Epidermoid cyst - thoracic spine
Mid-level spine pain.
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An intradural lesion is demonstrated at the level of T5 occupying the left posterolateral 2/3 of the cross-sectional area of the thecal sac. The spinal cord is distorted, displaced anterolaterally to the right, with no edema within the cord. The interface between the lesion and cord is indistinct at one level, raising the possibility of a combined intradural and partial intramedullary lesion-although note that the vast majority of the lesion is clearly extramedullary. There is no abnormal enhancement of the lesion, no evidence of lesional fat, and no abnormal enhancement of the dura.
The patient went on to have surgery and the lesion resected.
The sections show a collapsed cyst. This is lined by squamous epithelium with a discernible granular layer and contains laminated keratin. No appendageal structures or mesenchymal elements are identified. There is no evidence of a tumor.
FINAL DIAGNOSIS: spinal epidermoid cyst.