Mature teratoma of the filum terminale in an adult female. Report of a clinical case

Abstract

Abstract: 

Mature teratomas are benign tumors, composed of tissues derived from at least two of the three germ lines: ectoderm, mesoderm, and endoderm. They are most frequently located in the gonads, sacrococcygeal area, mediastinum, and cranial fossa. In the spinal cord they represent only 0.2-0.5% of all tumors, and within this location those in the thoracolumbar region are more frequent. Our objective is to report the case of a mature teratoma in the filum terminale, as this site of presentation is extremely infrequent.

We present the case of a 31-year-old patient, who consulted at Epidio Torres Hospital for a 5-year clinical picture of dysbasia, patchy hypoesthesia / paresthesia of the lower limbs, anesthesia in the genital region and sphincter incontinence. MRI showed a cystic lesion, 7 cm in maximum diameter in the spinal canal.

She was operated on, by the Neurosurgery team, carrying out an incomplete removal of the lesion, due to the interposition of nerve roots.

The tissues referred to Pathological Anatomy consisted of a fine capsule and a yellowish unctuous fragment, with hairy elements. Optical microscopy revealed that the capsule was lined by squamous mucosa, settling on fibroconnective, adipose and neural tissue with a mature appearance, with calcification foci. With these findings, the diagnosis of mature teratoma was reached.

The patient had to be re-operated on two occasions to undergo a surgical site toilet due to infection, and subsequently re-toilet with CSF fistula repair and placement of a spinal drain. She is currently hospitalized with antibiotic treatment, with good clinical evolution.

We conclude that mature spinal cord teratomas are not usually thought of as a differential diagnosis, since they are very rare in this location. Furthermore, despite being benign tumors, their surgical management with complete resection is very difficult to achieve, due to the complex anatomical location.