Answer for BIR CoW 11 Sep 2022
MATURE CYSTIC TERATOMA OF SPINAL CORD
Findings
Evidence of intramedullary T1 hypointense, T2 heterointense lesion causing expansion of cord noted extending from D12 to superior end plate of L2. evidence of patchy diffusion restriction within the lesion and causes abrupt myelographic cut off Lesion measures 6.4 cm(craniocaudal)x2.5 cm (anteroposterior)x1.8cm(mediolateral) Impression HPE proven case of mature cystic teratoma of spinal cord
Discussion
spinal intramedullary teratoma is a rare tumour characterised with slow progression course. Although symptoms are generally mild, long-term complaints can be observed due to the slow progression teratomas are classified as mature, immature, and malignant teratomas. Mature teratomas mainly contain mature elements such as cartilage, squamous epithelial cells, glands, mucosal tissue, and neural elements. Immature teratomas have a tendency to recur and are aggressive tumors, comprising primitive, undifferentiated components that resemble fetal tissues. Malignant teratomas are derived from the yolk sac or endodermal sinus, and especially, malignant teratomas, along with the high levels of serum α-fetoprotein, are associated with a poor prognosis. There are two dominant theories regarding the origin of intraspinal teratomas the dysembryogenic theory and the misplaced germ cell theory. According to the dysembryogenic theory, spinal teratomas arise from the pluripotent cell and that in a locally disturbed developmental environment, these pluripotent cells differentiate chaotically. When such disordered development occurs in a primitive streak or a caudal cell mass, a spinal teratoma forms. Another is the misplaced germ cell theory according to which certain pluripotent primordial germ cells of the neural tube that get misplaced during migration from the yolk sac to the gonad, lead to spinal teratoma formation. In adult intraspinal teratomas, which rarely present with significant dysraphism, the misplaced germ cell theory is likely to be more feasible
Findings
Evidence of intramedullary T1 hypointense, T2 heterointense lesion causing expansion of cord noted extending from D12 to superior end plate of L2. evidence of patchy diffusion restriction within the lesion and causes abrupt myelographic cut off Lesion measures 6.4 cm(craniocaudal)x2.5 cm (anteroposterior)x1.8cm(mediolateral) Impression HPE proven case of mature cystic teratoma of spinal cord
Discussion
spinal intramedullary teratoma is a rare tumour characterised with slow progression course. Although symptoms are generally mild, long-term complaints can be observed due to the slow progression teratomas are classified as mature, immature, and malignant teratomas. Mature teratomas mainly contain mature elements such as cartilage, squamous epithelial cells, glands, mucosal tissue, and neural elements. Immature teratomas have a tendency to recur and are aggressive tumors, comprising primitive, undifferentiated components that resemble fetal tissues. Malignant teratomas are derived from the yolk sac or endodermal sinus, and especially, malignant teratomas, along with the high levels of serum α-fetoprotein, are associated with a poor prognosis. There are two dominant theories regarding the origin of intraspinal teratomas the dysembryogenic theory and the misplaced germ cell theory. According to the dysembryogenic theory, spinal teratomas arise from the pluripotent cell and that in a locally disturbed developmental environment, these pluripotent cells differentiate chaotically. When such disordered development occurs in a primitive streak or a caudal cell mass, a spinal teratoma forms. Another is the misplaced germ cell theory according to which certain pluripotent primordial germ cells of the neural tube that get misplaced during migration from the yolk sac to the gonad, lead to spinal teratoma formation. In adult intraspinal teratomas, which rarely present with significant dysraphism, the misplaced germ cell theory is likely to be more feasible
Note:
We do not discourage differential diagnosis. But all the differentials must satisfy the findings noted in the case.
If you feel you have answered rightly but cannot find your name in the above list, please call 09551942599.
Did you Know?
The order in which the names appear in this winner's list is based on the time of submission. The first person to send the correct answer gets his/her name on top of the list!
We do not discourage differential diagnosis. But all the differentials must satisfy the findings noted in the case.
If you feel you have answered rightly but cannot find your name in the above list, please call 09551942599.
Did you Know?
The order in which the names appear in this winner's list is based on the time of submission. The first person to send the correct answer gets his/her name on top of the list!