Cystic teratoma of the conus

Case contributed by Assoc Prof Frank Gaillard

Presentation

Urinary symptoms and numbness.

Patient Data

Age: 30 years
Gender: Female
MRI

Within the conus (definitely intramedullary) is there a predominantly cystic lesion that occupies the entire canal. It is predominantly cystic (high T2) with some heterogeneous signal posterior inferiorly including areas of high intrinsic T1 signal that appear to drop signal on fat-saturated post-contrast sequences suggesting the presence of fat. There is likely a small heterogeneous component of enhancing soft tissue posteriorly on the right.  The film arises from the lower apex of the lesion, with cauda equina displaced a peripherally. 

This is an isolated lesion.  The remainder of the imaged cord, the cauda equina, and the thecal cul-de-sac appear unremarkable.

Incidental retro-aortic renal vein. 

Conclusion:

The lesion is definitely intramedullary, within the conus, and is predominantly cystic, with a heterogeneous solid component including what appears to be foci of fat.  These features strongly favor a cystic teratoma of the conus.

Case Discussion

The patient went on to have a resection. 

Histology

The sections show mature squamous epithelium with attached fibrous stroma, small blood vessels, small nerves and lobules of mature fat. The squamous epithelium is associated with loose abundant laminated keratin, features a granular layer, and is thin without dysplasia.  There are no adnexal skin structures.  There are no immature elements. There is no evidence for malignancy.

FINAL DIAGNOSIS: mature teratoma of the conus

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