[A huge intraspinal teratocarcinoma associated with an arachnoid cyst in a child]

The authors report a 11-year-old girl with a huge intraspinal malignant teratoma associated with spinal arachnoid cyst. At seven year of age, suprasellar tumor was diagnosed and the patient received radiation therapy for tumor bed with total dose of 4,225 rads. As the result, marked decrease of the size of tumor was seen by follow-up CT scan. Serum alphafetoprotein (AFP) and human chorionic gonadotropin (HCG) level were at 51ng/ml and 31IU/l when total dose of 2,000 rads were over, and they decreased to 3ng/ml and 6.6IU/l at the dose of 4,225 rads respectively. The histology of the suprasellar tumor was unverified. She was discharged without any neurological deficits. For next 24 months, she received intrathecal administration of Methotrexate by repeated lumber puncture in 14 times. She remained intact neurologically. At eleven years of age, four years later, she started complaining of the right leg pain. On the examination, hypesthesia in the L distribution and stiff neck with positive straight leg raising test were observed. Urinary and bowel function were intact. CT scan of the head revealed residual of the suprasellar tumor but the size of the tumor was unchanged. Myelography showed complete block at the level of L. Laminectomy at L was performed and brownish cyst was found in the intradural space. Aspiration of cyst content and cyst wall resection were carried out. Histology of the cyst membrane was arachnoid and spinal arachnoid cyst was diagnosed. The postoperative course was uneventful until 13th postoperative day, when acute progressive paraparesis and numbness of bilateral toes were seen.(ABSTRACT TRUNCATED AT 250 WORDS)