Intramedullary epidermoid cyst presenting with abnormal urological manifestations

Abstract

Study design: Report of an epidermoid cyst with intramedullary localization. Objective: To describe an atypical presentation of intramedullary epidermoid cyst. Summary of background data: Intramedullary epidermoid cysts are rare entities with a marked variability in the clinical presentation, essentially of neurological pertinence. Methods: Case report of a spinal epidermoid cyst in a 13-year-old girl presenting with urological symptoms: she had a 12-month history of recurrent low urinary tract infections, urinary frequency and nocturnal enuresis. A urodynamic evaluation was performed and showed the presence of involuntary bladder contractions with detrusor instability and low bladder compliance. Magnetic resonance imaging of the spine demonstrated an intramedullary lesion of the dorsal spinal cord. Results: The mass was excised and 6 months after surgical excision, urological manifestations improved with decreased detrusor hyper-reflexia, increased bladder capacity and compliance and no later report of urinary tract infections. Conclusions: In our patient, unusual clinical manifestations of the tumor have delayed the diagnosis, but its complete removal has led to remission of symptoms. Detailed neurological examination and investigations are indicated in patients with clinical and urodynamic features, suggestive of neuropathic bladder.

Epidermoid Cyst of the Thoracic Spine: A Rare Case

“…The cyst behaves like any other space-occupying lesion, and signs and symptoms at presentation are usually progressive paraparesis, sensory loss, and rarely urological manifestations. 9 The proliferation of magnetic resonance imaging has resulted in an early diagnosis in apparently normal patients. Patients with neurological findings should undergo surgery as soon as the diagnosis is made.…”

Malignant transformation of an intramedullary epidermoid cyst in the thoracic region of the spinal cord

“…18 Histologically, these cysts are characterized by stratified squamous epithelium supported by an outer layer of collagenous tissue; progressive desquamation and breakdown of keratin from the epithelial lining toward the interior of the cyst produce the soft white material. 4,8,18 These lesions typically present in the 3rd decade of life with a history of progressive symptoms, such as muscle weakness, sensory loss, back pain, or leg pain, that can vary depending on the location of the lesion.…”

Thoracic Spinal Intradural Intramedullary Epidermoid Cyst: Case Report

“…13 It is much less amongst the spinal tumors with incidence of 0.6 -1.1%. 9 Most spinal epidermoid tumors are located in intradural extra medullary position.…”

“…Sphincter troubles may occur later. 9 Magnetic resonance imaging is the diagnostic method of choice. In the last decade, MRI has undoubtedly revolutionized the diagnosis of intramedullary tumors, reducing the interval between onset of symptoms and diagnosis.…”

“…Of all the 58 cases of intramedullary epidermoid cysts reported, there have been only 15 cases with MR imaging reported in the literature earlier. [2][3][4]7,9,10,14,15,19,[20][21][22]24,26,27 Magnetic resonance imaging of epidermoid cyst is characterized by the absence of perifocal edema and being a well circumscribed lesion. Its lobulated aspect helps differentiating it from arachnoid cyst.…”