A rare case of intramedullary lipoma associated with cyst

Abstract

-Intramedullary lipomas are benign tumours of the spinal cord corresponding to 1% of all primitive intramedullary tumours. We report a rare case of true intramedullary lipoma associated with cyst. The patient underwent subtotal resection and the diagnosis was made by histopathological examination. There was postoperative neurological improvement. CASEA 48-year-old woman presented with a 10-year history of progressive bladder dysfunction. Five years after the onset of bladder dysfunction, she has developed numbness and a cramp in both lower limbs. At this time, she had a clinical examination and was investigated with electromyography and a lumbar computed tomography (CT) that were normal. There was a gradual worsening of leg numbness with distal anesthesia in the last three months and she was unable to walk unaided in the last month prior to admission. At admission the general physical examination revealed that she was 120 Kg overweight. The cardiovascular and respiratory systems were normal. There were no motor, reflex or sensory changes in the upper extremities. Both lower limbs were spastic with the knee and ankle jerks exaggerated. There were grade IV spastic paraparesis, bilateral. Babinskis sign was positive bilaterally. There was depression of spinothalamic and posterior column sensibility up to the level of D10. Muscle spasms were present in both lower limbs. There were no signs of spinal dysraphism.Routine blood tests were normal. Urine culture revealed the growth of E. coli that was treated with antibiotic therapy. Plain radiographs of the dorsal-lumbar spine were unremarkable. Dorsal MRI (Philips Gyroscan T5-NT) revealed an intradural lesion extending from D11 to D12 displacing the spinal cord anteriorly. The inferior part of the lesion was high-signal intensity on T1-weighted images (TR 450 / TE 15) which was characteristic of a fat component (Fig. 1). At the upper border of the lesion there was a cyst that had the same MRI characteristics as the cerebrospinal fluid on T2-weighted images (TR 3700 / TE 130) with a fat component in the lower portion that appear hyperintense to normal neural parenchyma. There was indefinition of the thoracic spinal cord at the level of the cyst without any gadolinium enhancement (Fig. 2).Surgery was performed with midline skin incision from spinous process of D10 to L1. There was no evidence of spinal dysraphism after exposure of the laminae. After Xray localization of D10 spinous process, a laminectomy

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 .…”

“…When lesional imaging characteristics are suggestive of an inclusion cyst, careful review of imaging studies may reveal subtle abnormalities in the osseous spine or adjacent soft tissue either as a response to slow tumor growth or as a result of imperfect midline fusion during development. The differential diagnosis of dermoid cysts on imaging includes lesions with high lipid content such as teratomas and lipomas 8,9 . The dermoid cyst is usually filled with a soft, whitish yellow waxy substance with hairs and glandular secretions in addition to areas of induration 1,2,4,6 .…”

Lipoma intradural extramedular sem disrafismo

“…Os lipomas medulares são tumorações benignas pouco freqüentes, representando menos de 1% de todos tumores espinhais. 4,7,8,10,16 São considerados intradurais quando o acúmulo de células adiposas situa-se completamente no espaço intradural. 3 A ocorrência de lipoma intradural sem disrafismo vertebral é considerada rara, 2,8,9,12,18 localizados com maior freqüência nas regiões torácica e cervical.…”

“…1,3,8,9 Seu curso clínico é variável, comumente associado a sintomas inespecíficos, com progressiva deterioração neurológica, sendo diagnosticado, usualmente, por volta da 2ª e 3ª décadas de vida e decorrente do seu efeito de massa sobre a medula. 3,7,9 A seguir apresentamos um caso de lipoma intradural extramedular, presente o nível de L1, sem disrafismo vertebral, seu tratamento cirúrgico e a evolução do quadro.…”