Dermoid epidermoid cyst
Introduction
Introduction of skin-like epidermoid cyst Skin-like epidermoid cysts can occur anywhere in the spinal canal, but are more common in the thoracolumbar region, the spinal cone, and the cauda equina. Lesions are more common in the subdural layer, and less in the intramedullary and epidural. basic knowledge The proportion of illness: 0.003% - 0.006% Susceptible people: no special people Mode of infection: non-infectious Complications: spina bifida
Cause
The cause of skin-like epidermoid cyst
(1) Causes of the disease
At present, the etiology is not completely clear, and some patients are accompanied by abnormal manifestations such as spina bifida. The most likely cause is the misplacement of naive germ cells in the early stage of embryogenesis.
(two) pathogenesis
Skin-like epidermoid cysts are derived from the residual germ cells in the embryonic development of the intra-embryonic tissue of the spinal canal. They can be divided into dermoid cysts, epidermoid cysts, teratoid cysts and terats depending on the tissue structure. Tumor, the first two are caused by ectodermal tissue. The dermoid cyst contains only epidermal tissue and keratin. Epidermoid cysts include epidermis and keratin, as well as dermis and its skin attachments such as sweat glands, sebaceous glands, hair follicles, etc. Teratomas contain 3 germ layer structures, and teratoid cysts contain 2 germ layer structures.
Prevention
Skin-like epidermoid cyst prevention
The cause is not fully understood. Some patients are accompanied by abnormal manifestations such as spina bifida. The most likely cause is the misplacement of naive germ cells in the early stage of embryogenesis. Therefore, it is impossible to prevent the cause. Regular examination should be done during pregnancy to achieve early detection and early intervention. If the child has obvious tendency to develop abnormalities, chromosome screening should be done in time, and whether abortion is needed according to the severity of the disease.
Complication
Dermoid epidermoid cyst complications Complications spina bifida
Skin-like epidermoid cysts usually incorporate other congenital malformations, such as spina bifida, abnormal skin and soft tissue in the lower back, and a few may have visceral malformations.
Symptom
Symptoms of skin-like epidermoid cysts Common symptoms Intense radiculopathy, dull pain, bladder dysfunction, cyst, sphincter dysfunction, back pain, sensory disturbance, lumbar back pilus
Such tumors, if they are small or non-functional, usually have no specific clinical manifestations. Early symptoms mainly include low back pain, lower extremity motor sensation and abnormal reflex, impotence and bladder and rectal sphincter dysfunction, and other tumors in the spinal canal. In contrast, patients with such tumors have the following characteristics in addition to the younger age of onset and longer duration of disease:
1 Because the cyst is mainly located in the lower part of the spinal cord, there are more cones and horsetails, so there are more painful waist and leg, often with dull pain or severe radiculopathy;
2 There are more rectal bladder dysfunction, and more than 80% of patients have dysuria and dysfunction;
3 motor system damage can be atypical, when the cyst combined with lumbosacral spina bifida, the lower end of the spinal cord is often fixed at a lower part;
4 If the fur sinus is combined, it can often cause intracranial infection, and there are also a few fur sinus, which are caused by the stimulation of the contents of the capsule.
Examine
Examination of skin-like epidermoid cyst
The spine X-ray showed a wide range or obvious vertebral stenosis, the pedicle of the lesion was narrow, the pedicle spacing was widened, and the posterior margin of the vertebral body was concave. In some cases, the performance of spina bifida was observed.
CT and magnetic resonance have obvious advantages in the diagnosis of endothelium-like epidermoid cysts, which can better show the heterogeneity of tumors. On magnetic resonance imaging, the epidermoid cysts of the skin show T1 high signal or other signals. Uniform, usually in addition to the discovery of tumors, often accompanied by spina bifida or vertebral dysplasia.
Diagnosis
Diagnosis and differentiation of skin-like epidermoid cyst
The diagnosis of spinal canal endothelium-like cyst is not difficult to diagnose in the era of magnetic resonance imaging. MRI can accurately determine the location, size, tumor characteristics and development of adjacent spinal cord, and the preparation and prognosis of the surgical plan. Judgment is of great significance. For patients with intracranial inflammation, especially recurrent episodes, and sinus in the lower back, the diagnosis of this disease should be considered first. For the presence of low back pain, the disease is longer, the age is lighter and the lower limbs are moved. And those with sensory disturbances and dysfunction of the bowel movements should be alert to the possibility of this disease, as soon as possible to perform chest and lumbar vertebrae MRI, in order to confirm the diagnosis.
Skin-like epidermoid cysts are usually indistinguishable in imaging. When there are no bone components in the teratoma, they cannot be differentiated from the epidermoid cysts.
