[A case of intradural xanthogranuloma in the upper cervical spine]

An 18-year-old female patient suffered from posterior neck pain and gait disturbance. The neurological examination revealed left hemiparesis, general hyperreflexia and hypoalgesia on the right neck and upper limb, and left trunk and lower limb. MRI showed a large mass lesion in the right side of the spinal canal at the level of the C1 cervical spine, which was obviously compressing the spinal cord. An operation was performed through a right suboccipital craniectomy and right hemilaminectomy of the first vertebra. Though the mass lesion in the subarachnoid space compressed the spinal cord, it adhered neither to the spinal cord nor to the nerve roots. However, as it clearly adhered to the dura mater, the attachment site was also completely removed. In the pathological examination, lymphocyte, foamed macrophage and the giant cell of Touton type were shown. The immunohistochemical study with CD68 (Kp1) was positive, but it was negative for the lysozyme, neuron specific enolase and S-100 protein. The diagnosis was xanthogranuloma. The patient recovered completely after the operation. This is a rare case of juvenile type xanthogranuloma. This lesion in the spinal canal has usually its onset in the adult age.