Cervical intramedullary epidermoid cyst with liquid contents

Abstract

Intramedullary spinal epidermoid cysts are benign ectopic embryological growths with reported incidence of less than 1% of intramedullary tumors. In this case we report an unusual cervical intramedullary epidermid with liquid contents. A 40-year-old patient presented with progressive weakness of all four limbs of four months duration, bowel and bladder disturbances of two days duration, pain and paresthesias in all four limbs. Magnetic resonance imaging (MRI) revealed a well defined intramedullary lesion extending from C2-C3 level with widening of the cord. The lesion was hypointense on T1W images, hyperintense on T2W and fluid attenuation and inversion recovery images with thin rim of enhancement after contrast administration. Histopathological examination of the excised specimen revealed epidermal lining and keratinous material features of an epidermoid cyst. As in present case, rarely epidermoid cyst can have clear contents, and an MRI finding can closely mimic the features of arachnoid cyst, findings not classical and is different than described in literature.

Keywords: Epidermal cyst; Intramedullary epidermoid; Magnetic resonance imaging; Spinal cord neoplasms.

Fig. 1

Preoperative MRI images demonstrating a well define cervical intramedullary lesion on hypointense T1W (A), becoming hyperintnese on T2W (B) and fluid attenuation and inversion recovery (C) images with thin rim of enhancement (D). MRI: Magnetic resonance imaging.

Fig. 2

Magnetic resonance imaging T1W and T2W axial images and T1W coronal images showing further details of the lesion.

Fig. 3

Intra-operative photographs (A) showing widened and pale cord, (B) after opening the cord and cyst capsule clear contents of the cyst cavity (ignore the artifact next to arrow).

Fig. 4

Pathological examination of the cyst showing thin walled capsule in left image and flecks of keratinous material in right images.

Fig. 5

Follow up magnetic resonance imaging showing complete excision of the lesion and thinning of the cord at that level.