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Vol. 22. Num. 5.January 2011
Pages 381-460
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Vol. 22. Num. 5.January 2011
Pages 381-460
DOI: 10.1016/S1130-1473(11)70047-1
Fatty filum with different histological features. Case report
Filum lipoatoso con características histológicas diferentes. Caso clínico
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Y. Izci, S. Pusat
Departments of Neurosurgery. Gulhane Military Medical Academy, Turkey
O. Onguru*
* Departments of Pathology. Gulhane Military Medical Academy, Turkey
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Summary

Split cord malformation and fatty filum are completely different clinical entities and thought to arise via different pathophysiologies. Recognition of these distinct lesions in the same patient is important for appropriate diagnosis and management.

A 3 year-old boy presented with skin lesions and mild leg weakness suggestive of spinal malformation. Magnetic resonance imaging revealed type II split cord malformation at T12–L1, syringomyelia at T8–T10 levels associated with tethered cord and fatty filum terminale. The patient underwent a T12–L1 laminotomy for the removal of fibrous band between the 2 hemicords and L4–L5 laminotomy for transection of the fatty filum. Histopathological examination of the filum confirmed the presence of bone, fat, and ciliated epithelial cells associated with meningothelial proliferation in the same specimen.

We report an unusual case of type II split cord malformation coexisting with a fatty filum which have different histological patterns. To the best of our knowledge, this histological appearance of a fatty filum has not yet been reported and this raises the question of a possible associative or causative relationship between these distinct pathologies.

Key words:
Split cord malformation
Fatty filum
Tethered cord
Child
Resumen

La diastematomielia y el filum lipomatoso son entidades clínicas completamente diferentes y cuya patogenia se considera diferente. El reconocimiento de estas lesiones en el mismo paciente es importante para el diagnóstico y manejo apropiados. Un niño de 3 años de edad se presentó con marcas cutáneas y moderada debilidad en piernas sugestivos de malformación espinal. La resonancia magnética reveló duplicación de la médula de tipo II y siringomielia T12–L1, que se asoció con anclaje medular y filum terminale lipomatoso. El paciente fue sometido a una laminotomía T12–L1 para la eliminación de la banda fibrosa entre las dos hemimédulas y laminotomía L4–L5 con sección del filum lipomatoso. El estudio anatomopatológico del filum confirmó la presencia de hueso, grasa, y células epiteliales ciliadas, que se asociaron con proliferación meningotelial.

Informamos un caso excepcional de diastematomielia tipo II que coexiste con un filum lipomatoso con patrón histológico diferente. En nuestra opinion, este patrón histológico correspondiente al filum lipomatoso no ha sido documentado previamente, y ello suscita cuestiones sobre una posible relación, sea de asociación o cusal, entre estas dos patologías.

Palabras clave:
Diastematomielia
Filum lipomatoso
Anclaje medular
Niño

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