Mature Spinal Teratoma With Intraspinal Extradural Extension And Spinal Dysraphism
Why is this case report worthy? Late and unusual presentation of a large paravertebral teratoma with intraspinal extension presented as radiculopathy in a young girl makes the case unusual and unique. Viewing the motley presence of the lesion due to peculiar component and their image spectrum on various radiological modalities with associated spinal malformation is a visual treat for all the radiologists. History: 19- year-old female presented with left leg pain for three months aggravated on physical exercise. Spine radiographs reveal marked dorsolumbar kyphoscoliosis with convexity to left side and anomalous deformed D11-L5 vertebral segment and L3-L5 hemivertebra. An ill-defined, amorphous soft tissue mass with extensive calcification seen in left paravertebral region. Non-contrast CT thin axial section with coronal and sagittal reconstruction shows a large left paravertebral mass with variegated appearance, measuring 13 x 11 x 8 cm in size. The lesion is heterogeneous with variable components of soft tissue and cystic attenuation, multifocal fat lucencies (-15 to -100 HU) and scattered dense calcification (500-700 HU). There is evidence of intraspinal extension through the dysraphic spine with associated widening of the ipsilateral neural foramen. Corroborative MRI shows T1 and T2 hyperintense fat, multiple hypointense calcifications and better tissue characterization. Axial and coronal MR images show left posterolateral intraspinal extension of the lesion with associated widening of left neural foramina. There is associated right anterior displacement of the spinal cord which shows no signal alteration, and significant impingement at the nerve root level. Diagnosis Mature spinal teratoma with intraspinal extradural extension and spinal dysraphism. Conclusion Spinal cord teratomas are rare and can be present in extra¬dural, intradural, or intramedullary locations. The asso¬ciation between intradural spinal cord teratomas and spinal cord dysraphism suggests origin on similar embryological principle. Neuroimaging is used to diagnose the extent and morphology of the lesion, neurological compromise and approach to the treatment protocols.