Elderly onset intramedullary epidermoid cyst in the conus medullaris: a case report
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JOURNAL OF MEDICAL
CASE REPORTS
CASE REPORT
Open Access
Elderly onset intramedullary epidermoid cyst in the conus medullaris: a case report Takeru Ohara1, Satoshi Maki1, Takeo Furuya1, Taigo Inada1, Koshiro Kamiya1, Mitsutoshi Ota1, Akihiko Okawa2, Osamu Ikeda3, Kazuhisa Takahashi1, Masashi Yamazaki4 and Masao Koda1*
Abstract Introduction: Epidermoid cysts are known as embryonic or acquired ectopic aberrations of the ectoderm. To the best of our knowledge, there are only a few reports of elderly onset intramedullary epidermoid cysts. We report a case of elderly onset intramedullary epidermoid cyst at the conus medullaris. Case presentation: A 63-year-old Japanese woman working as a farmer presented with slowly progressive gait disturbance and voiding dysfunction. A magnetic resonance imaging scan revealed an intramedullary mass lesion at L1 to L3. We diagnosed the lesion as an intramedullary spinal cord tumor. A laminectomy was performed at the level of Th12 to L3. Upon spinal cord dissection, a yellowish milky exudation erupted from the cystic lesion. We resected white cartilage-like pieces from the cystic cavity. Because the wall of the cystic lesion tightly adhered to the spinal cord parenchyma, we abandoned complete resection of the cyst wall. The pathological diagnosis was an epidermoid cyst. Conclusions: We propose that evacuation of the cyst contents is preferable, especially in cases with elderly onset and congenital origin. Keywords: Epidermoid cyst, Intramedullary tumor, Conus medullaris
Introduction Epidermoid cysts are known as embryonic or acquired ectopic aberrations of the ectoderm. Spinal cord epidermoid cysts are a rare condition, accounting for 1% of spinal cord tumors. In particular, intramedullary epidermoid cysts are extremely rare [1]. Past reports have described congenital intramedullary epidermoid cyst onset in children, adolescents and relatively young people. To the best of our knowledge, there are only a few reports of elderly onset intramedullary epidermoid cysts [1]. Here we report a case of elderly onset intramedullary epidermoid cyst at the conus medullaris. Case presentation A 63-year-old Japanese woman working as a farmer presented with slowly progressive gait disturbance and voiding dysfunction of approximately six months’ duration. * Correspondence: [email protected] 1 Department of Orthopedic Surgery, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo-Ku, Chiba 2608670, Japan Full list of author information is available at the end of the article
One month prior, she complained of general fatigue. She was diagnosed with chronic post renal failure caused by urinary retention. A magnetic resonance imaging (MRI) scan revealed a space-occupying lesion at the level of L1 to L3. She was subsequently referred to our institution for surgical treatment. She was medicated for mild hypertension. There was no past history of lumbar tap, myelography, spinal surgery or spinal injury. On admission, she could barely walk without holding on to a wall or table. Neurological e
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