1. Unusual Giant Spinal Teratoma In An Infant: Case Report Yueh-hsun Lu Feng-chi Chang Wan-yuo Guo Cheng-yen Chang Taipei Veterans General Hospital, Taiwan National Yang-Ming University, Taiwan

2. Introduction Teratomas are tumors composed of and admixture of well- differenitated tissue of adult form and organoid pattern derived from the three germinal layers. We report a rare case of pediatric intraspinal giant teratoma.

3. Admission History 4-month-girl, normal delivery history. No abnormal skin defect or hair noted at her back. Progressive lower limbs weakness with urine retention after birth. Before admission, paraplegia is noted.

4. Plain Film

5. Image - MRI T1WIT2WIT1WI+C FS

6. Image - MRI T1WIT2WIT1WI+C FS

7. Differential Diagnosis Teratoma Complicated neuroenteric cyst Astrocytoma Ependymoma

8. Detection of Fat T1WIT1WI+C FS

9. Surgical Intervention and Operative Findings L1-S2 Laminotomy Cystic tumor mass with invasion and adhesion of spinal cord. Partial removal was done.

12. Pathological Diagnosis Mature cystic teratoma

13. Current Condition Muscle power improved from paraplegia to grade 3-4. Neurogenic bladder still noted.

14. Follow Up Image - 6 months Later T1WI T2WI T1WI+C FS

15. Follow Up Image T1WIT2WIT1WI+C FS

16. Discussion - 1 Primary pediatric spinal tumors are rare, especially intraspinal teratomas Teratomas are common during the first decade of life Sometimes associated with spinal developmental deformities and meningocele. In a series of pediatric spinal tumors, incidence of teratoma is about 7.4% (6/81) J Neurosurgery 1979; 51: 437-445

17. Discussion - 2 Diagnosis of teratoma by image is detection of fat. T1WI images without and with fat saturation are necessary. Unlike teratomas in other sites, hair, bone or calcification is seldom detected in the CNS teratomas Almost the lesions are benign The lesions are intradural or intramedullary. The most common arising site is from dorsal lumbrosarcal area.

18. Discussion - 3 The treatment is surgical resection with total removal as possible. If total removal available, the prognosis is excellent Because of the location and size of lesions, sometimes total removal not available. Further gene study may be necessary at this case and other giant intraspinal teratomas.

19. Conclusion Spinal teratomas are rare. The diagnosis is easily made of detection of fat, solid and cystic component.

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