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Spinal ependymoma - myxopapillary type

Case contributed by Ammar Haouimi
Diagnosis certain

Presentation

Progressive weakness of the lower limbs with sphincter dysfunction.

Patient Data

Age: 35 years
Gender: Female

The MRI sequences demonstrate an intramedullary mass arising from the lower spinal cord, extending from T9 to L3 level (the length of seven vertebral body segments). It displays an isosignal to the spinal cord on T1WI, high signal on T2WI with heterogeneous enhancement on postcontrast sequences. Intramedullary edema in the proximal spinal cord as well as a nodular pial thickening with enhancement along the ventral and dorsal spinal cord from T7 to T10 level. Scalloping of the posterior vertebral bodies at T12 and L1 with mild tumoral extension through the neural exit foramen from T11-T12 to L1-L2 level.

Another lesion of the spinal canal at S1-S2, displaying the same signal and enhancement.

Post-surgical resection

mri

MRI exam performed three weeks after surgical resection of the tumor, showing a fusiform posterior epidural fluid collection extending from T11 up to L3 level with pial thickening and enhancement along the dorsal aspect of the spinal cord. Another superficial fluid collection is noted within the posterior soft tissue of the dorsolumbar region extending from T7 up to S1 level.

No residual soft tissue mass seen within the spinal cord or at S1-S2 level.

Case Discussion

A significant clinical improvement was noted from the 2nd week after surgery. The histopathological analysis with immunochemistry confirmed the diagnosis of a myxopapillary ependymoma, WHO grade I.

 

Additional contributors: M.H Amrane Neurosurgeon, CHU Batna Algeria, S. Nezar Histopathologist.

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