Presentation
Upper limb paresthesia
Patient Data
Well-circumscribed, homogeneous intramedullary cervical cord cystic lesion at the level of C2/3 is isointense to CSF on T1 and T2 sequences. There is no contrast enhancement or surrounding cord signal abnormality. The remainder of the cord is normal.
Pathology Report.
Macroscopic description: Minuscule brown red fragment, less than 1 mm. Processed in cell block. May not survive processing.
Microscopic description: The cell block sections show scant benign reactive neural tissue associated with some clot and scattered neutrophils. Granulomas, necrosis, vasculitis, viral cytopathic effect and parasites are not seen. A discrete cyst lining is not identified and there is no evidence of malignancy.
Diagnosis: Scant benign reactive neural tissue.
Pathology report courtesy of Dr S Kranz, The Royal Melbourne Hospital, Australia.
Case Discussion
This is a rare example of a benign intramedullary cystic lesion. The reported MRI characteristics of intramedullary ependymal cysts are well demonstrated on this case example and consist of a well circumscribed homogeneous lesion isointense to CSF across all sequences with no contrast enhancement.
The main role of surgical intervention is to fenestrate/decompress the cyst to alleviate patient symptoms. Surgically there is no dissection plane between the cyst and normal spinal cord making it difficult to fully excise the lesion. These patients therefore require long term follow up to evaluate the cyst size.
Unable to process the form. Check for errors and try again.