PMC7827574_01
Preoperative magnetic resonance imaging of the thoracic spine shows a T3/4 intradural, intramedullary cyst. (a) On T2-weighted MRI, the cyst is hyperintense to spinal cord, with cord fibers splayed over the lesion. (b) There is no enhancement of the cyst with gadolinium. (c) The ADC map MRI, confirms restricted diffusion.
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F1
On the MR, the lesion was solid, homogeneous, and hypointense on T1-weighted images, hyperintense on T2-weighted images and did not enhance with gadolinium [Figure 1a and b]. It also demonstrated restricted diffusion (e.g., on diffusion weighted studies), while spectroscopy identified water and lactate within the lesion [Figure 1c].
Intraoperative photos. (a) Intramedullary cyst with an exophytic component visualized on opening the intact spinal dura and arachnoid. Nerve roots are seen splayed laterally (arrow). (b) Cyst contents were flaky and "pearl-like" in appearance.
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F2
Once the dura was opened, the intramedullary cyst was immediately identified coming to the cord surface on the right; it is exophytic component was glistening white and thin walled [Figure 2a and b].
A low power photomicrograph of the cyst wall showing a stratified squamous epithelial lining (>), on a dense fibrocollagenous base (O) and anucleate squames within the lumen (*). No skin adnexae were identified (hematoxylin and eosin, x15).
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F3
No dermal skin appendages were identified in the wall of the cyst and there were no luminal hair shafts [Figure 3].