PMC6024502_01
Preoperative CT and MRI. (a-c) T1 and T2 weighted sagittal images showing intramedullary lesion at D8-9 level with faint peripheral enhancement on gadolinium contrast. (d and e) Preoperative CT dorsal spine axial and sagittal images: not showing any abnormality
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F1
T1, hyperintense on T2-weighted images, with a faint rim of enhancement with post gadolinium diethylenetriamine pentaacetate (GD-DTPA) injection [Figure 1]. The computed tomography (CT) was unremarkable.
Intraopeartive images. (a) Lesion surfacing after durotomy, (b) pearly white material seen during decompression of the tumor and (c) tumor cavity after decompression
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F2
It was pearly white and had a well-defined plane except posteriorly where capsule was densely adherent to the cord/parenchyma [Figure 2].
Histological images. (a and b): Photomicrograph of an epidermoid cyst with lamellated keratin. Adnexal structures were not seen. (H&E, x100)
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F3
Histopathology confirmed the diagnosis of an IEC; the epidermoid contained lamellated keratinous flakes, dystrophic calcification without adnexal structures, and an inflammatory response/giant cell formation [Figure 3].
Follow up MRI at 6 months. (a-c) T2 weighted sagittal, T1 gadolinium contrast and diffusion images: no evidence of recurrence. Post op changes noted. (Preoperative diffusion sequence was not available)
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F4
The follow-up contrast-enhanced MRI showed no residual/recurrent lesion [Figure 4].