Multifocal intradural extramedullary ependymoma

Abstract

<jats:p>In this paper, the authors present the case of a patient with multifocal intradural extramedullary ependymoma, and they review 18 previously reported cases.</jats:p> <jats:p>A 32-year-old man presented to the authors' institution with a 1-month history of partial medullary syndrome. Magnetic resonance imaging of the neuraxis revealed multifocal intradural extramedullary lesions at the bulbomedullary junction and C2–3, T5–11, L-2, L-4, L-5, and sacrum. Histological examination revealed a WHO Grade II ependymoma.</jats:p> <jats:p>The literature survey yielded 18 cases of ependymoma at the same location; none of them were multifocal at presentation. The authors analyzed the epidemiological, clinical, and surgical features of all 19 cases reported to date, including the present case.</jats:p> <jats:p>Patients' ages ranged from 24 to 69 years; 15 patients were women and 4 were men. The time elapsed from symptom onset to diagnosis ranged from 1 month to 8 years. Pain (in 13 patients) and medullary syndrome (in 12) were reported as the initial symptoms (information was not provided for 1 patient). Tumors were predominantly located in the thoracic spine (11), but they also occurred in the cervicothoracic (3), cervical (2), and lumbar (2) spine. The remaining tumor was multifocal. Solitary extramedullary tumors were found intraoperatively in 13 patients; 3 were described as exophytic and 3 as extramedullary with some degree of medullary invasion. Histological examination revealed 9 WHO Grade II tumors, 4 Grade III tumors, and 1 myxopapillary tumor. Data obtained for the remaining cases proved inconclusive. The clinical condition improved in 11 patients, remained stable in 2, and worsened (recurrence or progression) in 6. Of the 4 patients with Grade II tumors who presented with recurrence or neuraxis spreading, 3 had meningeal infiltration or adhesion to the pia mater, which does not rule out the possibility of neoplastic remnants in that area.</jats:p> <jats:p>Intradural extramedullary ependymomas are rare, they predominate in women in the 5th decade of life, and pain is the most frequent initial symptom. The extent of resection and the presence of meningeal infiltration seem to be key determinants of prognosis. The present case is the first intradural extramedullary ependymoma (with the exception of those occurring at the conus medullaris and terminal filum) with multiple lesions at presentation.</jats:p>

Spinal ependymomas. Part 2: Ependymomas of the filum terminale

“…With the exception of 2 unoperated patients presenting with large ependymomas, all patients demonstrating subarachnoid dissemination had undergone incomplete tumor removal, suggesting that dissemination is an iatrogenic phenomenon in the majority of instances. 28 Dissemination is unusual in previously unoperated patients 16,18,24,36 and was restricted to large tumors without capsules in this series. Therefore, the entire spinal axis should be examined on MRI whenever a large tumor extending over more than 4 spinal segments or a recurrent tumor is encountered.…”

Anaplastic Ependymoma With Holocordal and Intracranial Meningeal Carcinomatosis and Holospinal Bone Metastases

“…Only a few case reports have described extramedullary intradural tumors like the one we present, more frequently in female patients. [4][5][6] Dissemination at multiple spinal levels, retrograde intracranial dissemination, and metastases outside the nervous system have been described very rarely. 7 Dissemination is usually a delayed event in recurrent or treated tumors, and its presence at the initial diagnosis, as in our case, is infrequent (Table 1).…”

Chemo-Predictive Assay for Targeting Cancer Stem-Like Cells in Patients Affected by Brain Tumors

“…However, a total resection is not always achieved. Overall prognosis is improved when the entire tumor can be removed and there are no other neural axis metastasis [28]. Therefore, in cases in which the ependymoma is multifocal, metastatic, incompletely resected, or particularly aggressive; it is imperative to find the most effective alternative treatment to surgery available.…”