail) with skin-covered myelomeningocele and tethered cord is described. Surgical excision of the human tail and repair of the myelomeningocele were performed 3 days after birth. After the operation, the patient had an uneventful convalescence and received follow-up at our outpatient clinic without any neurological sequelae. To our knowledge, no similar case report exists in the literature. Like other skin-related lesions in the lumbosacral area, the present case of caudal appendage with myelomeningocele is only a cutaneous sign of underlying spinal dysraphism since the skin and nerve system are related by their similar ectodermal origin. After excision of the tail and repair of an underlying lesion, long-term follow-up of the neurological status is warranted.

Intradural spinal teratoma: evidence for a dysembryogenic origin. Report of four cases

Intradural spinal teratoma is a rare tumor that can be associated with dysraphic defects. Although the origin of these tumors is traditionally thought to be secondary to primordial germ cells misplaced early in embryogenesis, the pathogenesis of intraspinal teratoma remains unclear. The authors present a series of patients in whom an intradural teratoma arose at the same site as a developmental spinal cord abnormality, including a split cord malformation, myelomeningocele, and lipomyelomeningocele. It is postulated that these lesions were the result of a dysembryogenic mechanism and were not neoplastic.

Dorsal midline proboscis associated with diastematomyelia and tethered cord syndrome. Case report

There have been sporadic reports on tail proboscis, a vestigial appendage, as part of sacrococcygeal dysraphism. The case the authors present, different from the tail proboscis, is the first report linking a proboscis containing a hemilipomyelomeningocele with tethered cord syndrome, associated with diastematomyelia. Tethering was caused by the diastematomyelia that anchored the split spinal cord. The authors emphasize the importance of prompt diagnostic and therapeutic measures for treatment of this condition.

Description of two informative cases of occult spinal dysraphism with remarks on possible traits in the embryogenesis

Two cases of spinal occult dysraphism are described. The association of a dermoid cyst and ectopic tissue foci of both ecto- and mesodermal origin at the junction zone between lipoma and nervous tissue is argued to support the disjunction theory on lipomeningomyelocele formation.

Meningoceles, meningomyeloceles, and encephaloceles: a neuro-dermatopathologic study of 132 cases

Because there have been few comprehensive histopathologic studies of meningomyeloceles and related malformations, we undertook a systematic study of these lesions. One hundred and thirty two cases were obtained from our surgical pathology files; these included 38 meningoceles, 71 meningomyeloceles, and 23 encephaloceles. Tissue sections were stained with hematoxylin and eosin; special stains included trichrome, alcian blue, Fontana-Masson, Nissl, Holzer, and immunoperoxidase for glial fibrillary acidic protein. Epithelial changes included ulceration, atrophy, or nevoid hyperplasia of the epidermis, and loss of appendages. Mesodermal features included fibrous zones resembling dura, subarachnoid tissue or scar (99% of cases), increased numbers of blood vessels (83%), hypertrophy of arrector pili muscle (42%), lipoma formation (38%), and immature skeletal muscle fibers (5%) that rarely intermingled with neuropil-like matrix. The latter tissue was identified in 71% of cases and included neurons, astrocytes, oligodendroglia, and ependyma. Forty-eight percent of cases included peripheral nerve fibers or roots, and some fibers formed onion bulb or Pacinian corpuscle-like structures. Meningothelial cells were observed in 26% of cases and sometimes formed recognizable whorls. Choroid plexus was noted in 3 cases, one example showing an unusual dystrophic calcification that formed long parallel spicules. Pigmented dendritic cells were observed within zones of fibrous tissue in 10% of cases. These malformations involve complex arrangements of cutaneous, neuroectodermal, and mesodermal elements. Because they may be encountered by dermatopathologists, familiarity with the microscopic features of dysraphic lesions is essential.

[Sacral agenesis associated with a teratoma]

A case of a 29-year-old male with a huge sacrococcygeal teratoma completely removed by surgery, and associated with a sacral agenesis is reported. Roentgenograms revealed fusion of the T12, L1, L2, and L3 vertebral bodies, absence of the left 12th rib, partial agenesis of sacrococcygeal elements and a lumbar scoliosis convex to the left. Cystometry and myelograms were normal. No such association has been found in the literature reviewed. Some topics on the embryology of these lesions are discussed.

Teratomatous cyst of the spinal canal. Case report

A search of the English literature revealed 46 cases of primary intraspinal teratomas, of which 22 were teratomatous cysts of spinal cord. To clarify the confusion regarding this rare lesion, the definition, origin, presentation, and histological features of the lesion are discussed. An additional case is presented.

Teratoma occurring within a myelomeningocele. Case report

✓ A teratoma lying within a myelomeningocele is described and comparable reported cases reviewed. Most such lesions occur in children and are solid as compared with the more cystic masses occurring in adults. It is postulated that expansion of the cyst with increasing age causes the compression responsible for the late onset of symptoms.