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Adult Intradural Teratoma in the Lumbar Spine – Proof That Children Do Not Have a Monopoly on Spinal Teratoma 2014

Category 
General Spine
 Ashish R. Gandhe, MD
Mougnyan Cox
James Casey
Mark Curtis, MD
David Friedman
Purpose 
 We report a rare case of adult intradural teratoma in the lumbar spine, and discuss imaging findings enabling differentiation from other T1-hyperintense intradural lesions. INTRADURAL TERATOMA.pptx 

Materials & Methods 
A 49-year-old man presented with an 8-month history of overflow urinary incontinence. Past medical history and physical examination were unremarkable. MR imaging of the lumbar spine showed a large, intradural extramedullary mass at L1-L2, below the level of the conus, with peripheral displacement of the cauda equina nerve roots. The mass was inhomogeneously hyperintense on T1-weighted images, followed the signal of fat on all pulse sequences, and showed no significant enhancement. There was no dysraphism. The patient underwent near-complete tumor resection. Histopathology revealed keratin debris, benign squamous epithelium, adnexal glands, adipose tissue, and mature brain and peripheral nerve tissue; these findings were diagnostic of a mature teratoma. 


 Results 
Spinal teratomas are very uncommon, accounting for only 0.1–0.2% of all spinal tumors. The majority of spinal teratomas occur in the pediatric age group. Intradural teratomas in adults are very rare; less than 30 cases have been published in literature. There is no sex predilection. T1-hyperintense signal in the spine is usually caused by the presence of fat, methemoglobin, protein, melanin, or gadolinium enhancement. Intradural fat-containing lesions include lipoma, lipomeningocele, and schwannoma with fatty degeneration. Lipomas are typically uniformly hyperintense on T1-weighted images, while teratomas are more inhomogeneous. Lipomeningoceles are usually associated with spinal dysraphism. Intradural lesions that may contain methemoglobin include hemorrhagic dropped metastases, myxopapillary ependymomas, and subarachnoid hemorrhage. Ependymomas and metastases typically enhance after contrast administration. Melanotic dropped metastases can also be hyperintense on T1-weighted imaging. Methemoglobin and melanin will not suppress on fat-saturation sequences. 
 
 Conclusion
 Adult intradural spinal teratoma is a rare lesion; however, recognition of the MR imaging characteristics should allow the radiologist to distinguish this entity from other T1-hyperintense intradural lesions. 
 
 References 
1. Mature teratoma of the spinal cord in adults: An unusual case. Yuan et al Oncology letters 2013. 2. AIRP best cases: Spinal conusdermoid with lipid dissemination. Maio et al. Radiographics 2012 3. Intracranial lesions with high signal intensity on T1: differential diagnosis. Radiographics 2012. 4. Neuroradiology: The requisites. 3rd edition. Youssem D, Grossman R.