Intramedullary dermoid cyst with relatively atypical symptoms: a case report and review of the literature

Journal of Medical Case Reports

Sanaullah Bashir²  Abdul Sattar Mohammad Hashim⁴  Akhtar Amin Memon¹  Sidra Mumtaz³  Maryam Sanaullah³ 

[1] Department of Neurosurgery, Dow Medical College, Dow University of Health Sciences, Baba-e-Urdu Road, Karachi, 74200, Pakistan;Civil Hospital Karachi, Dow University of Health Sciences, Baba-e-Urdu Road, Karachi, 74200, Pakistan;Dow Medical College, Dow University of Health Sciences, Baba-e-Urdu Road, Karachi, 74200, Pakistan;Jinnah Postgraduate Medical Center, Rafique Shaheed Road, Karachi 35, Pakistan

关键词: Spinal tumors;    Space-occupying lesion;    Conus medullaris;    Dermoid cyst;    Intermedullary;   

Others  :  1181215
DOI  :  10.1186/1752-1947-7-104

 received in 2012-06-19, accepted in 2013-02-21,  发布年份 2013

【 摘 要 】

Background

Intraspinal dermoid cysts are rare and benign tumors that occur primarily due to the defective closure of the neural tube, an ectodermal derivative, during the process of development. They are slow-growing tumors manifesting in the second and third decades of life.

Case presentation

We present here a case of a 14-year-old Sindhi boy with a six-month history of paraparesis of the lower limbs and a progressive loss of power of grade 3/5, and hypoesthesia in the L4/L5 dermatomes of his right lower limb. A plain magnetic resonance imaging scan revealed a well-demarcated intraspinal intramedullary cyst containing an abscess at the level of T12 and L1 causing localized cord compression, which was producing the symptoms. Near total excision of the cyst was successfully performed and was sent for biopsy, which revealed keratinocytes and keratin flakes. With one month of follow-up, along with physiotherapeutic management, the patient gradually improved and was able to walk without support.

Conclusions

Critical evaluation of every case with aggravating symptoms should be carried out, and neurological and radiological examinations should be conducted to ensure the well-being of patients.

【 授权许可】

   
2013 Sanaullah et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

Figure 2.

【 参考文献 】

• [1]Moin H, Mohagheghzadeh P: A case of intracranial dermoid cyst presenting like an epidermoid cyst in Ethmoidal region. J Res Med Sci 2004, 6:312-314.
• [2]Muthukumar N, Srisaravanan J: Intramedullary dermoid in a low lying conus tethered by a fatty filum - embryological implications. Acta Neurochir (Wien) 2007, 149:1173-1175.
• [3]Patankar AP, Sheth JH, Cyst D: A rare intramedullary inclusion cyst. Asian J Neurosurg 2012, 7:81-83.
• [4]Shah JR, Patkar D, Gala BM: Multiple intramedullary lipomas with conal intramedullary dermoid: magnetic resonance appearances. Spine J 2007, 7:368-370.
• [5]Love JG, Kennohan JW: Dermoid and epidermoid tumors (cholesteatomas) of central nervous system. JAMA 1936, 107:1876-1883.
• [6]Miller NA, Epstein MH: Giant intracranial dermoid cysts: case report and review of the literature on intracranial dermoids and epidermoids. Can J Neurol Sci 1975, 2:127-134.
• [7]Lunardi P, Fortuna A, Cantore G, Missori P: Long-term evaluation of asymptomatic patients operated on for intracranial epidermoid cysts. Comparison of the diagnostic value of magnetic resonance imaging and computer-assisted cisternography for detection of cholesterin fragments. Acta Neurochir 1994, 128:122-125.
• [8]Najjar MW, Kusske JA, Hasso AN: Dorsal intramedullary dermoids. Neurosurgery Review 2005, 28:320-325.
• [9]McEachern JM: Intracranial dermoid cyst. Can Med Assoc J 1925, 15:942-943.
• [10]De Baecque C, Synder DH, Suzuki K: Congenital intramedullary spinal dermoid cyst associated with Arnold-Chiari malformation. Acta neuropath (Berl) 1977, 38:239-242.
• [11]Bradford FK: Intramedullary dermoid cyst. Ann Surg 1938, 107:107-115.
• [12]Cha JG, Paik SH, Park JS, Park SJ, Kim DH, Lee HK: Ruptured spinal dermoid cyst with disseminated intracranial fat droplets. Br J Radiol 2006, 79:167-169.
• [13]van Aalst J, Hoekstra F, Beuls EA, Cornips EM, Weber JW, Sival DA, Creytens DH, Vles JS: Intraspinal dermoid and epidermoid tumors: report of 18 cases and reappraisal of the literature. Pediatr Neurosurg 2009, 45:281-290.
• [14]Gercek E, Kaplan M, Erol FS, Overen MF: Dissynergic bladder and hydronephrosis in a case of spinal intramedullary dermoid cyst. Fırat Tıp Dergisi 2009, 14:137-140.
• [15]Visciani A, Savoiardo M, Balestrini MR, Solero CL: Iatrogenic intraspinal epidermoid tumor: myelo-CT and MRI diagnosis. Neuroradiology 1989, 31:273-275.