椎管内畸胎瘤.ppt

,单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,Case,discussion,Bone,Group,2016.12.22,History,Male,25y,Chief complaint:interspinal mass,Diagnose approach,Location,Epidural,Intradural extramedullary,？,Intramedullary,？,DDX,Imaging feature,Common diseases,Final diagnosis,Intraspinal teratoma,Diagnose approach,Location,Cauda equina area,Common tumors,Myxopapillary ependymoma(43.5%),schwannoma(30.4%),lymphoma/plasmacytoma(8.7%),and meningioma,dermoid/lipoma,other glioma,and“other tumor(,teratoma,hemangioblastoma,PNET and,chordoma),”(4.3%each).,I,ntroduction,Teratomas,can be subdivided into three,groups:,monodermoma,didermoma,tridermoma,Two types exist:,1)mature teratomas composed of well-differentiated elements,2)immature teratomas that contain primitive elements,I,ntroduction,Most intraspinal teratomas located,in the dorsal or,dorsolateral part of the spinal,C,an be epidural,intradural,extramedullary,and intramedullary,70%are benign,Spinal,cord and,nerve root,compression may appear depending on the location,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,Radiographic signs,X-ray:,thoracolumbar scoliosis and multiple vertebral structural abnormalities,CT:,spinal malformation&interspinal,mass with fat and calcification,MR:,Radiographic signs,DDX,Lipomas,location,Epidermoid,cyst for content,Dermoid cyst,enhancement,Intraspinal 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%,cervicothoracic in 24%,and cervical in 13%,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 sequences,Enhancement behavior:no or mild,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,rich in cholesterol,crystals,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 epidermoid tumors vary,widely,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 epidermal adnexa,such as hair follicles,sebaceous glands and sweat glands,Intraspinal dermoid cyst,Well-defined,smooth,opaque,round or oval masses,Usually hyper-on T1 and hypo-on T2,M,ixed,signal,mass,by,other components such as hair,glandular and sweat,secretion,D,ifficult,to differentiate it from the a lipoma with a high lipid content and unsaturated fatty acids without,cholesterol,S,ummary,To know what type of a tumor is likely to be encountered of the cauda equina area,imaging characteristics,incidence of the various histological types,Despite the low incidence of the teratoma,lipoma,epidermoid cyst and dermoid cyst,we should keep in mind of them,Thank you!,