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Lipoma of the filum terminale and tethered cord

Case contributed by Frank Gaillard
Diagnosis certain

Presentation

Bowel and bladder dysfunction.

Patient Data

Age: 20 years
Gender: Male

A fatty mass at the L4/5 level is present. The level of the conus is difficult to ascertain. No bony defects. 

MRI confirms the presence of an intrathecal fatty mass associated with the filum terminale which is somewhat thickened. The cord is low lying with conus terminating at L4/5. 

Features are those of lipoma of the filum terminale with spinal dysraphism. 

Case Discussion

The patient went on to have a resection. 

Histology: 

Filum terminale: sections show a piece of fibrocollagenous tissue containing solid nests of bland meningothelial cells. No inflammation or tumor is seen.

Fatty mass: sections show a well-circumscribed piece of mature adipose tissue. There is no evidence of atypia or malignancy.

FINAL DIAGNOSIS: lipoma of the filum terminale

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