Agarwal Sudarsan, Agarwal Reshma, Majety Sameer Kumar, Veldurthi Ananta Kiran Kumar, Koppala Santhoshi Devi, Muppana Gopichand
Department of Neurosurgery, Sri Venkateswara Medical College, Tirupati, India.
School of Medicine, China Medical University, Shenyang, P.R. China.
Ann Med Surg (Lond). 2025 Jul 9;87(8):5300-5306. doi: 10.1097/MS9.0000000000003561. eCollection 2025 Aug.
Spinal teratomas are rare tumors of pluripotent germ cells, accounting for <0.5% of all spinal cord tumors and 2% of all teratomas. While they commonly occur in gonads, extragonadal spinal presentation is uncommon. They are often associated with spinal dysraphism and present variably depending on tumor location and neural compression. MRI aids in diagnosis, but histopathological examination remains the gold standard. Early detection is vital to avoid irreversible neurological damage.
A 16-year-old Indian male presented with progressive lower back pain for one year, followed by involuntary micturition and bilateral temporal headaches for six months. Neurological examination was normal, but persistent urinary symptoms warranted imaging. MRI revealed an intradural lesion at D11-L1, consistent with a spinal teratoma. The patient underwent surgical excision, and histopathology confirmed a monodermal teratoma. At three-month follow-up, the patient's symptoms had completely resolved.
Spinal teratomas may be classified as mature, immature, or malignant. Mature teratomas are most common in adults. Theories regarding their origin include misplaced primordial germ cells and dysembryogenic malformations. Clinical presentation varies from pain to autonomic dysfunction, demanding high clinical suspicion and prompt imaging. Surgical excision remains the mainstay of treatment. Subtotal resection is considered when tumors adhere to critical neural structures. Although rare, recurrence, malignant transformation, and aseptic meningitis have been reported, emphasizing the need for long-term follow-up.
This case underscores the importance of early neuroimaging in patients with atypical spinal symptoms. Surgical resection is definitive, while histopathology confirms the diagnosis. Regular follow-up remains essential.
脊髓畸胎瘤是一种罕见的多能生殖细胞肿瘤，占所有脊髓肿瘤的比例小于0.5%，占所有畸胎瘤的2%。虽然它们通常发生在性腺，但性腺外脊髓表现并不常见。它们常与脊髓发育不良有关，并根据肿瘤位置和神经受压情况表现各异。磁共振成像（MRI）有助于诊断，但组织病理学检查仍是金标准。早期发现对于避免不可逆的神经损伤至关重要。
一名16岁印度男性，出现进行性下背部疼痛1年，随后出现非自主性排尿和双侧颞部头痛6个月。神经学检查正常，但持续的泌尿系统症状需要进行影像学检查。MRI显示在胸11至腰1水平硬膜内有一病变，符合脊髓畸胎瘤。患者接受了手术切除，组织病理学证实为单胚层畸胎瘤。在3个月的随访中，患者症状完全缓解。
脊髓畸胎瘤可分为成熟型、未成熟型或恶性型。成熟畸胎瘤在成年人中最为常见。关于其起源的理论包括原始生殖细胞错位和胚胎发育异常畸形。临床表现从疼痛到自主神经功能障碍各不相同，需要高度的临床怀疑并及时进行影像学检查。手术切除仍然是主要的治疗方法。当肿瘤与关键神经结构粘连时，考虑次全切除。虽然罕见，但已有复发、恶性转化和无菌性脑膜炎的报道，强调了长期随访的必要性。
本病例强调了对有非典型脊柱症状患者进行早期神经影像学检查的重要性。手术切除是确定性的治疗方法，但组织病理学可确诊。定期随访仍然至关重要。
