Mature Teratoma of the Filum Terminale in the Elderly, Incidentally Diagnosed after an Unmyelinated Lumbar Spine Trauma

##plugins.themes.bootstrap3.article.main##

##plugins.themes.bootstrap3.article.sidebar##

Published Jun 30, 2014
DOI: https://doi.org/10.22551/2014.01.0101.10007
Gabriela Florenţa Dumitrescu
Department of Pathology, “Prof. Dr. N. Oblu” Emergency Clinical Hospital, Iaşi, Romania
Lucian Eva Maria-Raluca Munteanu Mircea Daniel Albert Bogdan Dobrovăţ Elena Cojocaru Ana-Maria Dumitrescu Anca Sava

Abstract

Introduction: Spinal teratoma is an extremely rare entity as it represents 0.10-0.60% of all spinal tumors. It is mainly diagnosed during the first two decades of life and can be associated with spinal dysraphism. Aim: To present a case of an asymptomatic mature teratoma of filum terminale, incidentally diagnosed in an elderly patient admitted to the Neurosurgery Department for multiple traumas after falling from 3 meters height. Case description: A 76 year-old patient was admitted in the 2nd Neurosurgery Department, “Prof. Dr. N. Oblu” Emergency Clinical Hospital, Iaşi with multiple traumas after falling from 3 meters height. The patient presented bilateral paresthesia of lower limbs and urinary incontinence. Radiography of the dorsal-lumbar spine column in emergency highlighted a dorsal - lumbar fracture (D12-L1) with medullar compression. MRI examination revealed a neoformation of filum terminale that filled almost the entire spinal canal, which had a composite, fatty and fluid structure, corresponding to L2-L4 and compressing the medullary cone. The neurosurgical decision was the excision of the entire neoformation. The histopathological examination of excised pieces revealed the presence of adipose tissue mixed together with striated and smooth muscle fibers, small and large cysts lined by various epithelia ranging from malpighian keratinized multilayered to simple ciliated columnar epithelium. No immature or malignant cells were identified and therefore the diagnosis was mature teratoma of filum terminale. The evolution of the patient was favorable with the remission of the neurological deficit. Conclusions: Our patient is one of the oldest patients diagnosed up to date with a mature teratoma of filum terminale. Moreover, the location of neoformation at the lumbar (L2-L4) level is extremely rare. This case also highlights the fact that this mature teratoma was discovered by chance, when the patient came to the Neurosurgery Department for a spinal injury due to a falling from a tree.

##plugins.themes.bootstrap3.article.details##

Keywords

teratoma, filum terminale, spine trauma

References
1. Virchow R: Die krankhaften Geschwülste, Bd. I, August Hirschwtald, Berlin, 1863, p. 96.
2. Sinha CK, Davenport M (Eds.), Handbook of Pediatric Surgery, Springer-Verlag, London, 2010, p. 399.
3. Willis RA: Teratomas, in Atlas of Tumor Pathology, section III, Fascicle 9, Armed Forced Institute of Pathology, Washington, 1951.
4. Pantoja E, Rodríguez-Ibañez I: Sacrococcygeal Dermoids and Teratomas, Am J Surg, 1976, 132:377-382.
5. Keating RF, Goodrich JT, Parker RJ: Tumors of the Pediatric Central Nervous System, Thieme Medical Publishers, New York, 2001
6. Poeze M, Herpers M, Tjandra B, Freling G, Beuls E: Intramedullary spinal teratoma presenting with urinary retension: case report and review of the literature. Neurosurg, 1999, 45:379–385.
7. Sharma MC, Jain D, Sarkar C, et al: Spinal Teratomas: A Clinico-Pathological Study of 27 Patients. Acta Neurochir (Wien), 2009, 151(3):245-52.
8. Louis DN, Ohgaki H, Wiestler OD, Cavenee WK (Eds.), WHO Classification of Tumors of the Central Nervous System, 4th Edition, IARC, Lyon, 2007, pp. 201-202.
9. Friedman JA, Lynch JJ, Buckner JC, Scheithauer BW, Raffel C, Management of Malignant Pineal Germ Cell Tumors with Residual Mature Teratoma, Neurosurg, 2001, 48(3):518-22.
10. Sweiss RB, Shweikeh F, Sweiss FB, Zyck S, Dalvin L, Siddiqi J: Suprasellar Mature Cystic Teratoma: An Unusual Location for an Uncommon Tumor. Case Rep Neurol Med, vol. 2013, Article ID 180497, 4 pages, 2013. doi:10.1155/2013/180497.
11. Eckmann C, Hüneke B, Schlotfeldt TC, Carstensen MH, Reinhold S: Prenatal Diagnosis of Malignant Intracranial Teratoma in the Fetus, Geburtshilfe Frauenheilkd, 1991; 51(10):859-60.
12. Sanyal P, Barui S, Mathur S, Basak U: A Case of Mature Cystic Teratoma Arising from the Fourth Ventricle. Case Rep Pathol, 2013, 2013:702424. doi: 10.1155/2013/702424.
13. Agrawal M, Uppin MS, Patibandla MR, et al: Teratomas in the Central Nervous System: A Clinico – Morphological Study with Review of Literature, Neurol India, 2010, 58(6):841-846.
14. Fernández-Cornejo VJ, Martínez-Pérez M, Polo-García LA, Martínez-Lage JF, Poza M: Cystic Mature Teratoma of the FilumTerminale in an Adult Case Report and Review of the Literature, Neurocirugia (Astur), 2004, 15(3):290-3.
15. Sung KS, Sung SK, Choi HJ, Song YJ: Spinal Intradural Extramedullary Mature Cystic Teratoma in an Adult, J Korean Neurosurg Soc, 2008, 44:334-337.
16. Hamabuchi M, Hasegawa R, Murase T: Teratoma of the Spinal Cord. A Case Report with CT Scans, J Bone Joint Surg, 1989, 71-B(3):390-392.
17. Jeong SJ, Youm JY, Choi SW, Kim SH: Intradural Mature Teratoma in the Lumbar Spine Found in Adult, Kor J Spine, 2009, 6(3):211-13.
18. Yu J, Qu L, Li Y, Huang H: Coexistence of Spinal Teratoma of the Conus Medullaris and Arteriovenous Malformations in an adult: A Case Report, Turk Neurosurg, 2012, 22(4):510-14.
19. Ijiri K, Hida K, Yano S, Iwasaki Y: Huge Intradural Ossification Caused by a Mature Spinal Teratoma: Case Report, Neurosurg, 2009, 64(6) E1200-1; discussion E1201.
20. Ghostine S, Perry E, Vaynman S, et al: The Rare Case of an Intramedullary Cervical Spinal Cord Teratoma in an Elderly Adult: Case Report and Literature Review, Spine (Phila Pa 1976), 2009, 34(26):E973-8.
21. Stevens QE, Kattner KA, Chen YH, Rahman MA: Intradural Extramedullary Mature Cystic Teratoma: not only a Childhood Disease, J Spinal Disord Tech, 2006, 19(3):213-6.
22. Santos PC, Maia CP, Penha Pereira JC, de Alvarenga Oliveira TC: Giant Mediastinal Teratoma found during Surgery after Thoracic Trauma, Rev Bras Cir Cardiovasc, 2007, 22(2):252-4.
23. Yang WM, Chen ML, Lin TS: Traumatic Hemothorax Resulting from Rupture of Mediastinal Teratoma: A Case Report. Int Surg, 2005, 90(4):241-4.
24. Miyazawa M, Yoshida K, Komatsu K, Kobayashi N, Haba Y: Mediastinal Mature Teratoma with Rupture into Pleural Cavity Due to Blunt Trauma. Ann Thorac Surg, 2012, 93(3):990-2.
25. Chowdhury MM, Pierro A: Sacrococcygeal teratoma, in Spitz L., Coran A.G. (Eds.), Operative Pediatric Surgery, 6th Edition, Taylor & Francis Group, 2006, p. 725.
How to Cite
Dumitrescu, G. F., Eva, L., Munteanu, M.-R., Albert, M. D., Dobrovăţ, B., Cojocaru, E., Dumitrescu, A.-M., & Sava, A. (2014). Mature Teratoma of the Filum Terminale in the Elderly, Incidentally Diagnosed after an Unmyelinated Lumbar Spine Trauma. Archive of Clinical Cases, 1(1), Arch Clin Cases 2014; 1(1):28-33. https://doi.org/10.22551/2014.01.0101.10007
Issue
Vol. 1 No. 1 (2014)
Section
Case Reports

Archive of Clinical Cases is protected by copyright and may be used in accordance with copyright and other applicable laws. Content available at www.clinicalcases.eu and our digital applications is intended for personal noncommercial use.

Authors who submit a manuscript for publication in Archive of Clinical Cases agree to the following terms: a. Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal. b. Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal. c. Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) only after the final version of the manuscript was accepted and published, as it can lead to productive exchanges, as well as earlier and greater citation of published work (See The Effect of Open Access). d. It is compulsory that before submission authors ensure that their work was not published in any other medical journals or pending acceptance for publication and that "Archives of Clinical Cases" is the only beneficiary at that moment if their work/case will be accepted by us.

Guidelines for linking to www.clinicalcases.eu a. The main purpose of the site linking to the Archive of Clinical Casess site should be educational. b. Links should be made to the Archive of Clinical Casess home page (www.clinicalcases.eu) or to the articles abstract. c. It is forbidden to use the Archive of Clinical Casess cover by outside organizations unless permission has been granted in advance, notifying our Secretary. d. Material owned by the Archive of Clinical Cases (including the name, logo, cover, and text) may not be used in any manner that may induce the idea or suggest that the Archive of Clinical Cases is in some way recommending a specific company, product or service. e. You must not use or allow others to access or use, all or any part of our Site or the contents and/or applications on it for commercial purposes without our permission. To seek permission to do anything prohibited by or not contained in these TERMS, or which requires our prior consent or agreement, you can contact us.

How to Cite

Dumitrescu, G. F., Eva, L., Munteanu, M.-R., Albert, M. D., Dobrovăţ, B., Cojocaru, E., Dumitrescu, A.-M., & Sava, A. (2014). Mature Teratoma of the Filum Terminale in the Elderly, Incidentally Diagnosed after an Unmyelinated Lumbar Spine Trauma. Archive of Clinical Cases, 1(1), Arch Clin Cases 2014; 1(1):28-33. https://doi.org/10.22551/2014.01.0101.10007