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Case Report

Spinal intradural mature teratoma in an elderly patient

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Atef Ben Nsir , Karim Ben Hammouda , Imed Ben Said , Alia Zhani Kassar , Nidhameddine Kchir , Hafedh Jemel 2
1 Department of Neurological Surgery, Fattouma Bourguiba University Hospital, University of Medicine of Monastir, Monastir 5000, Tunisia.
2 Department of Neurological Surgery, Tunisian National Institute of Neurology, University of Medicine of Tunis El Manar, Tunis 1007, Tunisia.
3 Department of Pathology, La Rabta University Hospital, University of Medicine Tunis El Manar, Tunis 1007, Tunisia.
Correspondence to: Dr. Atef Ben Nsir, Department of Neurological Surgery, Fattouma Bourguiba University Hospital, University of Medicine of
Monastir, Monastir 5000, Tunisia. E-mail: atefbn@hotmail.fr
ABSTRACT
Spinal intradural mature teratomas are rarely encountered in adults. In this report, one of the oldest patients ever reported to harbor
an intradural mature teratoma of the conus medullaris is presented, and the relevant literature concerning the teratoma’s origin,
clinical presentation, radiological features, and treatment modalities is reviewed. A previously healthy 70-year-old woman presented
with a 2-month history of left sciatica. Her neurological examination was normal and the magnetic resonance imaging of the
thoracolumbar spine showed an intradural, partially cystic mass extending from T12 to L3 level. The patient underwent a T11-L4
laminectomy. After opening the dura, a yellowish vascular tumor attached to the conus medullaris came into view. Meticulous
dissection allowed for subtotal tumor removal. Only a thin part of the tumor wall, tightly attached to the conus medullaris, was
left. The tumor was diagnosed as mature teratoma by histological study, and no adjunctive therapy was administered. The pain
experienced by the patient disappeared postoperatively. Her condition remained unchanged with no radiological recurrence through
the most recent follow-up examination, 3 years after surgery. The present study outlines that mature teratoma can arise from
the conus medullaris, even in older adult patients. Functional preservation is of utmost importance, and long-term follow-up is
mandatory to spot recurrences early.
Key words: Conus medullaris tumor, mature teratoma, surgery

Introduction her neurological examination was unremarkable and
the physical examination including detailed clinical
In 1863, an unprecedented fi nding, Rudolf Virchow examination of the trunk and the extremities, did not fi nd
described the “ Krankenhaften Geschwülst,” an intraspinal any patchy area of abnormal hair or dimple on her back.
“monstrous tumor” better known today as teratoma. One Anteroposterior and lateral radiographs were normal,
hundred and fi fty years later, the origin, natural history, and spinal magnetic resonance imaging confi rmed the
and occurrence of teratoma in elderly individuals are presence of a partially cystic and enhancing intradural
still subjects of debate. Spinal teratoma is, in fact, an lesion extending from T12 to L3 level [Figure 1].
extremely rare entity representing only 0.1-0.6% of all
spinal tumors and mainly diagnosed during the fi rst A T12-L4 laminectomy was performed. The dura was
[1]
two decades of life. With only 31 described cases, adult opened in the midline, and a yellowish, vascular tumor
forms are most uncommon. This report contributes to came into view. The tumor originated from the conus
the understanding of these rare tumors by presenting an medullaris and developed freely between the nerve
exceptional case of a conus medullaris mature teratoma roots. Fatty substance was present outside the tumor, and
in a 70-year-old woman and reviewing the relevant mucous substance, bony fragments, and hair were found
literature concerning its origin, clinical characteristics, inside the tumor.
radiological features, and treatment modalities.
Curettage of the cystic content was performed and
Case Report progressive dissection allowed for a subtotal resection.
A thin rim of the capsule that was tightly adherent to
A previously healthy 70-year-old woman presented to the conus medullaris was left. This was considered
our department in July 2011 with a 2-month history of safer than performing a radical resection that would
left sciatica, with progressive aggravation. On admission, probably lead to a severe neurological defi cit. The
patient improved remarkably postoperatively. Her pain
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disappeared immediately. Histological examination
Quick Response Code: showed a large number of glandular formations covered
Website:
www.jcmtjournal.com by mature, prismatic, and fl attened cubic epithelial cells.
These structures were embedded between fi brovascular
tissue and mature fat tissue, which included some
DOI:
10.4103/2394-4722.157808 cystic formations. Three germ cell layers (including
ectodermal, mesodermal, and endodermal elements)

106 Journal of Cancer Metastasis and Treatment ¦ Volume 1 ¦ Issue 2 ¦ July 15, 2015 ¦