Babashahi Ali, Taheri Morteza, Fattahi Arash
Department of Neurosurgery, University of Medical Sciences, Rasool Akram Hospital, Tehran, Iran.
Surg Neurol Int. 2016 Nov 21;7(Suppl 38):S905-S907. doi: 10.4103/2152-7806.194516. eCollection 2016.
Dermoid tumors are slow growing, benign CNS lesions.
This case study concerns a 29-year-old female with a 6-year history of lower extremity paresthesias attributed to magnetic resonance (MR)/computed tomography (CT) documented intradural dermoid tumor that extended from L1 to S1. On MR, it was hypointense on T1, hyperintense on T2, and did not enhance with gadolinium. CT showed hyperdensity at the L1-L2 levels. The craniocervical MR imaging showed small hyperintense foci in the cisternal space favoring "fat dissemination." L1-S2 laminectomy revealed an intradural lesion characterized by "a solid and firm component compatible with fat tissue adherent to the conus medullaris and a solid-soft component within the cauda equina;" there were also "multiple fragments of white-creamy soft tissue with hair." Following tumor resection, the brain CT scan demonstrated fat dissemination within the intraventricular and cisternal space. Histopathologic examination confirmed the diagnosis of a dermoid tumor.
Dermoid tumors should be considered among the differential diagnosis of intradural lesions in young patients even without any other congenital abnormality.
皮样囊肿是生长缓慢的中枢神经系统良性病变。
本病例研究涉及一名29岁女性，有6年下肢感觉异常病史，磁共振成像（MR）/计算机断层扫描（CT）显示硬膜内皮样囊肿，从L1延伸至S1。在MR上，其在T1加权像上呈低信号，在T2加权像上呈高信号，注射钆后不强化。CT显示L1-L2水平处密度增高。颅颈MR成像显示脑池内有小的高信号灶，倾向于“脂肪播散”。L1-S2椎板切除术显示硬膜内病变，其特征为“一个与附着于脊髓圆锥的脂肪组织相符的实性且质地硬的成分以及马尾内一个实性-软质成分”；还有“多个白色奶油状软组织伴毛发碎片”。肿瘤切除后，脑部CT扫描显示脑室内和脑池内有脂肪播散。组织病理学检查确诊为皮样囊肿。
即使没有任何其他先天性异常，对于年轻患者硬膜内病变的鉴别诊断也应考虑皮样囊肿。
