Teratoma or enterogenous cyst? The histopathological and clinical dilemma in co-existing occult neural tube dysraphism.
BACKGROUND
Better understanding of embryology, histopathology and genetics of dysraphic conditions have lead to an expansion of this concept to entities with a similar microscopic appearance (e.g. enterogenous cysts, colloid cyst of the III-rd ventricle) or rated among neoplasms (e.g. mature teratoma), creating a certain conceptual confusion. Currently the diagnosis of "teratoma" is being substituted by "enterogenous cyst" or "teratomatous cyst".


OBJECTIVE
Clarification of concepts in this field and presentation of the experience of the Department of Neurosurgery of the Children's Memorial Health Institute associated therewith.


METHODS
Since January 1990 through April 2005 we had treated 7 children with the final diagnosis of "an enterogenous cyst". The mean age of the children was 10.5 years and the mean follow-up time was 4.1 years. The study was performed by a retrospective analysis of medical records, imaging studies and histological preparations.


RESULTS
the study group included: 3 cases of type I enterogenous cyst, 1 case of type II cyst and 3 cases of type III cyst (in 2 cases a former diagnosis of "mature teratoma" has been revised). Within this follow-up time, a good outcome was obtained in 3 cases, moderate disability - in 3 cases and severe disability - in 1 case.


CONCLUSIONS
(1) Enterogenous cyst often co-exists with other dysraphic features; (2) Clinical signs of an enterogenous cyst are non-typical and depend on location of the lesion. The presence of secreting gastric mucosa may lead to chemical myelitis; (3) Severity of the postoperative neurological deficit is due to the developmental nature of the lesion and common vascular supply; (4) Late results of treatment are satisfactory, provided the lesion is excised radically; (5) Enterogenous cyst may be diagnosed in the case of a tumor composed of tissues originating from 1, 2 or 3 embryonic layers coexisting with dysraphic stigmata, congenital vertebral abnormalities or a mediastinal tumor of the same type. Types II and III of enterogenous cyst were historically diagnosed as "adult teratoma".
Department of Neurosurgery, The Children's Memorial health Institute, Warsaw, Poland. nch@czd.waw.pl
Paweł
P
Daszkiewicz
Marcin
M
Roszkowski
Sławomir
S
Przasnek
Wiesława
W
Grajkowska
Elzbieta
E
Jurkiewicz
D000293:Adolescent; D020863:Central Nervous System Cysts / Q000150:complications* / Q000473:pathology* / Q000601:surgery; D002648:Child; D002675:Child, Preschool; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D008297:Male; D019635:Neurosurgical Procedures; D016135:Spinal Dysraphism / Q000150:complications*; D013724:Teratoma / Q000150:complications* / Q000473:pathology* / Q000601:surgery