Intradural extramedullary teratoma coexisting with multiple spinal anomalies in an adult.

A48-year-old woman presented with complaints of low back pain and weakness in lower extremities. Magnetic resonance imaging revealed a large, lobulated intradural extramedullary mass (60×40×25 mm) between the L2 and L4 levels (Figs. 1 and 2). The lesion was heterogeneously hyperintense on T1and T2-weighted images, and followed the signal of fat on all pulse sequences. Intermediate signal intensities were seen within the lesion. It showed no significant enhancement on postcontrast images. Computed tomography scan demonstrated lipid components andmultiple calcifications within the lesion (Fig. 1). Lipid components, calcifications, internal heterogeneity, and the absence of cystic components suggested the diagnosis of spinal teratoma. The diagnosis could not be confirmed by histology because the patient refused surgery. Clinical followup was decided because of the absence of neurologic deficits. Tethered cord (conus medullaris at L4–L5 levels), diastematomyelia with fibrous band (Fig. 2), block vertebra (L1–L2), and spina bifida occulta were the accompanying spinal anomalies. Spinal teratomas are quite rare in adults. Other lipidcontaining intradural tumors that should be included in the differential diagnosis are lipoma, dermoid cyst, lipomeningocele, and schwannoma with fatty degeneration [1].