Exophytic Intramedullary Mature Teratoma of the Conus Medullaris: Case Report and Review of the Literature

Abstract

Background: Intramedullary tumors affect a small but significant portion of patients with spinal tumors. Ependymomas and astrocytomas are the most common entities. The diagnosis of a mature teratoma is extremely rare, although not in the presence of associated developmental abnormalities. The medullary conus is the most common location. Such a case with caudal exophytic growth is presented here and the literature extensively reviewed.

Case presentation: Low back pain and muscle weakness led to diagnosis of a exophytic intramedullary lesion of the conus medullaris in a 52-year-old woman. After subtotal resection the symptomatology partially improved. Histopathological examination revealed mature teratoma.

Conclusion: Literature review identified 68 cases of intramedullary teratomas. These should be considered in the differential diagnosis when an associated developmental abnormality is present. Subtotal resection is a valid alternative to radical tumor removal when neurological function is at risk. The prognosis of adult patients with intramedullary mature teratoma is excellent.

Zusammenfassung

Hintergrund: Intramedulläre Tumoren betreffen einen kleinen, aber signifikanten Teil von Patienten mit spinalen Tumoren. Ependymome und Astrozytome sind die häufigsten Entitäten. Die Diagnose eines reifen Teratoms ist sehr selten, reife Teratome sind etwas häufiger, wenn sie mit Entwicklungsstörungen assoziiert auftreten. Der Rückenmarkskonus ist die häufigste Lokalisation. Ein solcher Fall mit einem kaudal exophytischen Wachstum wird vorgestellt und die Literatur ausgiebig gesichtet.

Fallvorstellung: Lumbale Rückenschmerzen und Muskelschwäche führten zur Diagnose einer exophytischen intramedullären Läsion im Konus bei einer 52 Jahre alten Frau. Nach subtotaler Resektion verbesserte sich die Symptomatik partiell. Histopathologisch ergab sich ein reifes Teratom.

Schlussfolgerung: Die Literaturübersicht ergab 68 Fälle von intramedullären Teratomen. Dieses sollte bei der Differentialdiagnose berücksichtigt werden, insbesondere wenn eine assoziierte Entwicklungsstörung vorliegt. Die subtotale Resektion ist eine gute Alternative zur radikalen Tumorresektion, falls die Bewahrung der neurologischen Funktion gefährdet ist. Die Prognose bei erwachsenen Patienten mit intramedullären reifen Teratomen ist sehr gut.

Key words

intramedullary teratoma - spinal cord tumor - spinal dysraphism - developmental abnormality - literature review

Schlüsselwörter

intramedulläres Teratom - Rückenmarkstumor - spinale Dysraphie - Entwicklungsstörung - Literaturübersicht

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