J Korean Soc Spine Surg.  2006 Jun;13(2):142-146. 10.4184/jkss.2006.13.2.142.

Epidermoid Cyst of the Conus Medullaris and Cauda Equina: A case report

• Moon MS
• Shim YS
• Sun DH

• KMID: 2097832
• DOI: http://doi.org/10.4184/jkss.2006.13.2.142

Abstract

The objective of this study is to report on a case of a huge epidermoid cyst in the conus medullaris and cauda equina in a 43 year-old lady with the characteristic MRI and histologic findings. She suffered from low back pain, hypoesthesia around the anus and urinary incontinence for over 20 years. Since 15 years previously, she gradually developed right foot drop and muscle atrophy. She underwent surgery and unfortunately, she developed complete paralysis below T12 after complete tumor excision. At postoperative 4 weeks, evidence of partial neurological recovery down to the L3 roots was observed, but as yet there has been no further neurological recovery. Although total surgical excision is thought to be the only radical treatment, we recommend partial tumor excision to avoid damaging the spinal cord and cauda equina during the surgical procedure, than the radical excision, because this cyst is a very slowly growing benign tumor.

Keyword

Epidermoid Cyst; Conus Medullaris; Cauda Equina

MeSH Terms

Adult
Anal Canal
Cauda Equina*
Conus Snail*
Epidermal Cyst*
Foot
Humans
Hypesthesia
Low Back Pain
Magnetic Resonance Imaging
Muscular Atrophy
Paralysis
Spinal Cord
Urinary Incontinence

Figure

• 

  Fig. 1. MRI finding of lumbar spine (A) Cystic segmented mass with hyperintense signal area in T1 weighted image and heterogeneous mass with hypointensity occupies the conus and the cauda equine from the T12 to L2. (B) Tumor mass occupies the almost entire canal, and the uninvolved root is extremely displaced to left side in axial views.

• 

  Fig. 2. Operative Findings : Huge irregularly shaped nodular tumor mass wall is seen, when the dura was open.

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  Fig. 3. (A) The microscopic finding shows keratin laid down by the well-developed squamous epithelium. The stroma reveals abun-dant skin appendages (100). But no sweat gland and hair follicles are seen. (B) The well-developed squamous epithelia are shown. The underlying stroma demonstrates loose mesenchymal tissue(X100).

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