Spinal ependymoma

Case contributed by Frank Gaillard


Gradual upper limb weakness.

Patient Data

Age: 45 years
Gender: Male

An enhancing mass is present within the substance of the cervical cord centered at the C5 level. It is of intermediate signal intensity on T1 and T2 weighted sequences and demonstrates contrast enhancement. It is surrounded at either end by dilated cystic spaces which are not surrounded by enhancing tissue and may represent a tumor syrinx rather than part of the mass itself. There is faint signal drop on on T2 weighted images which may represent peripheral blood product, although it is not pronounced.  

Annotated image

A mass ( * ) located centrally within the cord (note displaced 'normal' cord around the lesion (green arrows)) is of high T2 signal and demonstrates moderate contrast enhancement. At either end multiple cystic regions are demonstrated (blue arrows) most of which do not have any solid enhancing component and thus probably represent tumor syrinx rather than intra-tumoral cysts. Best seen inferiorly is a region of signal drop out (yellow arrow) which probably represents blood product (a poorly formed hemosiderin cap). 

The patient went on to have surgery and a biopsy.   


MICROSCOPIC DESCRIPTION: The  specimens  show  multiple   fragments  of tumor  tissue, together with a small  amount of gliotic spinal  cord tissue. The tumor is moderately cellular, with  prominent perivascular  pseudo rosetting as well as areas resembling  ependyma lined  channels. The tumor  cells range from polygonal to columnar to elongate, the latter component with well-developed unipolar   processes.   The  tumor  cell  nuclei  are rounded  and  mildly pleomorphic. Nucleoplasm is coarsely granular and sometimes vesicular, with nucleoli often  fairly prominent.   An occasional  mitotic  figure is seen. There is no tumor necrosis  and microvascular  proliferation is not found.

FINAL DIAGNOSIS: Ependymoma, WHO grade 2.

Case Discussion

This case demonstrates fairly typical appearances of a spinal ependymoma, although hemosiderin capping is often better defined. 

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