Tumores dermóides e epidermóides intra-espinhas

Abstract

São relatados dois casos de tumores epidermóides e um de tumor dermóide, todos intrarraquianos. Este último era de localização epidural ao nível da coluna torácica (caso 3); os dois tumores epidermóides situavam-se na coluna tóraco-lombar (caso 1) e lombar (caso 2), respectivamente, sendo o primeiro intramedular e o segundo intradural. Em dois casos (casos 2 e 3) os tumores associavam-se a fístula dérmica congênita. Um paciente (caso 3) foi operado aos dois meses de idade; a descoberta do tumor deveu-se à realização da raquimanometria que revelou bloqueio, apesar do paciente não apresentar qualquer sinal neurológico de compressão medular. Os autores são de opinião que, em presença de fístula dérmica congênita ao nível da coluna vertebral, principalmente quando localizada acima do segmento lombosacro, deve-se sempre suspeitar da possibilidade do tumor epidermóide ou dermóide intrarraquiano, mesmo na ausência de sinais neurológicos. A combinação de sintomas neurológicos de longa duração, a evidência radiológica de erosão e alargamento do canal raquiano e a história de fístula dérmica congênita proporcionaram o diagnóstico pré-operatório correto no caso 2.

Concomitant dermoid cysts of conus medullaris and cauda equina

“…They are usually located in the lumbosacral region, with few cases reported in the thoracic Conus medullaris and cauda equina concomitant cysts Falavigna et al and cervical spine [1][2][3][4][6][7][8] . In a series of 62 intradural conus and cauda equina tumors, Mathew and Todd 9 reported 11 cases of dermoids (17%), 9 epidermoids (14.5%), 3 teratomas (5%) and 3 lipomas (5%), with these congenital midline tumors compounding 41% of the tumors.…”

“…In a series of 12 dermoids, Arseni et al 1 reported that eight of them were extramedullary, three intramedullary and one in the coccygeal region. The association with other congenital spinal abnormalities is frequent 1,2,4,[6][7][8] . According to their origin, the dysembriogenic spinal tumors are classified in epidermoid, dermoid, theratoid or teratoma 4 .…”

“…The association with other congenital spinal abnormalities is frequent 1,2,4,[6][7][8] . According to their origin, the dysembriogenic spinal tumors are classified in epidermoid, dermoid, theratoid or teratoma 4 . The epidermoids are derived from the epithelium tissue, without dermal structures, while dermoids, in addition to the epiderm, present with hair, sebaceous glands and other skin appendages.…”

“…

Spinal dermoid cysts are benign tumors that results from congenital or adquired ectodermal inclusions [1][2][3][4][5][6][7] . Histologically they are characterized by the presence of dermal structures.

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“…In the pediatric population, the prevalence of dermoid tumors is much greater, with dermoids accounting for 5% to 17% of all intradural lesions in reported series 1,2,6 . A higher incidence of dermoid cysts has been described in patients with spina bifida, dermal sinuses, myelomeningocele, hemi-vertebrae and syringomyelia [1][2][3][4]6,7 . We present a rare case of an adult woman who presented with two separated dermoid cysts in the cauda equina and conus medullaris.…”