Mature Teratoma of the Filum Terminale in the Elderly, Incidentally Diagnosed after an Unmyelinated Lumbar Spine Trauma

Abstract

Introduction: Spinal teratoma is an extremely rare entity as it represents 0.10-0.60% of all spinal tumors. It is mainly diagnosed during the first two decades of life and can be associated with spinal dysraphism. Aim: To present a case of an asymptomatic mature teratoma of filum terminale, incidentally diagnosed in an elderly patient admitted to the Neurosurgery Department for multiple traumas after falling from 3 meters height. Case description: A 76 year-old patient was admitted in the 2 nd Neurosurgery Department, "Prof. Dr.N. Oblu" Emergency Clinical Hospital, Iaşi with multiple traumas after falling from 3 meters height. The patient presented bilateral paresthesia of lower limbs and urinary incontinence. Radiography of the dorsal-lumbar spine column in emergency highlighted a dorsal -lumbar fracture (D12-L1) with medullar compression. MRI examination revealed a neoformation of filum terminale that filled almost the entire spinal canal, which had a composite, fatty and fluid structure, corresponding to L2-L4 and compressing the medullary cone. The neurosurgical decision was the excision of the entire neoformation. The histopathological examination of excised pieces revealed the presence of adipose tissue mixed together with striated and smooth muscle fibers, small and large cysts lined by various epithelia ranging from malpighian keratinized multilayered to simple ciliated columnar epithelium. No immature or malignant cells were identified and therefore the diagnosis was mature teratoma of filum terminale. The evolution of the patient was favorable with the remission of the neurological deficit. Conclusions: Our patient is one of the oldest patients diagnosed up to date with a mature teratoma of filum terminale. Moreover, the location of neoformation at the lumbar (L2-L4) level is extremely rare. This case also highlights the fact that this mature teratoma was discovered by chance, when the patient came to the Neurosurgery Department for a spinal injury due to a falling from a tree.

Malignant Sacrococcygeal Teratoma with Yolk Sac Differentiation in a Child—A Case Presentation

“…Although most GCT in children originates in the gonads, the most common primary site for yolk sac tumor (YST) is the sacrococcygeal region [4]. In other study, Keslar et al [8] also mentioned sacrococcygeal region as the most common location for GCT in children [9], other less common sites for GCT include the mediastinum, testes, retroperitoneum, brain & head & neck region [9] and rarely in spinal location which is often associated (42%) with spinal malformation [10].…”

“…The term mixed malignant SCT implies that elements of YST are present along with either form of teratoma. Pure YST may also occur [9]. YST is rare and male to female ratio is about 1: 2.5 [5].…”

“…Patients with GCT typically have a bimodal age distribution, with a peak before three years of age and a second peak during adolescence. Most SCTs are discovered in the neonatal period as an obvious mass but may be detected prenatally [9]. YSTs are usually discovered later in early childhood [9] and exclusively develop in children less than three years of age [4].…”

“…Most SCTs are discovered in the neonatal period as an obvious mass but may be detected prenatally [9]. YSTs are usually discovered later in early childhood [9] and exclusively develop in children less than three years of age [4]. SCTs that are predominantly external anatomically have a lower malignant potential than internal (presacral) that are always malignant [5].…”