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were observed, and the fi nal histological diagnosis was
mature teratoma [Figure 2]. No adjunctive therapy was
administered. The patient has shown no clinical or
radiological sign of progression through the most recent
follow-up examination, 3 years after surgery [Figure 3].
Discussion
Teratoma is one of the rarest intraspinal neoplasms,
representing 0.1-0.6% of all spinal tumors. It typically
[1]
affects young individuals in their fi rst or second decade
of life and is frequently associated with spinal dysraphic
defects. Adult cases are exceptional. Their rarity and the
use of various terms to describe them led to limitations a b
in understanding of the disorder and speculation about Figure 1: Sagittal T2-weighted (a) and T1-weighted post-gadolinium
their true origin and natural history. We searched the (b) magnetic resonance images showing a partially cystic and enhancing
PubMed and Medline databases for adult intradural mature intradural mass located between T12 and L3 spinal levels
teratomas and present here a comprehensive review of the
literature concerning these rare tumors.

The total number of adult spinal intradural mature
teratomas reported to date is 31. They are summarized
in Table 1. The mean age at presentation was 36 years
in men and 44 years in women, with a slight female
predominance (sex ratio: 0.8). These lesions were
predominantly located in the lower thoracic and a b
thoracolumbar spine. Only fi ve cases of conus medullaris Figure 2: Photomicrographs of the tissue obtained intraoperatively. (a) A
mature teratoma were reported. [14-16,26,27] slightly disorganized cartilage surrounded by respiratory mucosa complete with
bronchial glands and ciliated columnar epithelium (H and E, ×20); (b) cystic
The review indicates that, in sharp contrast to pediatric formations covered by multiple levels of keratinous squamous epithelial cells
cases, adult cases typically presented with subtle, containing keratin lamellae (H and E, ×20). H and E: Hematoxylin and eosin stain
nonspecifi c symptoms like back pain or radiculopathy.
Furthermore, although these patients commonly
experienced a certain degree of neurological disorder,
motor weakness was not always obvious. [30,31] Associated
dysraphism, commonly seen in young patients, was found
in only 6 adult patients (19%). [3,5,13,14,21,22]
Radiologically, displaced pedicles, erosions, thinned
laminae or calcifi cations on conventional X-rays are of
signifi cance and should be followed by a more extensive
investigation. However, as demonstrated in this
[21]
case, these fi ndings are not always present. Computed
tomography provides an optimal assessment of bony
structures, but it is of limited interest for the exploration
of the spinal cord and the extent of the tumor.
Magnetic resonance imaging is regarded as the gold
standard imaging technique because it best delineates Figure 3: Sagittal T1-weighted post-gadolinium follow-up magnetic resonance
the tumor characteristics and depicts the degree of imaging showing the stabilized tumor remnant at the conus medullaris level
spinal cord involvement. The morphological presentation elderly individuals. From the histological point of view,
varies according to the location of the tumor. Intradural Russel and Rubinstein [32] describe teratomas as tumors
teratomas are commonly oval or lobulated, heterogeneous that contain a mixture of the three germinal layers of
masses. Cystic components are usually found in adult ectoderm, endoderm, and mesoderm. The review of the
cases, which can lead to confusion with more common literature revealed that in a number of cases, only two
epidermoid and dermoid cysts. [17]
of the three germinal layers were observable, perhaps
In the present case, a well-demarcated and strongly because the derivatives of one or two of the layers
enhancing tumor was found, compounding the may overgrow others. [10,19] Spinal mature teratomas do
diagnostic challenges and highlighting the unspecifi c not differ from extragonadal ones and are composed
radiological aspect of spinal mature teratomas in exclusively of fully differentiated “adult type” tissue

Journal of Cancer Metastasis and Treatment ¦ Volume 1 ¦ Issue 2 ¦ July 15, 2015 ¦ 107