Myxopapillary Ependymoma of the Sacrum

Sacral Chordoma

“…Chondrosarcomas typically do not contain areas of hemorrhage, a fact that helps differentiate them from chordomas. Myxopapillary ependymomas, which also cause sacral destruction, may have imaging characteristics very similar to those of chordomas; however, myxopapillary ependymomas arise in the spinal canal rather than bone, and they may demonstrate more intense gadolinium-based contrast enhancement than chordomas do (7,8).…”

Giant destructive myxopapillary ependymomas of the sacrum

“…11,12 These tumors are typically isointense relative to the spinal cord and roots on T1weighted images and hyperintense on T2 weighted images. 16 Occasionally, these tumors may be hyperintense relative to the spinal cord and roots on un enhanced T1weighted images due to the proteinaceous mucoid matrix, 16 which may be useful in distinguishing myxopapillary ependymomas from other ependymoma subtypes, which are almost always hypo or isointense on T1weighted images. Similar to the other ependymoma subtypes, myxopapillary lesions enhance intensely with contrast administration.…”

“…Enhancement is usually homog eneous but may be heterogeneous when hemorrhage or necrosis is present. 16 A CT scan is useful for demonstrat ing erosive bone changes that can vary from nonspecific canal widening, to scalloped vertebral bodies, to neural foraminal enlargement, and finally to osseous destruc tion. 16 Patients who undergo grosstotal resection of intra dural myxopapillary ependymomas have a good progno sis, with a mean survival time of 19 years.…”

“…16 A CT scan is useful for demonstrat ing erosive bone changes that can vary from nonspecific canal widening, to scalloped vertebral bodies, to neural foraminal enlargement, and finally to osseous destruc tion. 16 Patients who undergo grosstotal resection of intra dural myxopapillary ependymomas have a good progno sis, with a mean survival time of 19 years. 17 Unfortunate ly, patients with extradural ependymomas do not have the same prognosis.…”

“…15 If local recur rence occurs, the mortality rate is 50% after 15 years with postsacral tumors and 75% after 4 years with presacral tumors. 16 If metastases develop, survival beyond 5 years is unlikely in patients with presacral ependymomas. 16…”