“Primary” Benign Retroperitoneal and Intraspinal Dumbbell-Shaped Cystic Teratoma

Abstract

A case of unusual dumbbell-shaped cystic teratoma is presented. To investigate and describe an unusual case of retroperitoneal cystic teratoma with spinal invasion in an adult. The image findings, minimally invasive surgical procedures, and clinical outcome were discussed, and the literature was reviewed. Primary benign cystic teratomas of the retroperitoneum are rare. Extension of these lesions into the spinal canal is more rare. In this report, by presenting a case of cystic teratoma with such extension, the origin of the tumor, and the value of computerized tomography and magnetic resonance imaging (MRI) in the preoperative diagnosis and surgical approach for the extended lesion are discussed. The patient was a 24-year-old female who had had low back pain with bilateral sciatica for 2 months. Preoperative computerized tomography and MRI of the thoracic and lumbar spines showed a dumbbell-shaped tumor, with the solid part residing in the right retroperitoneum near the neuroforamen of the L2-L3 spines and the cystic part extending into the spinal canal. By performing right L2-L4 hemilaminectomies with a mini retroperitoneal approach, the tumor was removed en bloc in one stage. Diagnosis of cystic teratoma was confirmed by pathologic examination. The patient recovered well without any neurologic deficits, and recurrence of tumor has not been found for 9 years postoperatively. Total surgical removal of tumor is an ideal treatment for retroperitoneal and intraspinal dumbbell-shaped cystic teratoma. MRI displays the precise location, morphology, and adjacent structures of the tumor, which provide for better preoperative planning and more complete removal of tumor with less neurologic damage.