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10% of the overlying bone defect is possible, but less frequent than in dermoid or some extramedullary
epidermoids [2,4,11,12] . Dermoid and epidermoid tumors are usually intradural extramedullary (60%)
or intramedullary (40%). The lower thoracic and lumbar regions are the most common locations.
Conventional radiographs are generally normal but may demonstrate benign spinal canal widening with
flattening of the pedicles and laminae. On computed tomography these tumors are usually seen as well
demarcated masses are similar to the attenuation of CSF. The presence of calcification is more suggestive of
a dermoid than an epidermoid tumor. Again, there may be focal osseous erosion or spinal canal widening.
On MRI, dermoids are typically hypointense to hyperintense on T1 with variable signal intensities that
reflect fat (hyperintense on T1) or calcium (decreased signal intensity on T1). Epidermoids on T1 are
usually equal signal. Both tumors showed increased signal intensity on T2-weighted images. Typically,
[13]
these tumors do not enhance after contrast administration and may demonstrate restricted diffusion . In
our case, MRI showed mixed intensity on T2 film and isointense on T1 film with contrast enhancement
within the margin of the lesions [Figure 1]. Before operation it was confused regarding actual diagnosis of
this lesion but per operative appearance and histopathology was confirmed the diagnosis of upper dorsal
(D2/3) intramedullary epidermoid.

In conclusion, upper dorsal inamedullary epidermoids are simply rare lesions in neurosurgical practice.
Only a few literatures showed spinal intramedullary epidermoid in different areas rather than upper dorsal.
We report this case as a rare entity and found intramedullary epidermoid at the abnormal locations.

DECLARATIONS
Authors’ contributions
Conception, diagnosis, design, and manuscript editing: Rahman MA
Manuscript preparation: Hossain MA
Histological diagnosis: Habib S
Technical and manuscript revision: Barua KK
Literature search: Chaurasia BK

Financial support and sponsorship
None.

Conflicts of interest
There are no conflicts of interest.

Patient consent
It was obtained from the patient.

Ethics approval
Not applicable.

Copyright
© The Author(s) 2018.

REFERENCES
1. Greenberg MS. Cyst and tumor like lesions. In: Handbook of Neurosurgery 8th Edition. New York: Thieme Publishers; 2016. p. 760.
2. Penisson-Besnier I, Guy G, Gandon Y. Intramedullary epidermoid cyst evaluated by computed tomographic scan and magnetic resonance
imaging: case report. Neurosurgery 1989;25:955-9.
3. Craig RL. A case of epidermoid tumor of the spinal cord. Review of literature of spinal epidermoids and dermoids. Surgery 1943;13:354-67.
4. Manno NJ, Uihle A, Kernohan JW. Intraspinal epidermoids. J Neurosurg 1962;19:754-65.
5. Chandra PS, Manjari T, Devi BI, Chandramouli BA, Srikanth SG, Shankar SK. Intramedullary spinal epidermoid cyst. Neurol India