Erdal KALKAN, Fatih ERDİ, FATİH KESKİN, Bülent KAYA, Kemal İLİK, Yaşar KARATAŞ

Enfekte lumbosakral spinal dermoid kist

Amaç: Bu olgu sunumun amacı nadir görülen ve tanıda karışıklığa sebep olabilecek intradural yerleşimli enfekte olmuş bir dermoid kist olgusu sunmaktır. Olgu sunumu: Beş aylık kız bebek, belinde hassasiyet ve kızarıklık oluşturan şişlik ve iltihabi akıntı şikayetleri ile başvurdu. Lumbosakral bölgede eritemli, ısı artışı olan şişlik mevcut olup, şişliğin ortasındaki cilt lezyonundan iltihabi akıntı oluşmakta idi. Manyetik rezonans görüntülemesinde L3- S1 arasında uzanım gösteren; hiperintens, heterojen, intradural yerleşimli, spinal kordda ekspansiyona yol açan kitle lezyonu tespit edildi. Hasta opere edilerek L3-4 total laminektomi ile abse drenajı, traktus ve subtotal kitle eksizyonu uygulandı. Eksize edilen tümöral dokunun histopatolojik incelemesinde kistik dermoid tümör tanısına ulaşıldı. Abseye yönelik antibiyotik tedavisi düzenlenen hasta tedavisi tamamlandıktan sonra önerilerle taburcu edildi. Sonuç: Dermoid tümörler nadir görülen spinal tümörlerdir. Genellikle yavaş ve asemptomatik seyrederlerken araya giren enfeksiyon ya da tümöral kistin rüptürü gibi nedenlerle akut ve bazen geri dönüşümsüz tehlikeli sonuçlara neden olabilirler. Bu olgu sunumu ile özellikle pediatrik çağda görülen spinal kitlelerin ayırıcı tanısında dermoid tümörlerin akılda tutulması ve bunlarda görülebilen enfeksiyon ve rüptür riski göz önüne alınarak uygun zamanda cerrahi tedavi planlanması gerekliliği hatırlatılmak istenmektedir.

Infected spinal lumbosacral dermoid cyst: Case report

Objective: To present a case of an infected dermoid cyst. Infected dermoid cyst can be seen rarely and may exist some difficulties in the differential diagnosis of spinal tumor like lesions. Case report: Five-month-old patient was admitted to our clinic with lumbar tenderness and redness complaints. An erythematous lumbosacral hump with local temperature increase found in physical examination. A purulent discharge was found in the middle of the hump. Magnetic resonance imaging was showed a hyperintense, heterogeneous mass lesion located intradurally between the L3-S1 levels. The patients was operated with L3-4 total laminectomy and abscess drainage, tract excision and subtotal tumor excision performed. Histopathologic examination was consistent with infected dermoid cyst. Conclusion: Dermoid tumors are uncommon spinal tumors. They grow slowly and their courses are usually asymptomatic. Infection or acute tumoral cyst rupture can be seen in the course of the disease and this situation may cause dangerous irreversible consequences. Spinal dermoid cysts should keep in mind in the differential diagnosis of spinal tumor like lesions especially in pediatric population. Planning the appropriate time of surgical treatment in these cases is necessary for avoiding undesirable risks such as cyst rupture and infection.

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1. Messori A, Polonara G, Serio A, Gambelli E, Salvolini U. Expanding experience with spontaneous dermoid rupture in the MRI: diagnosis and follow-up. Eur J Radiol 2002;43:19- 27.
2. Sharma MC, Jain D, Sarkar C, Suri V, Garg A, Singh M, et al. Spinal teratomas:a clinico-pathological study of 27 patients. Acta Neurochir (Wien). 2009 (Epub ahead of print)
3. Yasargil MG, Abernathey CD, Sarioglu AC. Microneurosurgical treatment of intracranial dermoid and epidermoid tumors. Neurosurgery 1989;24:561-7.
4. Lunardi P, Missori P. Supratentorial dermoid cysts. J Neurosurg 1991;75: 262-6.
5. Phillips WE, Martinez CR, Cahill DW. Ruptured intracranial dermoid tumor secondary to closed head trauma. Computed tomography and magnetic resonance imaging. J Neuroimaging 1994;4:169-70.
6. Scearce TA, Shaw CM, Bronstein AD, Swanson PD. Intraventricular fat from a ruptured sacral dermoid cyst: clinical, radiographic, and pathological correlation. Case report. J Neurosurg 1993;78:666-8.
7. Graham DV, Tampieri D, Villemure JG. Intramedullary dermoid tumor diagnosed with the assistance of magnetic resonance imaging. Neurosurgery 1988;23:765-7.
8. Lunardi P, Fortuna A, Cantore G, Missori P. Long-term evaluation of asymptomatic patients operated on for intracranial epidermoid cysts. Comparison of the diagnostic value of magnetic resonance imaging and computer-assisted cisternography for detection of cholesterin fragments. Acta Neurochir 1994;128:122-5.
9. Liu JK, Gottfried ON, Salzman KL, Schmidt RH, Couldwell WT. Ruptured intracranial dermoid cysts: clinical, radiographic, and surgical features. Neurosurgery. 2008;62: 377-84.
10. Stendel R, Pietilä TA, Lehmann K, Kurth R, Suess O, Brock M. Ruptured intracranial dermoid cysts. Surg Neurol. 2002;57: 391-8.
11. Kalkan E, Karabagli H, Karabagli P, Baysefer A. Congenital cranial and spinal dermal sinuses: A report of 3 cases. Advances in Therapy. 2006;23:543-8.