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Eslami M, Ilaghi M, Shahabinejad E, Khajepour F, Karamouzian S, Reihani‐Kermani H. Mature teratoma of conus medullaris: A case report and review of literature. Clin Case Rep 2023; 11:e7966. [PMID: 37767146 PMCID: PMC10520346 DOI: 10.1002/ccr3.7966] [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] [Received: 07/11/2023] [Revised: 07/31/2023] [Accepted: 09/15/2023] [Indexed: 09/29/2023] Open
Abstract
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.
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Affiliation(s)
- Masoud Eslami
- Department of NeurosurgeryKerman University of Medical SciencesKermanIran
| | - Mehran Ilaghi
- Institute of Neuropharmacology, Kerman Neuroscience Research Center, Kerman University of Medical SciencesKermanIran
| | - Erfan Shahabinejad
- Student Research CommitteeRafsanjan University of Medical SciencesRafsanjanIran
- USERN Office, Rafsanjan University of Medical SciencesRafsanjanIran
| | | | - Saeed Karamouzian
- Department of NeurosurgeryKerman University of Medical SciencesKermanIran
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Sharma R, Bora S, Sulaiman M, Garg A, Laythaling RK. Ossified upper thoracic intradural mature teratoma in a teenager - A technical case report with special emphasis on surgical strategy. J Neurosci Rural Pract 2023; 14:349-354. [PMID: 37181192 PMCID: PMC10174177 DOI: 10.25259/jnrp_21_2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Accepted: 10/01/2022] [Indexed: 01/11/2023] Open
Abstract
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.
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Affiliation(s)
| | - Santanu Bora
- Department of Neurosurgery, AIIMS, New Delhi, India
| | | | - Ajay Garg
- Department of Neuroradiology, AIIMS, New Delhi, India
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3
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Spinal Intradural Intramedullary Mature Cystic Teratoma in a Young Adult: A Rare Tumor. Case Rep Orthop 2022; 2022:9365719. [PMID: 35127191 PMCID: PMC8808163 DOI: 10.1155/2022/9365719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Accepted: 12/22/2021] [Indexed: 11/18/2022] Open
Abstract
Intradural mature teratomas are spinal tumors containing all the germinal layers and rarely present in adulthood. This study describes an unusual case of intradural mature teratoma in a 19-year-old male who presented with persistent lower limb pain and difficulty in micturition. The magnetic resonance imaging (MRI) scan showed heterogeneously enhancing intramedullary mass in the L3-L4 vertebral region and was associated with tethering of the spinal cord. Scalloping of the posterior aspect of vertebral body and narrowing of the pedicles were present. Subtotal excision of the tumor was done because of its adherence to the conus. Attempt to completely excise such adherent intramedullary tumors can lead to permanent neurological deficits. The tissue was sent for histopathological examination which showed tissue from all the three germinal layers confirming the diagnosis. The patient showed improvement of symptoms following the surgery. This study also compared the literature of similar cases and the treatments available for this disease.
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Cunningham C, Flores C, Dabecco R, Nisarga P, Ahn J, Williamson R. Symptomatic mature teratoma of the lumbar spine: A case report. Surg Neurol Int 2022; 13:16. [PMID: 35127216 PMCID: PMC8813606 DOI: 10.25259/sni_845_2021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2021] [Accepted: 12/12/2021] [Indexed: 11/06/2022] Open
Abstract
Background: Teratomas are a unique family of tumors derived from two or more of the three embryonic layers: endoderm, mesoderm, and ectoderm. Mature teratomas are comprised the most well-differentiated tissue types and may contain skin, hair, teeth, smooth muscle, respiratory tissues, etc. Infrequently, mature teratomas may be found within the central nervous system and, in exceedingly rare cases, may be occur within the spinal cord itself (i.e., intramedullary/intradural). Case Description: A 78-year-old female presented with a subacute progressive lower extremity paraparesis. The MR revealed a cystic 81 × 30 × 25 mm intradural/intramedullary spinal mass involving the distal conus with exophytic extension into the L1-L4 spinal canal. Following surgical intervention consisting of a L1-L4 laminectomy, the lesion was largely removed. Pathology of the mass confirmed a large mature teratoma containing a multilobulated cyst that intraoperatively compressed the conus and cauda equina. Immediately postoperatively, the patient significantly improved neurologically. However, on postoperative day 2, she acutely developed a change in mental status with the left gaze preference and hemiparesis. CT brain in the acute setting showed no evidence of causative pathology and subsequent MR brain was unremarkable. The patient’s neurologic deficits progressively improved leading to eventual discharge. Conclusion: Intrathecal intramedullary/extramedullary mature teratomas of the conus that results in subacute cauda equina syndromes are rare. The differential diagnosis for such lesions exophytic to the conus must include mature teratomas which, though rare, may be readily resected resulting in generally favorable outcomes.
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Affiliation(s)
- Coby Cunningham
- Department of Neurosurgery, Drexel University College of Medicine, Philadelphia, United States
| | - Chiara Flores
- Department of Neurosurgery, Drexel University College of Medicine, Philadelphia, United States
| | - Rocco Dabecco
- Department of Neurosurgery Allegheny General Hospital, Pittsburgh, Pennsylvania, United States
| | - Palgun Nisarga
- Department of Pathology, Allegheny General Hospital, Pittsburgh, Pennsylvania, United States
| | - Janice Ahn
- Department of Pathology, Allegheny General Hospital, Pittsburgh, Pennsylvania, United States
| | - Richard Williamson
- Department of Neurosurgery Allegheny General Hospital, Pittsburgh, Pennsylvania, United States
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Patel V, Desai S, Thakkar V, Chaudhari S. Upper cervical spinal bronchogenic cyst: A rare lesion at an exceptional location. Indian J Radiol Imaging 2020; 30:513-516. [PMID: 33737784 PMCID: PMC7954160 DOI: 10.4103/ijri.ijri_262_19] [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: 06/18/2019] [Revised: 08/11/2020] [Accepted: 09/21/2020] [Indexed: 11/23/2022] Open
Abstract
An intraspinal bronchogenic cyst is a rare but important cause of compressive cord myelopathy, commonly seen in the cervicothoracic spine. We report a case of a 30-year-old female, presented with complaints of neck pain and progressive weakness of the extremities. The magnetic resonance imaging of the cervical spine revealed an intradural extramedullary, well-defined, multiloculated, cystic lesion in the upper cervical canal extending from the C2 to C5 vertebral levels. To our knowledge, only 11 cases of spinal bronchogenic cysts have been reported in the literature so far. We discuss the rare location of this unusual lesion, possible embryological reasons, and the overall surgical outcome.
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Affiliation(s)
- Viral Patel
- Department of Radio-Diagnosis, Pramukh Swami Medical College and Shree Krishna Hospital, Karamsad, Gujarat, India
| | - Shreya Desai
- Department of Radio-Diagnosis, Pramukh Swami Medical College and Shree Krishna Hospital, Karamsad, Gujarat, India
| | - Vishal Thakkar
- Department of Radio-Diagnosis, Pramukh Swami Medical College and Shree Krishna Hospital, Karamsad, Gujarat, India
| | - Sanjay Chaudhari
- Department of Pathology, Pramukh Swami Medical College and Shree Krishna Hospital, Karamsad, Gujarat, India
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Chen Y, Li Z, Chen X, Yin Y, Qiao G. Surgical Treatment Outcomes of Patients with Conus Medullaris Teratoma: A Single-Center Experience of 39 Patients. World Neurosurg 2020; 143:e374-e383. [PMID: 32730968 DOI: 10.1016/j.wneu.2020.07.148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 07/20/2020] [Accepted: 07/21/2020] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Conus medullaris teratomas are extremely rare, and the treatment experience has been limited. The purpose of the present study was to evaluate the clinical characteristics, radiological features, surgical outcomes, and prognosis of patients with conus medullaris teratoma. METHODS We retrospectively reviewed the data from 39 patients who had undergone surgical resection for conus medullaris teratomas from January 2008 to December 2018. All the operations were performed by 1 senior doctor. The clinical features, pre- and postoperative magnetic resonance imaging findings, pathological features, treatment strategies, and outcomes were analyzed. The neurological status was evaluated using the modified Japanese Orthopaedic Association scale score. RESULTS Of the 39 patients, the mean age was 30.9 years. Of the 39 patients, 20 were male and 19 were female. The symptom duration ranged from 0.3 to 252 months (mean, 61.6 months). Bladder and bowel dysfunction was the most common symptom (76.9%). Total resection was achieved in 25 patients (64.1%), subtotal resection in 11 (28.2%), and partial resection in 3 (7.7%). A mature teratoma was confirmed in all 39 patients. The neurological outcomes were improved 16 patients (45.7%), stable in 14 (40.0%), and aggravated in 5 (14.3%) at a mean follow-up of 62.7 months. Recurrence developed in 1 patient who had undergone subtotal resection. A second surgery with total resection was performed, and the patient's neurological symptoms were stable during follow-up. CONCLUSIONS Total surgical resection is the optimal treatment strategy for patients with conus medullaris teratoma. Safe maximum tumor removal and residual tumor inactivation using electrocoagulation are recommended when total resection cannot be achieved. Surgery can provide a low recurrence rate and an acceptable low complication rate.
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Affiliation(s)
- Yakun Chen
- Department of Neurosurgery, The First Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Ze Li
- Department of Neurosurgery, The First Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Xin Chen
- Department of Pathology, The First Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Yiheng Yin
- Department of Neurosurgery, The First Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Guangyu Qiao
- Department of Neurosurgery, The First Medical Center of Chinese PLA General Hospital, Beijing, China.
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Keykhosravi E, Tavallaii A, Rezaee H, Ebrahimzadeh K, Pishjoo M, Abdi R, Maftouh M, Aminzadeh B. Conus Medullaris Teratoma: Case Report and Literature Review. Brain Tumor Res Treat 2020; 8:119-123. [PMID: 32648386 PMCID: PMC7595849 DOI: 10.14791/btrt.2020.8.e14] [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: 03/30/2020] [Revised: 05/24/2020] [Accepted: 05/26/2020] [Indexed: 11/20/2022] Open
Abstract
Teratomas are benign germ cell tumors that usually found out of their anatomical origin. Teratomas usually are found in sacrococcygeal area, gonads, mediastinum, cervicofacial region and intracranial fossa. Spinal teratomas are rare. In this study we describe a case of conus medullaris teratoma which was diagnosed based on imaging studies. The patient underwent surgery. We did bilateral laminectomy. The mass lesion had an obvious and rigid attachment to the conus medullaris. The wall of the lesion was resected as much as possible, but total resection of the lesion's wall could not be done due to changes in neural monitoring. Previous related studies are reviewed.
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Affiliation(s)
- Ehsan Keykhosravi
- Department of Neurosurgery, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Amin Tavallaii
- Department of Neurosurgery, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Hamid Rezaee
- Department of Neurosurgery, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Kaveh Ebrahimzadeh
- Skull Base Research Center, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Masoud Pishjoo
- Department of Neurosurgery, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Reza Abdi
- Department of Orthopedic Surgery, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mona Maftouh
- Department of Radiology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Behzad Aminzadeh
- Department of Radiology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
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8
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Khalighinejad F, Hajizadeh M, Mokhtari A, Rakhshan R, Hajizadeh M, Rezvani M. Spinal Intradural Extramedullary Dermoid Cyst. World Neurosurg 2019; 134:448-451. [PMID: 31759148 DOI: 10.1016/j.wneu.2019.11.073] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Revised: 11/11/2019] [Accepted: 11/12/2019] [Indexed: 10/25/2022]
Abstract
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.
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Affiliation(s)
| | - Mahsa Hajizadeh
- Isfahan Research Committee of Pathology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.
| | - Ali Mokhtari
- Department of Neurosurgery, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Reza Rakhshan
- Department of Pathology, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Majid Hajizadeh
- Department of Radiology, Abadan University of medical sciences, Abadan, Iran
| | - Majid Rezvani
- Department of Neurosurgery, Isfahan University of Medical Sciences, Isfahan, Iran
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A case report of an intramedullary cervical teratoma in an adult patient with cervical spondylotic radiculopathy. Neurocirugia (Astur) 2019; 30:238-242. [DOI: 10.1016/j.neucir.2018.09.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Revised: 08/31/2018] [Accepted: 09/25/2018] [Indexed: 12/27/2022]
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Prasad GL, Divya S. A comprehensive review of adult onset spinal teratomas: analysis of factors related to outcomes and recurrences. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2019; 29:221-237. [PMID: 31227969 DOI: 10.1007/s00586-019-06037-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/17/2018] [Accepted: 06/16/2019] [Indexed: 11/28/2022]
Abstract
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.
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Affiliation(s)
- G Lakshmi Prasad
- Department of Neurosurgery, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, India.
| | - S Divya
- Department of Orthodontics, Manipal College of Dental Sciences, Manipal, Manipal Academy of Higher Education, Manipal, India
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A case of conus medullaris teratoma. J Clin Neurosci 2018; 47:123-126. [DOI: 10.1016/j.jocn.2017.09.025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2017] [Accepted: 09/30/2017] [Indexed: 11/21/2022]
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12
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Lin YP, Li YJ, Chen BL, Guo YH. Lumbar laminotomy and replantation for the treatment of adult spinal epidermoid cyst: A case report. Medicine (Baltimore) 2018; 97:e9334. [PMID: 29505514 PMCID: PMC5943114 DOI: 10.1097/md.0000000000009334] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
RATIONALE Adult spinal epidermoid cyst (SEC) is a rare tumor. Lumbar laminectomy and tumor removal was a routine surgical procedure for adult spinal epidermoid cyst according to the literature, but postoperative lumbar instability and intractable low back pain may occur. In this study, we presented a brief report of an adult lumbar epidermoid cyst and introduced another surgical approach. PATIENT CONCERNS This 28-year-old woman has been complaining of the severe right buttock pain and right thigh radiating pain for half a year. She had been diagnosed as sacroiliitis, spinal arthritis, and lumbar disc herniation at 3 different hospitals before coming to our hospital. And she received a variety of conservative treatments, including non-steroidal anti-inflammatory drugs, aspirin, acetaminophen, glucocorticoids, acupuncture, physical therapy, and so on. However, her pain did not diminish at all. Finally, we find a space-occupying lesion in her lumbar magnetic resonance images (MRI). The lesion was slightly low, equal, and uneven equal-low signals on T1WI. T2WI showed slightly higher, equal, and uneven equal-high signals. And a thin-rim enhancement was observed on Gd-DTPA-enhanced MRI. DIAGNOSES Adult spinal epidermoid cyst. INTERVENTIONS The patient underwent a surgery of lumbar laminectomy, tumor excision, and spinous process-vertebral plate in situ replantation. OUTCOMES Postoperative pathology prompted that the tumor was cystoid. The patient's symptoms were completely removed 1 week after surgery. Three-month postoperative MRI confirmed that the spinal epidermoid cyst had been completely removed and three-dimensional CT prompted lumbar lamina in situ. Bony fusion occurred at 6 months after the surgery. LESSONS Lumbar laminotomy and replantation provides an ideal option to treat adult spinal epidermoid cyst because it can completely remove the cyst and simultaneously reduce the risk of iatrogenic lumbar instability.
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Kharosekar HU, Naik H, Velho V. Mature Cystic Teratoma of Dorsal Spinal Cord in Adult: An Unusual Lesion. Asian J Neurosurg 2018; 13:140-143. [PMID: 29492146 PMCID: PMC5820871 DOI: 10.4103/1793-5482.181132] [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: 11/30/2022] Open
Abstract
Teratomas are a type of multipotential cell tumor that contain a mixture of multiple germinal layers formed by normal organogenesis and reproductive tissues the incidence of intracranial teratomas is low, approximately 0.5-2.2% of all intracranial tumors. The occurrence of teratomas in the spine is extremely rare. Except for in the sacrococcygeal region, teratomas constitute <0.5% of all intraspinal tumors. According to the literature this is only 8th case of dorsal spinal mature cystic teratoma reported till date.
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Affiliation(s)
| | - Harish Naik
- Department of Neurosurgery, Grant Medical College and Sir J.J. Group of Hospitals, Mumbai, Maharashtra, India
| | - Vernon Velho
- Department of Neurosurgery, Grant Medical College and Sir J.J. Group of Hospitals, Mumbai, Maharashtra, India
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14
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Intradural Intramedullary Teratoma Presenting in the Lumbar Spine: Report of a Rare Case. World Neurosurg 2017; 106:1051.e5-1051.e8. [DOI: 10.1016/j.wneu.2017.06.175] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Revised: 06/29/2017] [Accepted: 06/30/2017] [Indexed: 11/20/2022]
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15
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Ma X, Li W, Niu C, Liang F, Guo L, Shakir TM, Zhang M. Intraspinal bronchogenic cyst: Series of case reports and literature review. J Spinal Cord Med 2017; 40:141-146. [PMID: 28317447 PMCID: PMC5430469 DOI: 10.1080/10790268.2017.1279816] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
PURPOSE Spinal bronchogenic cysts (SBCs) are rare congenital lesions. The clinical and imaging characteristics and treatment of SBCs are not well known. We studied three cases of SBCs retrospectively, which were registered in our department and analyzed eight case reports which were all published in English, focusing on providing a deeper knowledge of SBCs. METHODS Three patients with SBCs registered in our department were retrospectively reviewed. Eight reported SBCs cases published from 1992 to 2015 were enrolled in our study. Imaging diagnosis was confirmed by computed tomography (CT), MRI, and computed tomography angiography (CTA). All of our patients and reviewed cases had undergone surgical resection and the final diagnosis was made by pathological examination. RESULTS Five lesions were located at the cervical spinal canal. Most patients presented with pain in the limbs and back, which might be related to compression of the spinal cord and the reduced blood supply of the anterior spinal artery. The signal intensity on MRI was correlated with cystic fluid traits to a large extent. Seven lesions were partially removed because of the adhesions to the nearby spinal cord. All reported cases had no recurrence in the later follow-up. CONCLUSIONS SBCs can occur anywhere in the spinal canal, but they are more likely to present at the cervical canal and might be present along with some developmental malformations of the spine. We emphasize the role of CT and MRI findings in the disease diagnosis. It is recommended that the lesion should be removed as completely as possible.
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Affiliation(s)
| | | | | | | | | | | | - Ming Zhang
- Correspondence to: Ming Zhang, 277#, Yan Ta Xi Lu, Department of Medical Imaging, First Affiliated Hospital of Xi'an Jiaotong University College of Medicine, Xi'an, Shan'Xi, China, 710061.
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16
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Khazendar A, Hama Ameen HM, Jabbar NI, Hasan SO, Ahmed TS, Ali AA. Upper Lumbar Mature Cystic Teratoma: A Case Report. World Neurosurg 2016; 96:609.e7-609.e11. [PMID: 27641261 DOI: 10.1016/j.wneu.2016.09.038] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2016] [Revised: 09/01/2016] [Accepted: 09/06/2016] [Indexed: 11/28/2022]
Abstract
BACKGROUND Intradural extramedullary spinal teratoma (IEST) is a rare condition in adults, with a male predominance. It is commonly associated with spinal dysraphism, lumbar puncture, and previous spinal surgery. This case is a 37-year-old male diagnosed with a mature cystic IEST without dysraphism or previous surgical interventions. CASE DESCRIPTION The patient's symptoms included a lumbar backache that progressed to the toes, as well as the anterior region of both thighs. Subsequently, he could not walk for >3 minutes and experienced saddle paresthesias, heaviness, and numbness in both lower limbs. The teratoma was diagnosed by magnetic resonance imaging (MRI), which showed a mixed signal intensity mass with a fatty component in the conus medullaris at the L1-L2 level. The treatment strategy included total surgical excision of the teratoma, followed by histopathological examination, at which the mass was diagnosed as a mature cystic teratoma. On postoperative follow-up, the patient reported urinary and fecal incontinence. Neurologic examination of both the lower limbs revealed hyperreflexia of the left knee and atrophy of the left calf muscles, but no residual mass at the site of surgery. CONCLUSIONS MRI is a standard tool for diagnosing IEST, but the diagnosis is confirmed by histopathological examination. Total surgical excision is the treatment of choice, but when adhesions to the neural tissue are present, subtotal excision should be attempted. The patient should be followed up with serial clinical and radiologic examinations to ensure the absence of residual mass at the site of surgery.
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Affiliation(s)
- Awder Khazendar
- Department of Neurosurgery, Shahid Doctor Aso Neurosurgical and Ophthalmological Hospital and Surgical Emergency Hospital, Sulaymaniyah, Kurdistan, Iraq
| | - Hemin M Hama Ameen
- Department of Neurosurgery, Shahid Doctor Aso Neurosurgical and Ophthalmological Hospital and Surgical Emergency Hospital, Sulaymaniyah, Kurdistan, Iraq
| | - Nzar I Jabbar
- Department of Neurosurgery, Shahid Doctor Aso Neurosurgical and Ophthalmological Hospital and Surgical Emergency Hospital, Sulaymaniyah, Kurdistan, Iraq
| | - Seerwan O Hasan
- Department of Neurosurgery, Shahid Doctor Aso Neurosurgical and Ophthalmological Hospital and Surgical Emergency Hospital, Sulaymaniyah, Kurdistan, Iraq.
| | - Talar S Ahmed
- Histopathology Department, Shorsh Hospital, Sulaymaniyah, Kurdistan, Iraq
| | - Alaa A Ali
- Histopathology Department, Shorsh Hospital, Sulaymaniyah, Kurdistan, Iraq
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Singh K, Pandey S, Gupta PK, Sharma V, Santhosh D, Ghosh A. Acquired dorsal intraspinal epidermoid cyst in an adult female. Surg Neurol Int 2016; 7:S67-9. [PMID: 26904369 PMCID: PMC4743265 DOI: 10.4103/2152-7806.174890] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2015] [Accepted: 11/25/2015] [Indexed: 11/23/2022] Open
Abstract
Background: Epidermoid and dermoid cyst comprise <1% of spinal tumors and may be congenital (hamartoma) or acquired (iatrogenic) in origin. Epidermoid cysts within the neuraxis are rare benign neoplasms that are most commonly located in the intracranial region. Case Description: Here, we report the a case of an acquired intradural extramedullary epidermoid cyst involving the thoracic region in an adult female who had no associated history of an accompanying congenital spinal deformity. Conclusion: Early diagnosis and immediate surgical intervention reduce patient morbidity. Near complete or subtotal excision of the cyst wall is warranted to prevent inadvertent injury to the spinal cord thus minimizing neurological morbidity.
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Affiliation(s)
- Kulwant Singh
- Department of Neurosurgery, Sir Sunderlal Hospital, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - Sharad Pandey
- Department of Neurosurgery, Sir Sunderlal Hospital, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - Praveen Kumar Gupta
- Department of Neurosurgery, Sir Sunderlal Hospital, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - Vivek Sharma
- Department of Neurosurgery, Sir Sunderlal Hospital, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - Deepa Santhosh
- Department of Pathology, Sir Sunderlal Hospital, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - Amrita Ghosh
- Department of Pathology, Sir Sunderlal Hospital, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
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