Sporadic Spinal Lumber Epidermoid Cyst in an Obese Adolescent: A Radiological and Pathological Review

Patient: Male, 17-year-old Final Diagnosis: Spinal epidermoid cyst Symptoms: Back pain • electrical sensation • lower limb muscle weakness Clinical Procedure: Total surgical excision Specialty: Neurosurgery • Radiology OBJECTIVE: Unusual clinical course BACKGROUND: We report a case of a sporadic lumbar epidermoid cyst in a patient with no apparent risk factors for the condition. The lesion is considered an uncommon lesion that has a potentially debilitating effect on the spinal cord. CASE REPORT: Our patient was a 17-year-old boy who presented to the neurosurgery clinic with lower back pain, accompanied by an electrical sensation radiating bilaterally to the buttocks, thighs, and knees. He has been increasingly reliant on a walking cane over the past few months. The patient was considered obese, with a BMI of 44. Otherwise, his physical examination was unremarkable, with no signs of dysraphism. He underwent magnetic resonance imaging (MRI) of the spine, which revealed a lumbar spine lesion, compressing the adjacent cauda equina nerve roots. MRI imaging showed the lesion was an intradural extramedullary mass showing hypoin-tense signal on T1- and hyperintense on T2-weighted images, with diffusion restriction on diffusion-weighted imaging (DWI). The imaging findings were consistent with an epidermoid cyst. CONCLUSIONS: Epidermoid cysts are benign lesions, usually found in the head and trunk. When found in the spine, they can cause a range of symptoms that can be debilitating. Patients presenting with signs and symptoms of spinal cord compression should be promptly investigated. MRI is an excellent tool for characterizing an epidermoid cyst. The lesion appears oval and hypointense on T1-weighted imaging, and characteristically shows diffusion restriction on diffusion-weighted imaging (DWI). With surgical treatment, the outcome is usually favorable.