Spinal Epidermoid Tumors: Case Report and Review of the Literature

Abstract

Spinal epidermoid tumors are rare, benign tumors that are either acquired from trauma, surgery, or lumbar puncture or arise as congenital lesions, particularly spinal dysraphisms. We report a case of a massive spinal epidermoid tumor and review the literature with a focus on the surgical outcomes. A 71-year-old female patient presented after a fall with subsequent symptoms of severe back and hip pain, as well as loss of motor strength in the left leg. Her magnetic resonance imaging demonstrated a T2/short tau inversion recovery hyperintense mass extending from the level of the T10-11 disc caudally through S2. A biopsy was recommended to determine whether the tumor was radio- or chemo-sensitive. The patient underwent a L4 laminectomy and a pearly-white tumor was encountered, with a subsequent biopsy confirming it to be an epidermoid tumor. The following conclusions can be drawn from a review of the literature. Spinal epidermoid tumors are more common in women and tend to present in younger patients (median age of 23). The majority of patients had acquired lesions (46%). In terms of surgical outcomes for adherent tumors, gross total resection was found to provide optimal outcomes, with 90% of patients improving clinically after surgery.

Keywords: Epidermoid tumor; Intradural spine tumor; Spine tumor; Epidermoid cyst.

Fig. 1.

(A) Sagittal computed tomography of the lumbar spine demonstrating osseous remodeling from L4 through the sacrum. (B) T2 sagittal magnetic resonance imaging demonstrating expansive mass located at T10–11 intervertebral disc through S2.

Fig. 2.

Appearance of epidermoid tumor during surgical biopsy. The classic pearly white tumor is seen extruding from the durotomy. Cr, cranial; Ca, caudal.

Fig. 3.

Histopathological examination of hematoxylin and eosin (H&E) stained sections shows the classic morphology of epidermoid cyst, including a cyst lining composed of keratinizing stratified squamous epithelium, and cyst contents comprising sheets of flaky keratin (anucleate squames). No dermal adnexal structures are present (H&E, × 200).