Congenital Midline Spinal Hamartoma in a 5-month-old Infant.

BACKGROUND: Congenital midline spinal hamartoma is a very rare tumor-like proliferation that mostly occurred during childhood. It consists of mature, well-differentiated ectodermal and mesodermal elements that present in an abnormal location and mostly associated with neurofibromatosis type 1 and spinal dysraphism.

CASE DESCRIPTION: A 5-month-old male patient presented with a complaint of a bump over the lower back. The bump is already presented since birth with the size is approximately 3 cm in diameter and growth slowly. There are no other associated symptoms besides the bump on the lower back. We found a subcutaneous mass with associated skin dimple located on the midline of the lower back. CT scan of the spine shows a mass that arose from inside the dura and a closed spinal dysraphism from L3 vertebra to the sacrum. A subtotal resection was performed and the histopathology feature showing fat cells, cartilage, skeletal muscle fibers, nerve, and blood vessel. After 6 months follow up, no symptoms nor neurological deficit was present, and no further growth is shown on the latest CT scan.

CONCLUSIONS: Congenital midline spinal hamartoma is very rare and seldom addressed. Mostly patient presenting with a cosmetic defect and rarely with associated symptoms. Tissue biopsy is still the best modality to definitively diagnose hamartoma and to exclude other diagnoses. Surgical excision of the tumor is still the mainstay treatment especially for patients who are not neurological intact and to correct the cosmetic skin defect.