Teratoma occurring within a myelomeningocele. Case report

Spinal epidural teratoma: review of spinal teratoma with consideration on the pathogenesis: case report

BACKGROUND AND IMPORTANCE

Of the 170 cases of teratomas in the spinal canal reported in the English literature, only 13 were spinal epidural teratomas (SETs). We present a case of SET, review the characteristics of SETs in comparison with spinal intradural teratomas (SITs), and investigate the pathogenesis of spinal teratoma.

CLINICAL PRESENTATION

A 17-month-old boy visited our clinic with paraparesis. A multicystic mass was noted in the left epidural space from T8 to T10 and the left paraspinal area. Complete resection of the tumor, including the paraspinal portion, was accomplished by laminoplastic laminotomy. The tumor was well encapsulated and filled with heterogeneous contents. The tumor was suspected to originate from the left T9 root.

CONCLUSION

On histopathological examination, the tumor was found to be a mature teratoma. The clinical characteristics of SETs and SITs show similarities in age, male preponderance, location, associated anomalies, and pathology. SETs and SITs are probably 2 different types of a single disease entity. Pluripotent somatic cell from the Hensen's node and caudal cell mass is the probable origin of spinal teratoma. However, originating from misplaced primordial germ cell could not be excluded.

Spinal rhabdomyosarcoma in a child with lipomyelomeningocele

Malignant tumors arising within dysrhaphic malformations are very rare and are mostly teratomas; so far, only one rhabdomyosarcoma has been reported in this context. We report another case of a girl with lipomyelomeningocele who developed a lumbar rhabdomyosarcoma 2 years after birth and primary closure of the neural tube defect. We present clinical, radiological and pathological findings, discuss possible mechanisms of malignant transformation and review the literature.

Cervical spine dysraphism with teratoma exhibiting pulmonary differentiation: case report and review of the literature

Spinal dysraphism and teratomas are well-recognized spinal cord lesions, but both entities are rare in the cervical spinal cord. Rarely, teratomas have been described within dysraphic lesions in the thoracic and lumbosacral regions. To date, teratomas contained within cervical spine dysraphic lesions have not been described. Although mature cystic teratomas are renowned for the array of organoid tissue differentiation they display, mature lung differentiation is a rarity. While pulmonary differentiation has been described in six female genital tract teratomas, it has not been reported in spinal teratomas. The clinicopathologic features of a complex cervical lesion, comprising a combination of cervical spine dysraphism with a mature cystic teratoma that exhibited pulmonary differentiation, is presented, and the literature on teratomas exhibiting pulmonary differentiation is reviewed.

Dermoid cyst within an upper thoracic meningocele

A case of dermoid cyst within an upper thoracic meningocele is reported. The incidental feature of this combination is extremely rare. As upper thoracic meningocele is often associated with other spinal and intracranial abnormalities, close observation and radiologic evaluation of the craniospinal axis are necessary to obtain an exact diagnosis and to achieve an appropriate treatment.

Poorly organized parasitic conjoined twins: report of four cases

We report four examples of parasitic conjoined twins (PCT) that created difficulties in diagnosis and treatment because of their unusual presentation and poor internal organization. Case 1 appeared as a tumor on the back containing an adrenal gland and part of the small bowel and stomach; two spines with spinal cords were present. Case 2 was similar, but mature and immature renal tissue were included and a meningocele with Arnold-Chiari type II malformation was recognized in the autosite spine. Retrospective interpretation of both cases suggested that the left lower limb and pelvis were part of the parasites. In case 3 the parasite was attached at the perineum and lower abdomen, contained a rudimentary spine in continuity with the coccyx of the autosite, and was partially covered by scalp. Case 4 presented as a limblike tumor attached at the suprapubic region. All cases were complicated by disruptions in the autosites. Surgical treatment was successful in cases 1, 2, and 3. These four anatomically poorly organized PCT are best categorized as intermediate between teratomas and the more common types of PCT.

Spinal dysraphism with accessory male genital organs (a case report)

Clinico-Radiological and operative observations of a case of spinal dysraphism with accessory male genital organs are presented. Operative observations substantiated the presence of myelomeningocele in association with the spinal dysraphism in a case with normal sized penis, urethra and scrotum on top of a huge swelling over the back.

[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.

Congenital spinal cord tumors in children

The paediatric spinal cord may host a wide variety of congenital tumors, the most common of which have been discussed. Although the majority of these lesions are benign their delayed diagnosis, serious infectious complications or associated congenital anomalies may expose the patient to life threatening morbidity or serious permanent disabilities. Prompt surgical management provides a cure in most instances, and the gratification of a neurologically intact child.

Epidermoid cyst occurring within a lumbosacral myelomeningocele. Case report

The authors report the case of an infant who presented with an epidermoid tumor contained in a lumbosacral myelomeningocele. The association of spina bifida aperta and congenital intraspinal tumors is rare. Only two cases of teratoma and two cases of epidermoid tumors arising within a meningocele have been documented previously.

Spinal teratoma

A very rare case of intramedullary spinal teratoma without spina bifida is described in a man with congenital kyphoscoliosis. A connection is suggested between the spinal tumour and the dorsal deformity.

Spinal endodermal cysts without associated vertebral or other congenital abnormalities. Report of four cases and review of the literature

Four cases of spinal cysts lined by simple columnar epithelium of endodermal origin, without associated vertebral or other congenital anomalies, are reported. Pathology, pathogenesis and nomenclature of such cysts are discussed. Misplacement of endodermal cells is though to be the common developmental error leading to the formation of such cysts, as well as of those replicating intestinal wall or containing other endodermal derivatives such as bronchial tissue.