Neurenteric cyst of the mediastinum

Case of split notochord syndrome: a neonate with thoracic neuroenteric cyst, abdominal duodenal duplication cyst, malrotation and vertebral anomalies

The authors describe a case of a male neonate with split notochord syndrome presenting with cervico-thoracic deformity, thoracic neuroenteric cyst, separate abdominal duodenal duplication cyst and concurrent intestinal malrotation. This combination of abnormalities is very rare. When these lesions are suspected, patients must be investigated carefully.This case is presented not only to recount an infrequent combination of structural abnormalities but also to raise awareness of the signs that should point to clinical suspicion and prompt diagnosis.Following surgical excision of the thoracic neuroenteric cyst, the patient has made a good recovery.

Neurenteric cyst of the posterior mediastinum

We report a case of a large posterior mediastinal neurenteric cyst in a neonate demonstrated by chest radiographs, barium swallow examination, ultrasonography and CT of the thorax. All the investigations revealed a large posterior mediastinal cystic mass with vertebral anomalies in the form of scoliosis and hemivertebra. The cyst was completely excised by a right posterolateral thoracotomy and biopsy showed the features of a neurenteric cyst. The rarity of the lesion prompted us to report this case.

Neurenteric cysts--a spectrum

This review encompasses seven patients with clinically important cystic lesions of the gastrointestinal (GI) tract, exhibiting a wide range of vertebral anomalies and connections to the neural canal. Three patients had mediastinal masses connected to lower cervical and upper thoracic anomalous vertebrae with intraspinal extensions. In addition, one of these patients had a separate, juxtapancreatic intestinal duplication cyst. One infant with colonic duplication had a lumbar vertebral anomaly and an epithelial-lined tract between the two. Another patient had a presacral cystic mass which was the site of recurrent infections and meningitis until a connection with the rectum was divided. A newborn baby had a completely split notochord syndrome with a large dorsal enteric fistula. Finally, one patient had a dorsal enteric cyst with a direct intraspinal connection. Four of the seven patients had associated significant congenital anomalies, two of whom died early in the neonatal period. The rest of the patients did well. This broad range of enteric lesions with associated vertebral and intraspinal abnormalities suggests that the clinical spectrum of neurenteric cystic lesions is much wider than is generally appreciated.

Epithelial cells in a so-called intraspinal neurenteric cyst: a light and electron microscopic study

A case of so-called intraspinal neurenteric cyst is described. A single epithelial cyst, associated with a dimple in the sacral region, was located ventral to the spinal cord in the lower cervical region. On light microscopy, a single epithelial layer lining the cyst wall contained a few ciliated cells and squamous cells, in addition to many goblet cells. An electron microscopic study also demonstrated three different kind of cells. The goblet cells contained many secretory granules, the ciliated cells had many cilia, and the squamous cells were characterized by abundant tonofilaments and desmosomes.

Decrease in size of intrathoracic meningocele following insertion of a ventriculo-venous shunt

A case of spontaneous disappearance of an intrathoracic meningocele following insertion of a ventriculo-venous shunt is reported. The shunt was performed for treatment of hydrocephalus secondary to Arnold-Chiari malformation. The intrathoracic meningocele reappeared when the shunt obstructed and decreased in size when the obstruction was relieved.

Vertebral malformations and associated somaticovisceral abnormalities

Numerous references to spine abnormalities and associated somatic and/or visceral abnormalities are reported. An implication is present in each that the association is more than just coincidental and some cause and effect relationship might exist. A series of cases was collected in which congenital spine abnormalities were noted on roentgenograms from patients evaluated for varied reasons. Other roentgenograms of these patients and their medical records were reviewed in an attempt to find associated congenital abnormalities. Another group of patients with known congenital visceral malformations had their roentgenograms reviewed to see if they had spinal variations. It was found that patients with congenital vertebral malformations had an extremely high rate of associated visceral abnormalities, especially of the heart and kidneys. Other relationships between the spine and viscera include congenital lesions of the gastrointestinal and respiratory system and other parts of the renal system. This study also suggests the possible relationship between vesicoureteral reflux and spina bifida occulta. Embryologic considerations yield likely reasons for the relationships which have been suggested previously and are emphasised and augmented by this investigation. The supporting argument that a definite relationship exists between spinal variations and visceral abnormalities, as well as the embryologic reasons, is presented in this review of our selected cases and the appropriate literature.