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LETTER TO EDITOR
Year : 2013  |  Volume : 61  |  Issue : 2  |  Page : 191-192

An unusual intramedullary spinal cord tumour in a young female


1 Department of Radiodiagnosis, Employees State Insurance Hospital and Post Graduate Institute of Medical Science and Research, Delhi, India
2 Department of Pathology, Employees State Insurance Hospital and Post Graduate Institute of Medical Science and Research, Delhi, India

Date of Submission28-Dec-2012
Date of Decision30-Dec-2012
Date of Acceptance20-Jan-2013
Date of Web Publication29-Apr-2013

Correspondence Address:
Bhawna Satija
Department of Radiodiagnosis, Employees State Insurance Hospital and Post Graduate Institute of Medical Science and Research, Delhi
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0028-3886.111154

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How to cite this article:
Kumar S, Satija B, Jain B, Yadav N. An unusual intramedullary spinal cord tumour in a young female. Neurol India 2013;61:191-2

How to cite this URL:
Kumar S, Satija B, Jain B, Yadav N. An unusual intramedullary spinal cord tumour in a young female. Neurol India [serial online] 2013 [cited 2019 Dec 15];61:191-2. Available from: http://www.neurologyindia.com/text.asp?2013/61/2/191/111154


Sir,

Spinal dermoids are uncommon, especially in an intramedullary location. [1] Absence of spinal dysraphism associated with spinal dermoid is extremely rare and only seven cases have been reported in the literature till date. [2] Also, only three cases of intramedullary dermoid in association with lipoma have been reported. [3] This report presents a female with intramedullary dermoid and lipoma without associated spinal dysraphism.

A 31-year-old woman presented with complaints of gradually progressive left-sided low backache radiating to the left lower limb for of 3 years duration. She also complained of weakness and numbness of left lower limb of 1.5 years duration. Neurological examination showed increased tone in both lower limbs. Motor power at right hip was grade 5/5, at knee and ankle, it was grade 4/5, and, on the left side, the motor power was grade 3/5 in all group of muscles. Deep tendon reflexes were brisk in both the lower limbs, and plantar response was extensor on both the sides. There was sensory level below T10 on the left side and below T12 on the right side. Plain X-ray of the spine was unremarkable with no evidence of spinal dysraphism. Magnetic resonance imaging (MRI) of the spine showed a well-defined lobulated heterogeneous signal intensity mass lesion expanding the spinal cord, extending from T6 to T11 spinal level [Figure 1]. The cranial component of the mass, opposite T6-9, demonstrated isointense signal to cord on T1-weighted sequence and hyperintense signal on T2-weighted and STIR sequences. The caudal portion of the mass T9-11 level was hyperintense on both T1-weighted and T2-weighed sequences and showed suppression on STIR imaging, consistent with fat. Based on the radiological findings, a diagnosis of intramedullary dermoid with lipoma was made. Laminoplasty was done at T6-10 level with decompression of the spinal dermoid and lipoma, along with partial removal of the cyst wall. Histopathology confirmed the diagnosis of intramedullary dermoid cyst with lipoma [Figure 2].
Figure 1: Magnetic resonance imaging of spine, T1W (a), T2W (b), and STIR (c) images. There is a well - defined lobulated intramedullary mass expanding the dorsal spinal cord. The cranial cystic component (M) is hypointense on T1W and hyperintense on T2W and STIR images. The caudal component (arrows) is hyperintense on T1W, T2 W images and shows suppression on STIR images consistent with fat

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Figure 2: Pathological examination of the cyst showing pilosebaceous units, a bit of squamous epithelium and melanin pigment

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Spinal dermoid account for 0.8-1.1% of primary spinal tumors and the majority are in the extramedullary or subdural juxtamedullary in the lumbosacral region, usually in the conus or cauda equina. [4] Many of the intraspinal dermoid cysts are seen in association with other congenital anomalies including spina bifida occulta, dorsal dermal sinus, myelomeningocoele, tethered cord, hypertrichosis, and other dermal abnormalities. The association of dermoid with an adjacent intramedullary lipoma is extremely uncommon. [5] Najjar et al.[3] described a case of intramedullary dermoid associated with an intramedullary lipoma at a distant thoracic level. Intramedullary dermoid are slow growing lesions and do not cause symptoms till adult life and become clinically apparent during the second or third decade of life. [4] Treatment of spinal dermoid is usually surgical. A conservative approach is advised regarding the cyst wall as the capsule is adherent to the adjacent neural tissue, and attempts at total resection can be catastrophic.

 
  References Top

1.Arseni C, Danaila L, Constantinescu N, Carp N. Spinal dermoid tumours. Neurochirurgia (Stuttq) 1977; 20:108-16.  Back to cited text no. 1
    
2.Patankar AP, Sheth JH. Dermoid cyst: A rare intramedullary inclusion cyst. Asian J Neurosurg 2012;7:81-3.  Back to cited text no. 2
[PUBMED]  Medknow Journal  
3.Najjar MW, Kusske JA, Hasso AN. Dorsal intramedullary dermoids. Neurosurg Rev 2005;28:320-5.  Back to cited text no. 3
    
4.Lunardi P, Missori P, Gagliardi FM, Fortuna A. Long-term results of the surgical treatment of spinal dermoid and epidermoid tumors. Neurosurgery 1989;25:860-4.  Back to cited text no. 4
    
5.Falavigna A, Segatto AC, Salgado K. A rare case of intramedullary lipoma associated with cyst. Arq Neuropsiquiatr 2001;59:112-5.  Back to cited text no. 5
    


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