Co-existent epidermoid and dermoid in a child with spinal dysraphism
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CASE REPORT
Co-existent epidermoid and dermoid in a child with spinal dysraphism Madhivanan Karthigeyan 1
&
Kavindra Singh 1 & Pravin Salunke 1 & Kirti Gupta 2
Received: 24 August 2020 / Accepted: 6 November 2020 # Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Both spinal epidermoids and dermoids, given their common embryological origin, are referred as a single entity under the category of spinal inclusion tumors. Many theories, although speculative, have been proposed in relevance to their development. We present a unique case of dual pathology consisting of both epidermoid and dermoid components in a child with spinal dysraphism and succinctly touch upon the related embryological aspects and plausible pathogenesis. To the best of our knowledge, such co-existent entity has not been observed in the pediatric spine. The report adds to the gamut of the diverse observations of spinal dysraphic anomalies. Keywords Dermoid . Epidermoid . Inclusion cyst . Spinal dysraphism . Ectoderm . Neural tube . Myelomeningocele
Introduction
Case summary
Epidermoid-dermoid cysts are closely related, developmental pathologies occurring in the spinal cord and usually seen as part of the spectrum of spinal dysraphism. Both are ectodermal derivatives and often considered under the blanket term of “spinal cutaneous inclusion tumors” [1, 2]. Though the radiologic, management, and prognostic aspects may not differ much between the two, their embryological perspective has been intriguing and has been a source of controversy [1–4]. The two, although share the feature of cyst wall lining by simple stratified squamous epithelium, are distinguished from each other by the typical keratin pearls (desquamated epithelium) in case of an epidermoid and the additional presence of dermal appendages in a dermoid [2, 3, 5, 6]. In this report, we describe an interesting case of a child with simultaneous occurrence of spinal epidermoid and dermoid and the related embryological aspects.
This 9-year-old boy presented with weakness in the left foot of 5-month duration. His past history was significant for having undergone surgery for myelomeningocele at day 2 of life, elsewhere. He had decreased muscle strength in left lower limb (proximal 4/5 and distal 3/5) with impaired pain and touch sensations. Magnetic resonance imaging demonstrated a 46*32*24 mm sized, lobulated, mildly enhancing lesion at L2–3 level (Fig. 1). On T1-weighted sequence, the lesion was isointense. The T2-sequence delineated two components in the lesion, the upper portion relatively more hypodense than the lower one, with an intervening septum. At surgery, under neuromonitoring, the previous scar was re-explored, adhesions released, and dural tube delineated. After myelotomy, there were two distinct lesions identified, intervened by a septum. The cranial one showed an epidermoid cyst with smooth glistening capsule and typical pearly white contents (Fig. 1). On opening the caudal lesion which was distinct from the upper one, thick, cheesy, yellowish content wa
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