Lumbar spine extramedullary mature cystic teratoma presenting with neurogenic claudication and urinary incontinence: Case report and review of literature

Intradural spine teratoma is a rare neoplasm (0.1% to 0.5% of spinal tumors). Its incidence is even lower in adults and in patients without any history of spine traumas/surgical procedures or split cord malformations. We present a case of adult lumbar extramedullary mature cystic teratoma that belongs to this particular group. A 52-year-old woman presented to our attention with a long-standing, progressive, and worsening history of urinary incontinence and lower limb weakness. The lesion was known since she was 28 years old, when she underwent MRI for low back pain. Images revealed a cystic lesion at L1 level, nodular in shape, isointense to spinal roots, and iperintense to cerebrospinal fluid in T1 and T2 sequences, respectively. Afterwards the patient suffered episodic low back pain, responsive to analgesic drugs till 2007, when neurological symptoms started progressively. A new MRI confirmed the tumor, compressing the cauda equina roots. Surgical removal of the lesion was performed, with subsequent improvement of the patient. Histology on surgery specimen revealed mature cystic teratoma. Although teratoma is rare in adulthood, this condition has to be considered in differential diagnosis for lumbar spine root pathology. MRI is the gold standard diagnosis technique. The low growth rate of the tumor, lumbar location, and age-related lumbar spine degenerative processes can contribute to late, slow, and progressive appearance of clinical symptoms, which can sometimes be misinterpreted, creating a diagnostic challenge.