Presentation
Interscapular pain and bilateral brachialgia with numbness and paresthesia.
Patient Data
Intraspinal intradural extramedullary ventral well-defined ovoid cystic lesion seen opposite C4-5 and C5-6 levels. It measures 1.5 x 1.5 x 2.5 cm. It elicits typical fluid signals (low signal in T1 and high signal in T2). It presents a thin wall with no internal septations. No enhancement in the post-contrast study. The lesion is seen compressing the spinal cord with subsequent cord edema.
Case Discussion
Endodermal cysts are intradural extramedullary spinal cysts that commonly involve the lower cervical or upper thoracic region from the ventral aspect compressing the spinal cord. It presents a fluid signal with no enhancement. Differential diagnosis includes arachnoid and epidermoid cyst. MRI diffusion can exclude epidermoid cyst as it is restricted in diffusion study. The differentiation between endodermal and arachnoid cyst is not possible on imaging, only by histopathology. In this case, the patient subjected to surgery and histopathology revealed an endodermal cyst.