Intramedullary spinal cystic teratoma of the conus medullaris with caudal exophytic development: case report

Cervicomedullary junction mature teratoma with pulmonary differentiation and diastematomyelia in an adult - A rare case

Background

Intradural extramedullary teratomas in the cervical or cervicomedullary region are rare in adults.

Case Description

We report a symptomatic, mature teratoma at the cervicomedullary junction in a 52-year-old Hispanic female who also has a type I diastematomyelia in the thoracolumbar spine. The patient underwent surgical resection of the lesion with the resolution of presenting symptoms. Histopathology of the lesion revealed a mature cystic teratoma with pulmonary differentiation.

Conclusion

We discuss the case along with a review of pertinent literature and considerations with regard to the diagnosis, etiology, prognosis, and management of this unusual pathology.

A comprehensive review of adult onset spinal teratomas: analysis of factors related to outcomes and recurrences

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.

Intramedullary Teratoma: Case Report and Review of the Literature

Aims and Background

Intramedullary teratoma is an extremely exceptional tumor (5 cases), although a careful review of international literature has shown it to be more frequent (32 cases) than believed.

Methods

The authors present a personal case with some unusual aspects.

Results

Our case is unusual not only because it was diagnosed by MRI (only one case has been reported in the literature) but also because surgical removal of the tumor was apparently total (only 4 other cases have been described), with a long follow-up period (4.5 years) and excellent results, in clinical and neuroradiologic terms.

Conus Medullaris Teratoma with Utilization of Fiber Tractography: Case Report

Objective Conus medullaris teratomas are very rare tumors. Traditional preoperative diagnosis depended on the findings from magnetic resonance imaging (MRI). Tractography is a novel technique that has recently been utilized to diagnose spinal cord lesions. This case report shows that fiber tractography has great potential in preoperative diagnosis and postoperative follow-up of teratomas of the conus medullaris.

Methods A 50-year-old man with a conus medullaris teratoma underwent tractography with the aim of visualizing the tumor in relation to the white matter tracts. The patient underwent a T12–L2 laminectomy, and the lesion was resected. The histopathology diagnosis was of a mature teratoma.

Study Design Case report.

Results Diffusion tensor imaging (DTI) and tractography provide more details about the white matter tracts in relation to space-occupying lesions that may be more sensitive than conventional MRI and have recently been utilized in spinal cord lesions. Fiber tracking has the ability to visualize the integrity of the white matter tracts at the level of the conus medullaris in relation to the lesion. The tracts appeared to be displaced by the lesion at the conus medullaris. Tractography also showed no white matter tracts within the lesion. Such findings are consistent with the characteristics of a benign lesion. Exploiting tractography in this case was helpful in predicting the nature of the lesion preoperatively and in planning the surgical intervention.

Conclusions Conus medullaris teratomas mostly affect adults. Patients generally present with a long history of clinical symptoms prior to diagnosis. Surgery is required for diagnosis, and the goal should be complete tumor excision without sacrificing any neurologic functions. The use of DTI and tractography, in addition to conventional MRI, has the potential to be very valuable for the diagnosis, surgical planning, and follow-up of patients with conus medullaris teratomas.

Mature teratoma of the spinal cord in adults: An unusual case

Intraspinal mature teratomas rarely occur in adults. The present study describes an unusual case of adult intradural mature teratoma, which was completely resected. A 22-year-old female presented with an intermittent pinching pain in the lower right shank that had lasted for three months. Magnetic resonance imaging (MRI) results indicated a multicystic mass extending from the T12 to L2 vertebrae, and the tumors were certified as teratomas by a histopathological examination. The level of pain experienced by the patient was improved following the surgery. The present study also compared the literature concerning adult intradural mature teratoma, summarized the basic clinical characteristics and theory of origin of adult intradural mature teratoma and reviewed the available treatments for this disease.

The rare case of an intramedullary cervical spinal cord teratoma in an elderly adult: case report and literature review

STUDY DESIGN.: Case report and literature review. OBJECTIVES.: To report the very rare case of a mature intramedullary teratoma with exophytic extension localized to the uppermost cervical spinal level in a 65-year-old woman and review the pertinent medical literature. SUMMARY OF BACKGROUND DATA.: Cervical intramedullary teratomas are extremely rare in adults, especially in patients older than 50 years. METHODS.: The patient presented with progressive ataxia, mild bilateral kinetic hand tremors, and dizziness. Magnetic resonance imaging revealed an intramedullary 1.7 x 1.3 x 2.3 cm mass at C1 with exophytic extension. A C1-C2 laminectomy and a partial suboccipital craniotomy were performed, followed by a subtotal microscopic resection of the tumor. Pathology was consistent with a mature teratoma. RESULTS.: After surgery, the patient's ataxia, tremor, and dizziness resolved almost immediately. CONCLUSION.: This report presents the very rare case of a mature intramedullary teratoma located in the upper cervical spine of an elderly patient, possibly the oldest patient documented with this type of lesion. The authors recommend a conservative subtotal surgical resection of cervical intramedullary tumors because it may improve symptoms that relate to direct mechanical cord compression and avoid further harm from a gross resection.

Part I: Spinal-cord neoplasms—intradural neoplasms

Intradural spinal-cord tumours are an uncommon but important consideration in the differential diagnosis of patients with back pain, radicular pain, sensorimotor deficits, or sphincter dysfunction. Intradural spinal tumours can be divided into intramedullary and extramedullary spinal-cord tumours on the basis of their anatomical relation to the spinal parenchyma. The heterogeneous cell composition of the intradural compartment allows the formation of neoplasms, arising from glial cells, neurons, and cells of spinal vasculature. Additionally, developmental tumours, metastases, and intradural extension of extradural tumours are represented. In this Review, we discuss the published work on intradural spinal-cord tumours in terms of epidemiological, radiographic, and histological characteristics. Surgical and adjuvant treatment strategies are also reviewed.

Adult intramedullary mature teratoma of the spinal cord: review of the literature illustrated with an unusual example

Intramedullary mature teratomas particularly in adults are rarely encountered. In this manuscript the authors have reviewed the adult intramedullary lesions of the spinal cord published in the literature that are harbouring the characteristics of a mature teratoma and analysed the results with respect to histopathology, epidemiology, diagnostic methods and treatment. An illustrative case of an extremely unusual localization is also presented.

A case of intramedullary spinal cord tumor producing human chorionic gonadotropin

We experienced a case of a persistent trophoblastic disease associated with gradually progressive Brown-Sequard syndrome, which was found to be due to a primary intramedullary spinal cord germinoma with syncytiotrophoblastic giant cells (STGC). We performed both chemotherapy and radiotherapy on separate occasions. Although the chemotherapy appeared to be ineffective, radiotherapy resulted in the disappearance of spinal cord lesions for four years. We reported a case of intramedullary spinal cord germinoma with STGC for which radiotherapy was a better therapeutic modality.

Hemangioblastomas and other uncommon intramedullary tumors

Astrocytoma and ependymoma make up 90% of intramedullary tumors between them. However, a host of less common tumors form the remaining 10%: these include hemangioblastomas, subependymomas, gangliogliomas and other neuronal variants, metastases from extraneural cancers, and a host of other lesions that typically occur intracranially but which present on rare occasions in the intramedullary location. Most neurosurgeons will encounter the unusual tumors of the spinal cord described in this review only a few times during their professional careers, but it is nevertheless important to recognize the distinct radiological and intraoperative features of those for which significant series of patients have been accumulated. Metastases and germinomas aside, the other neoplasms described here are relatively benign in their clinical and histological behavior, and can be meaningfully resected by careful microsurgical technique.

Intramedullary spinal teratoma presenting with urinary retention: case report and review of the literature

OBJECTIVE AND IMPORTANCE

Intramedullary tumors affect a small but significant segment of patients with spinal cord tumors. Intramedullary teratomas are rare entities that are usually located in the sacrococcygeal region. Although some reports claim that diagnostic studies can exactly predict the nature of intramedullary tumors, this case report demonstrates the lack of preoperative diagnostic specificity. Therefore, the aim of surgery should be radical extirpation whenever possible.

CLINICAL PRESENTATION

A case report of a thoracolumbar intramedullary teratoma is presented. This young male patient displayed urinary retention and motor deficits. Computed tomographic and magnetic resonance imaging examination revealed an intramedullary tumor; however, the exact nature of the tumor could not be determined preoperatively. The literature concerning these tumors is extensively reviewed.

INTERVENTION

During surgery, a multicystic tumor was found at the base of the filum terminale, which was resected as far as possible.

CONCLUSION

It is concluded that surgery should be the first choice for treatment. More aggressive teratomas are found in intramedullary locations, especially in children, emphasizing the importance of radical tumor resection. The use of adjuvant chemo- or radiotherapy should be explicitly substantiated for the nonbenign teratoma group.

Sacrococcygeal teratoma with an intradural and extramedullary extension in a neonate: case report

OBJECTIVE AND IMPORTANCE

The intradural extension of a sacrococcygeal teratoma is rare and has been reported previously in only two cases. We present a case of a sacrococcygeal teratoma with an intradural and extramedullary extension.

CLINICAL PRESENTATION

The patient was a full-term female infant, born with a sacral mass. Ultrasonography, computed tomography, and magnetic resonance imaging showed an intraspinal extension.

INTERVENTION

The operation confirmed the extension of the mass up to the T4 level, and total tumor removal was achieved. The pathological examination showed a mature teratoma.

CONCLUSION

The postoperative course was uneventful, and at the 3-year follow-up examination, the patient had experienced normal growth without deficit in the lower limbs but had a neurogenic bladder. Magnetic resonance imaging disclosed no tumor recurrence. This case represents the third case in the literature of an intradural extension of a sacrococcygeal teratoma and the first one with an extramedullary component so extensive.

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.

Clinicopathological study of seven cases of spinal cord teratoma: a possible germ cell origin

AIMS

To establish the clinical and pathological aspects of teratoma affecting the spinal cord.

METHOD AND RESULTS

We reviewed our neurosurgical records for the last 15 years and found seven cases of teratoma of the spinal cord. The cases were reviewed clinically, radiologically and pathologically using immunohistochemical markers to identify various tissue components. We found that spinal cord teratoma is an extremely rare tumour of spinal cord affecting patients aged 23-47 years and of approximately equal male to female distribution. The terminal portions of spinal cord and intradural location of the tumour are common. Three cases were associated with vertebral anomaly. Most tumours showed benign (mature) components derived from more than one germ cell layer; one showed malignant adenocarcinomatous component. All cases were treated by surgical resection and two recurred at 6 and 10 year intervals without malignant transformation.

CONCLUSION

Spinal cord teratoma is a rare, mainly benign tumour, which could be associated with vertebral anomaly. The pathogenesis of this tumour is controversial, possibly due to germinal cell aberration.

Giant thoracolumbosacral teratoma in an infant

A case of sacrococcygeal teratoma with unusually high intraspinal extension is reported and the symptomatology and treatment are discussed. A 7-month-old male presented at birth with a prominent mass of the right gluteal region preventing him from straightening his legs and causing undue effort during defecation. Magnetic resonance T1-weighted imaging revealed a thoracolumbosacrococcygeal, partly cystic tumor with intraspinal extension up to the mid-thoracic spine. During two-staged surgery, a cystic tumor containing fragments of hair, teeth, and bone and adherent to its surroundings was completely removed. The histologic examination confirmed the presence of a benign teratoma. A neurogenic bladder of the lower-motor-neuron type and constipation improved spontaneously. No further neurological deficits before and during a 3-year postoperative follow-up period were recorded.