Neurology India Medknow Publications on behalf of the Neurological Society of India ISSN: 0028-3886 EISSN: 1998-4022 Vol. 52, Num. 3, 2004, pp. 402-403

Neurology India, Vol. 52, No. 3, July-September, 2004, pp. 402-403

Letter To Editor

Thoracic neurenteric cyst in a 60 year old male

Jain SK, Chopra S, Mathur PPS

Department of Neurosurgery, SMS Medical College, Jaipur

Correspondence Address:Department of Neurosurgery, SMS Medical College, Jaipur
Shashi_neelu@yahoo.com

Code Number: ni04140

Sir,
Neurenteric cysts are congenital intraspinal cysts. They are rare, particularly in the sixth decade of life. The cyst may remain undiagnosed for a long time or may be misdiagnosed.[1] A case of isolated high thoracic neurenteric cyst in a 60-year-old male is discussed. The patient presented with a thoracic back pain, which worsened in the last two years. The pain was located in mid-scapular region and it radiated anteriorly and to the right side. There was progressive weakness of both lower limbs for one year. Bowel and bladder functions were normal.

On examination, he had spastic Grade 3 paraparesis. Sensory examination was normal. MRI thoracic spine revealed an oval, thin walled, well-defined, intradural cystic lesion located at the level of T_1-2 vertebrae, on the right side of cord. The lesion was hyperintense on T₂ and hypointense on T₁ weighted images. It measured 2.3 cms x 1.7 cms x 1.3cms [Figure - 1] and [Figure - 2].

A laminectomy was performed and the intradural cyst was identified at the ventrolateral aspect of spinal cord. The cyst had a thin membrane and contained xanthochromic fluid. After needle aspiration of the cyst content, the wall of the cyst was resected. Microscopic examination of cyst wall revealed fibrous connective tissue lined by a cuboidal columnar epithelium with focal pseudostratified epithelium [Figure - 3]. Postoperative period was uneventful and the weakness in the lower limbs improved rapidly.

Neurenteric cysts are rare developmental cysts, which arise as a result of endodermal - ectodermal adhesions or as a result of abnormal separation of the germ cell layer in early embryological life.[2] Neurenteric cysts may also be associated with anterior or posterior spina bifida, widened vertebral bodies, fused vertebrae, hemivertebrae and diastomatomyelia.[3],[4]

These cysts have been described by various names, including enteric cysts, enterogenous and archenteric cysts. The review by Agnoli et al of 33 histologically verified enterogenous intraspinal cysts, showed that 18 were located in the cervicodorsal spine, 80% were intradural extramedullary and 12% were intramedullary cysts.[5]

The cysts can mimic arachnoid, epidermoid and teratomatous cysts. The content of these neurenteric cysts are known to be irritative to neural tissue which results in adhesions and subsequent attempts at excision become more difficult. The risk of recurrence in intracranial enterogenous cysts has been reported to be 37%.[5] However there have been only isolated reports regarding recurrence in intra spinal cysts after partial excision.

In light microscopic analysis, the epithelium varies from a ciliated columnar lining to a typical gastric or small intestinal lining i.e. single pseudostratified columnar epithelium with or without muscularis mucosa and a smooth muscle layer. There may be goblet cells. The entergenous cysts lack the serosal layer.[1] The cyst fluid can be mucoid, black, brown, chocolate, yellowish or occasionally colorless.

Neurentric cysts, which are present ventral to cord, are not associated with vertebral anomaly. This is said to be due to notochord splitting or allowing endoderm to herniate into spinal canal. Subsequently the split notochord reunites giving rise to normal vertebrae.[2]

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