Spinal myxopapillary ependymoma - large

Case contributed by Dr Ian Bickle

Presentation

Weakness in both legs. Progressive.

Patient Data

Age: 25 years
Gender: Male

Large well defined smooth expansile mixed signal, heterogeneously enhancing intradural, extramedullary mass arising from the filum terminale and extending from L1 to L4.

This is truncating the conus and totally obliterating the central canal from L1-L4 with cauda equina compression.

Posterior vertebral scalloping at L2-L4, most pronounced at L2.  No bony destruction.

X-ray

7 months prior to MRI.

Minor scalloping of the posterior aspect of the L2 vertebral body.

Normal alignment.

Case Discussion

Spinal surgery was performed.  The histology was of a spinal myxopapillary ependymoma.

Realistically, virtually nobody is going to see or call the subtle L2 posterior vertebral scalloping on the prior radiograph.

This is an example of a particularly large spinal ependymoma with cauda equina compression.

It makes for a good viva case in a fellowship exam as one can explore the candidate's knowledge on the differentials for an intradural extramedullary mass and posterior vertebral scalloping.

The candidate's ability to describe and methodically approach such a profound appearance may also be observed as well as the immediate clinical management.

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Case information

rID: 76944
Published: 7th May 2020
Last edited: 8th May 2020
System: Spine
Inclusion in quiz mode: Included

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