Abstract
Introduction
Spinal dermoid cysts are benign tumors that results from congenital or acquired ectodermal inclusion. These tumors account for 0.8 to 1.1% of all primary spinal tumors with the majority occurring in the extramedullary area mainly in the pediatric population. We present a rare case of an adult woman with two separate dermoid cysts in the cauda equina and conus medullaris. The literature concerning dermoids is also reviewed focusing on tumor etiopathogenesis.
Patient and Methods: We report a case of 35-year-old woman who presented with chronic low back pain and left ciatalgia. She had a history of two abdominal surgeries to treat chronic constipation with an intraoperative diagnosis of intestinal adhesions. No history of spinal trauma, surgery, or lumbar puncture was reported. Neurological examination revealed hypoesthesia in the lateral surface of the left leg, weakness on dorsiflexion of the left foot, and Lasègue sign on the left leg. The magnetic resonance imaging evidenced a large mass located at the cauda equina and a smaller mass located at the conus medullaris. The literature was reviewed in PubMed. Surgical resection was accomplished through a posterior midline incision exposing L2 to S2. The histological examination of the tumors in cauda equina and conus yielded a diagnosis of dermoid cysts. Postoperatively, the patient had urinary retention which reverted in 2 months. Follow-up at 4 years showed complete resolution of preoperative symptoms.
Results
Our case is interesting because the adult patient with chronic low back and leg pain and intestinal dysfunction presented with two distinct dermoids located in the lumbosacral region. The patient had no history of spinal manipulation or trauma or any sign of dysraphism on physical and image examinations. Although the most common spinal localization is in the lumbosacral region, a concomitance of two separate tumors had never been reported in the literature to the best of our knowledge.
Conclusion
Spinal dermoid cysts are rare tumors that results from congenital or acquired implantation of embryogenic cells in the spinal canal. We do not know the origin of the two tumors in the presented case, they may have developed from two different embryogenic cells during fetal development or may have been secondary to a possible past cyst rupture whose contents spread to the conus medullaris. Total tumor removal should be the goal for preventing cystic recurrence and future malignization.