Presentation
Follow up case of testicular seminoma with chronic low back pain, which is getting worse over the last 2 months and radiating down to the right leg. Also complain of incomplete urinary bladder emptying.
Patient Data
Reduced L1/L2 intervertebral disc space; the remaining intervertebral disc spaces are grossly intact. Vertebral body heights are well-maintained.
Well-defined, longitudinally oriented intradural extramedullary spinal lesion at D12-L2 level. It is isointense on T1, hyperintense on T2 weighted images, and shows vivid enhancement on post contrast images. It measures 1.6 x 1.2 x 8.2 cm and is displacing the cord anteriorly. No internal hemorrhage or diffusion restriction is seen. L1-L2 focal posterior central disc along with the aforementioned extramedullary lesion causing spinal canal stenosis and cord compression. No suspicious marrow signal abnormality is seen.
Case Discussion
- Based on the MRI features, the lesion is likely a myxopapillary ependymoma of the conus/filum terminale. Other possible differential diagnosis includes intradural metastases (in view of past history of testicular seminoma), schwannoma and meningioma.
- Procedure: Resection of spinal tumor. Microscopic Description: The tumor consists of monomorphic round to elongated cells with fine chromatin. The tumor cells are arranged around vascular cores with fibrillary acellular zone. The tumor also has a papillary architecture with intervening myxoid material. Some areas show coagulative necrosis.
Immunohistochemistry: GFAP (6F2) is positive and EMA (E29) is negative.
Diagnosis: Myxopapillary ependymoma (WHO grade II).
Re-staging CT chest, abdomen & pelvis and tumor markers (AFP, B-HCG & LDH) (for the past history of testicular seminoma were negative.