Mature teratoma of conus medullaris: A case report and review of literature

Abstract

In conus medullaris, mature teratomas are rare. We report a case of a 40-year-old man who presented with urinary incontinence, low back pain, and muscle weakness. Magnetic resonance imaging revealed a mass in conus medullaris (T₁₁-L₁), further confirmed as a mature teratoma by pathological examination. We identified 63 cases of conus medullaris teratoma over the past two decades by systematically analyzing the case reports. Findings demonstrated that most cases were diagnosed in the fourth decade of life, with the majority of cases (57.6%) being male. Lower back pain, radiating pain in the extremities, hypoesthesia, and urinary dysfunction are the most common clinical presentations among patients with teratoma of conus medullaris. Mature teratoma is the dominant pathologic subtype of teratomas in this region, comprising more than 95% of cases. Our case highlights the importance of considering spinal teratoma as a differential diagnosis in patients presenting with urinary incontinence and lumbar pain.

Keywords: conus medullaris; mature teratoma; spinal tumor.

FIGURE 1

Preoperative sagittal T1‐weighted (A) and T2‐weighted (B) magnetic resonance imaging demonstrate an intradural extramedullary mass lesion at T₁₁–L₁ (conus medullaris). Axial section (C) demonstrates a large‐sized capsular lesion causing spinal cord compression. White arrows point to the tumor location.

FIGURE 2

Macroscopic view of the tumoral contents demonstrating hair and fatlike soft tissue.

FIGURE 3

Microscopic histopathological findings demonstrate the presence of central nervous tissue at the periphery and a cyst covered by non‐keratinized stratified squamous epithelium (A). Nervous tissue at the periphery in addition to non‐keratinized stratified squamous epithelium and keratin is shown in (B).

FIGURE 4

Flow chart of study selection for systematic review of the literature. *Databases were searched for published case reports/case series of conus medullaris teratoma within 2000–2022.