Adult cervical intramedullary teratoma: first reported immature case

Case report

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Intramedullary teratomas, particularly adult cervicothoracic lesions, are extremely rare. Up to now only 6 cases of intramedullary cervical teratomas have been reported in adults, and all of these were histologically mature. The authors present the case of a 35-year-old man with progressive myelopathic symptoms who was admitted through an outpatient clinic and was surgically treated. The characteristics, diagnosis, epidemiology, and treatment of cervical intramedullary teratomas in adults are also reviewed. Postoperative MR imaging showed that the tumor had been near totally removed, and severely adherent tissue remained ventrocranially with tiny focal enhancement on follow-up MR imaging. Pathological examinations revealed immature teratoma without any malignant component. Adjuvant therapy was not performed. Although no change in neurological findings and symptoms was apparent postoperatively, lesion regrowth was demonstrated on MR imaging 4 months after surgery. At 8 months postoperatively, myelopathic symptoms had developed and a huge intramedullary tumor recurred according to MR imaging. This case is the seventh reported instance of intramedullary cervical teratoma in an adult, and the first case report of the immature type with malignant features.

Article Information

Address correspondence to: Youn-Kwan Park, M.D., Ph.D., Department of Neurosurgery, Korea University Guro Hospital, Korea University College of Medicine, 80 Guro-dong, Guro-gu, Seoul 152-703, Korea. email: vagusmoon@hotmail.com.

© AANS, except where prohibited by US copyright law.

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Figures

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    Sagittal (A–C) and axial (D–F) MR images revealing an intramedullary lesion at C6–7 with peritumoral heterogeneous high signal intensity at C3–T3 on T2-weighted images, and scattered lesions with diverse high signal intensities. In T1-weighted MR images, focal lesions with slightly elevated signal intensity were observed. A gadolinium enhancement study showed a highly enhanced lesion with heterogeneous features.

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    A: Immediate postoperative Gd-enhanced T1-weighted MR images showing near-total removal of the tumor, but severely adherent tissue ventrocranially with tiny focal enhancement (arrows). B: Four-month follow-up MR images showing definite regrowth. C: Eight-month follow-up MR image revealing tumor progression beyond its preoperative size.

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    The tumor was composed of a mixture of immature epithelial and stromal components. A: Photomicrograph demonstrating epithelial components, including some primitive glandular structures (circle). B: Photomicrograph showing stromal tissue composed mostly of primitive mesenchymal cells with small, spindle-shaped nuclei and scanty cytoplasm, although some islands of immature cartilage (rectangle) also can be observed. C: Photomicrograph demonstrating epithelial components, such as some primitive glandular structures, which are immunohistochemically positive for α-fetoprotein, a marker of the immature type. Original magnification × 40 (A) and × 200 (B and C).

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