[A case of cervical endodermal cyst].
A very rare case involving an endodermal cyst of the cervical spinal canal was documented. In 1999, a 28-year-old male presented with mild tetraplegia due to a traffic accident and consequently, he was admitted to another hospital. Magnetic resonance imaging (MRI) performed at that time demonstrated a cervical cord cyst. He was treated conservatively and as a result, complete resolution of symptoms was achieved. Five years later, he presented with progressive right hemiparesis and was referred to our institute. MRI at the time of admission exhibited an intradural extramedullary cystic lesion on the ventral side of the spinal cord at the C5-6 levels, which was characterized by low intensity on T1-weighted, and by high intensity on T2-weighted images. The cyst, which had increased in size, compressed the spinal cord remarkably backward. The anterior central vertebrectomy approach was performed. Subtotal resection of the cyst wall was conducted due to its tight partical adhesion to the spinal cord. The vertebral defect was reconstructed with an autogenous iliac graft. According to histological findings the cyst wall consisted of a single layer of columnar epithelial cells with secretory granules and immunohistochemical examination revealed that the cyst wall was positive for cytokeratin 7. Symptoms improved immediately. Subsequently, the patient was discharged with good performance status. Endodermal cysts are very rare developmental cysts derived from the embryonic endodermal layer. Moreover, these lesions are usually located intradurally in the cervical and upper dorsal spine ventral to the spinal cord. Total removal of the cyst is recommended if it is possible. However, total resection is often difficult due to adhesion of the cyst wall to the neural tissue so invasive resection should be avoided. In such cases, follow-up MRI is necessary in order to exclude recurrence of the remnant lesion.
Kusaka
Noboru
N
Department of Neurosurgery, National Hospital Organization Iwakuni Clinical Center, 2-5-1 Kuroiso-cho, Iwakuni, Yamaguchi 740-0041, Japan. kusaka@iwakuni-nh.go.jp
Maruo
Tomoko
T
Nishiguchi
Mitsuhisa
M
Takayama
Kazuhiro
K
Maeda
Yasuhiko
Y
Ogihara
Kotaro
K
Gotoh
Masaki
M
Nishiura
Tsukasa
T
Murakami
Ichiro
I
D000328:Adult; D015415:Biomarkers / Q000032:analysis; D020863:Central Nervous System Cysts / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery*; D002574:Cervical Vertebrae / Q000473:pathology; D003937:Diagnosis, Differential; D004707:Endoderm / Q000473:pathology; D006801:Humans; D053552:Keratin-7; D007633:Keratins / Q000032:analysis; D007796:Laminectomy; D008279:Magnetic Resonance Imaging; D008297:Male
D015415:Biomarkers; C507497:KRT7 protein, human; D053552:Keratin-7; D007633:Keratins