Extensive spinal epidural immature teratoma in an infant: case report

Abstract

<jats:p>Here, the authors present an extremely rare case of an extensive spinal epidural teratoma (SET) in an infant and provide a review of the cases in the literature. In this report, the authors focused on the clinical manifestation and management of extensive SET. A 64-day-old girl presented with severe dyspnea and paraparesis caused by a large thoracic mass. Imaging studies revealed that the mass originated from the epidural space of the thoracic spine and extended from C7 to L1. The tumor extended bilaterally through the intervertebral foramina and formed a large posterior mediastinal mass. The tumor was partially resected via laminotomy after an emergency thoracotomy. The remnant grade I immature teratoma grew rapidly. After a re-laminotomy and bilateral thoracotomy, the residual tumor stopped growing. However, the patient’s paraparesis improved very little, and her scoliosis progressed gradually. Therefore, SET should be included in the differential diagnosis when an infant patient with paraparesis of the lower extremities is encountered. Timely diagnosis, aggressive treatment, and close monitoring are of critical importance to successful recovery in such patients.</jats:p>

Pediatric Extramedullary Epidural Spinal Teratomas: A Case Report and Review of the Literature

“…Thus, other subtler findings on clinical exam are relied upon to strengthen a diagnosis. Clinical features such as progressive scoliosis and anomalies like skin stigmata and spinal dysraphism are shown to occur in conjunction with intraspinal tumors and lesions and can provide important clues to the underlying diagnosis [ 1 , 3 , 7 , 11 ]. In the case presented, a thoracic levoscoliosis and spinal prominence were the only significant findings on clinical exam.…”

“…Depending on the extent of tumor adherence to surrounding structures, subtotal resection has been reported as a means of preserving surrounding tissue while also removing the bulk of tumor. Given the slow growing and benign nature of teratomas, the incidence of recurrence is relatively low, especially if total resection is performed [ 7 ]. However, careful monitoring for recurrence remains a potential concern [ 7 , 15 , 17 , 20 ].…”

“…Most commonly, teratomas in the pediatric population are found in the sacrococcygeal region (41%), ovaries (28%), and testes (7%), though there have been case reports of retroperitoneal teratomas [ 5 , 6 ]. While most will present as mature teratomas, immature, spinal epidural teratomas have been described in the literature, and demonstrate more aggressive behavior [ 7 ]. The overall incidence of intraspinal teratomas is estimated to be between 0.15% and 0.18% [ 8 ].…”

Intramedullary cervical spinal cord teratoma

“…The latter can be located extramedullary or intramedullary. [ 22 , 23 ] Cervical ICTs are very rare, as reflected by the exceptionally low number of case reports published to date.…”

Conus Medullaris Teratoma: Case Report and Literature Review

“…Adjuvant radiotherapy is recommended for teratomas containing malignant components, but there is no evidence of the efficacy of adjuvant chemotherapy in these patients [ 9 23 25 ]. In very rare cases of immature types with evidence of malignancy, postoperative adjuvant chemotherapy may alter the aggressive behavior of this tumors and lead to complete and permanent cure [ 10 26 ]. Also the age of the patient and surgical approaches may influence the clinical outcomes [ 27 ].…”