Intramedullary cervical spinal cord teratoma

Abstract

Background: Intramedullary cervical spinal cord teratomas (ICTs) are extremely rare, and diagnosis and treatment are challenging. We conducted a systematic review of the literature on the diagnosis and treatment of ICT. Method: The presentation, imaging manifestations, diagnosis, management, surgery findings, prognosis and histology were reviewed following Preferred Reporting Items for Systematic Reviews and Meta Analyses guidelines. English-language studies and case reports published from inception to 2018 were retrieved. Data on presentation, imaging characteristics, diagnosis, management, surgery findings, outcomes, and histopathology were extracted. Results: Ten articles involving 10 patients were selected. The lesions were located in the upper cervical vertebrae in 4 cases, whereas in the lower cervical vertebrae in the remaining 6 cases. In 5 cases, the lesions were located on the dorsal side of the spinal cord, and in the center of the spinal cord in the remaining 5 cases. Quadriparesis (60%), paraplegia (30%), monoplegia (10%), and neck pain (50%) were the main presentations. The lesion appeared as a intramedullary heterogeneous signal during an MRI scan, and the lesion signal would be partially enhanced after the contrast medium was applied. All patients underwent surgical intervention through a posterior approach. Neurological function improved postoperatively in all patients. Two patients with pathology confirmed to be immature teratomas experienced recurrence. Conclusion: ICTs are extremely rare entities that are mainly located in the center or dorsal part of the spinal cord which mainly manifest as quadriplegia and neck pain. MRI is a useful modality that provides diagnostic clues. Surgery from a posterior approach is the primary treatment, and the effect of adjuvant therapy remains uncertain. The prognosis is mainly related to the pathological nature of the tumor and not the method of resection.

Resection Methods of Tumors Posterior Fossa and Medulla with mixed Histological Characteristics

“…The most frequent place of presentation of tumors is the cervical region in 22.5%, followed in 12% of cervicalthoracic location, 20% of these tumor lesions are associated with syringomyelia [5]. Histopathologically, until 1950 there were no reports of mixed tumors, the year in which neuronal, glial, and mixed tumors were described [10,19]. .…”

“…The functional prognosis is carried out by means of the Mc Cormick scale. In this functional prognosis, the strongest predictor is the pre-operative one, that is, if you enter surgery with a greatly diminished functional capacity, the prognosis is reserved, compared to a scale of optimal functional capacity [4,[6][7][8]10,12]. In cases of recurrence of EP, especially in children, the use of MRI-guided laserinduced thermal therapy is highlighted in patients especially with recurrent intracranial Anaplastic Ependymoma.…”

“…This lesion was designated from the histological analysis of French and Bucy. As "Subependymal Astrocytoma", however, SE will be considered as a variant of EP [9,10]. Below we present three representative clinical cases of histologically mixed tumor lesions and the management of cervical spinal cord resection.…”

Malignant Transformation of Primary Spinal Teratoma with Intracranial Metastasis: A Case Report and review of the literature

“…Spinal cord teratomas are mainly prone to occur in the sacrococcygeal region in neonates, and in adults, they tend to occur more frequently in the thoracolumbar region [1][2][3] .Teratomas in the spinal cord can be located either intradurally (within the dura mater) or extradurally (outside the dura mater). Tumors occurring within the dura mater can be situated within the spinal cord (intradural-intramedullary) or outside the spinal cord (intradural-extramedullary) 4 .…”

“…In cases where teratomas affect the cervical spine, patients may present with quadriplegia and sensory disturbances in all four limbs. During a physical examination, some patients may exhibit hyperactive deep tendon re exes and ankle clonus 4 .…”