Presentation
Neurogenic claudication.
Patient Data
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MRI demonstrates an ovoid lesion immediately below the conus, which is isointense to cord on T1 and somewhat hyperintense on T2, with small regions of signal drop out posteriorly. It enhances vividly following contrast.
A second smaller nodule with similar signal intensity is located in the thecal cul de sac immediately above a left sided small Tarlov cyst.
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There are in fact two, both intradural, extramedullary. The larger of the two (yellow arrow) is located just below the conus. The smaller (blue arrow) is in the thecal cul de sac.
The patient went on to have a laminectomy and excision of the larger tumor, for both diagnosis and symptomatic relief.
Histology
MICROSCOPIC DESCRIPTION: Paraffin sections show fragments of moderately cellular tumor comprising perivascular pseudorosettes and small clusters of mildly atypical cells embedded in a fibrillary matrix. There are mucin containing microcystic spaces surrounded by tumor cells. No mitoses are identified. There is no endothelial cell hyperplasia or necrosis. The features are of myxopapillary ependymoma. The Ki-67 proliferative index is less than 1%.
FINAL DIAGNOSIS: L2 intradural lesion: Myxopapillary ependymoma (WHO Grade I).
Case Discussion
This case illustrates typical appearances of a myxopapillary ependymoma, in this instance with seeding to the thecal cul de sac.
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