Presentation
Four-month history of lumbar pain radiating down to the lower extremities, with progressive worsening, associated with numbness in the thighs and legs.
Patient Data
A well-demarcated central intramedullary tumor at T11-T12, which is isointense on T1, heterogeneously hyperintense on T2 and has intense contrast enhancement. There is a small polar cyst component at the inferior margin of the tumor. This mass promotes local cord expansion. The lesion measures 1.2 x 1,2 x 2,8 cm. There is a hyperintense T2 signal in the medulla segment above the tumor, which may represent edema and some syringomyelia component.
The patient went on to have surgery and a biopsy with gross total resection of the tumor.
Histology
Final diagnosis: The morphological features are of an ependymoma (WHO grade II).
Case Discussion
Spinal ependymomas are glial tumors that originate from differentiated cells lining the surface of the central canal of the spinal cord 1,2. Ependymomas constitute tumors with different molecular types, which enables new therapeutic targets 3,4. This case demonstrates imaging features strongly suggestive of a typical spinal cord ependymoma, with a central location, intense enhancement, and the presence of a cleavage plane.
Case courtesy
- Sterfferson Morais, MD - PGY-3, Radiology Resident, Department of Radiology
- Antonio Rodrigues de Aguiar Neto, MD - Radiologist, Department of Radiology
Hospital da Restauração – Recife, PE – Brazil