Unusual presentation of an adult intramedullary spinal teratoma with diplomyelia

Abstract

Background Spinal teratomas are rare lesions. The authors present an intramedullary spinal teratoma associated with diplomyelia. Case Description This 34-year-old female patient presented with right lower extremity weakness, left lower extremity sensory deficit, and urinary retention. Magnetic resonance imaging showed a focally expansile, intramedullary lesion at L1-2 levels with exophytic component, which was located at the apex of diplomyelia separating the cord into equal hemicords and low-lying spinal cord ending at L3 level. Intraoperative electrophysiologic monitoring was used. Tumor was composed of both intramedullary solid/cystic parts and exophytic fatty infiltrated tissue. There was diplomyelia located caudal to intramedullary lesion and harboring an exophytic lobule at the junction of the nondiplomyelic and the diplomyelic cord. A complete removal was not accomplished because of presence of functional neural tissue within the exophytic component of the lesion. Histopathological examination revealed a mature teratoma. This is the fourth intramedullary teratoma associated with SCM to be reported in the literature. Conclusions Teratomas should be taken into consideration in differential diagnosis of intramedullary lesions associated with SCM. Neuroimaging is helpful, but definitive diagnosis is done by histopathological examination. Radical resection should be the aim; however, excision should be tailored according to intraoperative electrophysiologic monitoring. A truly intramedullary teratoma and an exophytic midline fatty infiltrated tissue bisecting spinal cord is another unique feature of the present case that supports the dysembryogenic origin of spinal teratomas.