Myxopapillary ependymoma

Case contributed by Ammar Ashraf


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

Age: 40 years
Gender: Male

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. 

How to use cases

You can use Radiopaedia cases in a variety of ways to help you learn and teach.

Creating your own cases is easy.

Updating… Please wait.

 Unable to process the form. Check for errors and try again.

 Thank you for updating your details.