Post-traumatic Sacral Epidermoid Cyst Masquerading as Chordoma on Imaging: A Case Report

Subash Phuyal,Anuj Prabhakar,Sailesh Gaikwad,Parthiban Bala

doi:10.31729/jnma.4268

Abstract

Intradural spinal epidermoid cysts are rare, benign lesions either acquired from trauma, surgery, lumbar puncture or arise as congenital lesions, particularly associated with spinal dysraphism. Epidermoid cyst arising from the spine with expansile destruction of vertebrae has not been reported yet in the literature. We report a case of 36-years male presented with history of fall 8 years back with progressive symptoms of lower back pain, weakness of left lower limb and bladder/bowel incontinence. Computed tomography revealed large lytic expansile, midline sacral vertebral lesion with soft tissue component and multiple calcific foci. Magnetic resonance imaging demonstrated large non-enhancing heterogeneous mass showing restricted diffusion on diffusion weighted images. The patient underwent biopsy confirming the diagnosis of an epidermoid cyst. The possibility of an epidermoid tumor should be kept in the differential diagnosis in patients presenting with post-traumatic sacral mass.

Highlights

Epidermoid cysts are benign, slow-growing lesions and may often reach an enormous size without producing neurological symptoms
Phuyal et al Post-traumatic Sacral Epidermoid Cyst Masquerading as Chordoma on Imaging: A Case Report restriction of the lesion
Spinal epidermoid tumors are difficult to diagnose on clinical symptoms alone

Summary

Introduction

Epidermoid cysts are benign, slow-growing lesions and may often reach an enormous size without producing neurological symptoms. The common locations of epidermoid tumors are intradural spinal canal and prevertebral. Intradural spinal epidermoid tumors are rare, comprising less than 1% of tumors involving the spine.[1] Spinal epidermoids are typically found in the lumbosacral region but can be found in other locations as well.[2] Patients usually present with pain as well as neurologic dysfunction that may include, muscle weakness and atrophy, sensory disturbances, and loss of sphincter control.[3] Based on history and CT imaging, the differential diagnosis included chordoma, epidermoid tumor, schwannoma and chondrosarcoma.

Results

Conclusion