椎管内畸胎瘤ppt课件

1、.,1,Case discussion,Bone Group 2016.12.22,.,2,History,Male, 25y Chief complaint: interspinal mass,.,3,.,4,.,5,.,6,Diagnose approach,.,7,Final diagnosis,Intraspinal teratoma,.,8,Diagnose approach,.,9,Introduction,Teratomas can be subdivided into three groups: monodermoma didermoma tridermoma Two type

2、s exist: 1) mature teratomas composed of well-differentiated elements 2) immature teratomas that contain primitive elements,.,10,Introduction,Most intraspinal teratomas located in the dorsal or dorsolateral part of the spinal Can be epidural, intradural extramedullary and intramedullary 70% are beni

3、gn Spinal cord and nerve root compression may appear depending on the location,.,11,Mixed signal characteristics suggestive of both solid and cystic components Contained connective tissue, fat, and cartilage May association with a split cord malformation, myelomeningocele, or lipomyelomeningocele,Ra

4、diographic signs,.,12,X-ray: thoracolumbar scoliosis and multiple vertebral structural abnormalities CT: spinal malformation & interspinal mass with fat and calcification MR:,Radiographic signs,.,13,.,14,.,15,.,16,.,17,DDX,Lipomas location Epidermoid cyst for content Dermoid cyst enhancement,.,18,In

5、traspinal lipomas,Intraspinal lipomas are rare (accounting for 1% of all intraspinal tumors) Clinical symptoms usually resulted from cord compression and due to secondary tethering of the spinal cord Most located in the lumbosacral area (90%) Excluding the lumbosacral spine, thoracic in 32% , cervic

6、othoracic in 24%, and cervical in 13%,.,19,Intraspinal lipomas,The margin of the lipoma was well demarcate (Spinal malformation & cause widening of the spinal canal & tethered cord syndrome) CT: homogenously low-density (-100 HU) MRI: hyperintensity on T1 and T2, hypointensity on fat supprenssion se

7、quences Enhancement behavior: no or mild,.,20,.,21,.,22,.,23,Intraspinal epidermoid cyst,Spinal cutaneous inclusion tumors may develop after introducing cutaneous cells in the CNS Rare, benign and slow-growing tumors Congenital or acquired (history of lumbar puncture or injury) A soft white bulk, ri

8、ch in cholesterol crystals,.,24,Intraspinal epidermoid cyst,Epidermoid tumors are well-circumscribed, encapsulated lesions MR: Hypo- or isointense on T1, hyperintense on T2, and may be homogeneous or heterogeneous Enhancement behavior: no or mild (rim) However, the signal characteristics of epidermo

9、id tumors vary widely,.,25,.,26,.,27,.,28,.,29,Intraspinal dermoid cyst,Clinical presentation, radiological characteristics, intraoperative findings and outcome do not differ from epidermoid cyst In the lumbosacral region, epidermoid tumor is more common, dermoid tumor is relatively uncommon With ep

10、idermal adnexa, such as hair follicles, sebaceous glands and sweat glands,.,30,Intraspinal dermoid cyst,Well-defined, smooth, opaque, round or oval masses Usually hyper- on T1 and hypo- on T2 Mixed signal mass by other components such as hair, glandular and sweat secretion Difficult to differentiate it from the a lipoma with a high lipid content and unsaturated fatty acids without cholesterol,.,31,.,32,.,33,.,34,Summary,To know what type of a tumor is likely to be encountered of the cauda equina area imaging characteristics incide