Ruptured conus medullaris dermoid cyst with fat droplets in the central canal [corrected]

Abstract

Spinal dermoid tumors are rare, benign, slow growing tumors. These tumors may become acutely symptomatic after rupture or infection. Excision of the lesion with long term close follow-up studies is required for the management of these lesions. We present a very rare case of ruptured conus medullaris dermoid cyst in a 22-year-old male presented with urinary retention and low back pain. Magnetic resonance imaging scan with contrast reveals a lesion in the cauda equina inseparable from conus medullaris with fat droplets within the central spinal canal extending up to the medulla. Patient was operated with laminectomy and near complete excision of the lesion was done. Patient's low back pain was relieved following surgery. However patient had persistent urinary incontinence and on clean intermittent self-catheterization. Histopathology was suggestive of dermoid cyst.

Keywords: Dermoid cyst; Ruptured; Spinal cord.

Fig. 1

Magnetic resonance imaging. T1 weighted (sagittal view) images showing hyperintense fat content in the central canal extending up to the medulla secondary to rupture of the mass.

Fig. 2

Magnetic resonance imaging scan T1 weighted (axial view) images at D-12 vertebral level showing hyper intense fat content in the central canal.

Fig. 3

Magnetic resonance imaging scan T1-weighted fat suppressed (sagittal view) images at conus medullaris extending in to the dorsal spinal cord demonstrates signal suppression of the fat content and no significant enhancement.

Fig. 4

Magnetic resonance imaging scan T1-weighted post-contrast (sagittal view) images at conus medullaris showing no significant post contrast enhancement.

Fig. 5

Histopathological examination showing a fibro collagenous cyst wall lined by stratified squamous epithelium with hair follicles and sebaceous glands in the dermis suggestive of dermoid cyst (×10).