Thoracolumbar intramedullary subependymoma with multiple cystic formation: a case report and review

Abstract

Background: An intramedullary subependymoma is rare, particularly in the thoracolumbar region. Moreover, a radiographical obvious cystic formation of subependymoma of spinal cord rarely occurs in comparison to ependymoma.

Case report: A 57-year-old woman presented with paraparesis. MRI revealed a multinodular and multicystic lesion in the spinal cord that was difficult to diagnose correctly. Intraoperative observation via midline myelotomy revealed a grayish, gelatinous solid mass with an eccentric localization. In addition, DREZtomy on the caudal side of the tumor revealed cystic formation. The cyst was punctured and xanthochromic fluid was collected. Attenuation of motor evoked potential (MEP) resulted in the partial removal of tumor. A pathological examination revealed the mass to be a subependymoma. The patient experienced transient worsening of symptoms, but improved gradually. No adjuvant radiosurgery was administered. Follow-up estimation 30 months after surgery revealed no evidences of regrowth.

Conclusions: This report presents this rare case, a review of the literature associated with thoracolumbar subependymomas, and a discussion of the clinical and radiographical characteristics.

Fig. 1

MRI of the patient. T2-weighted sagittal (a), axial (b, c) and Gd-DTPA enhancement (d) showing multinodular and cystic intracordal mass with nonenhancement

Fig. 2

a Photomicrograph of the resected specimen showing clusters of cells in a dense fibrillary background. Nuclei are round and oval. HE stain, original magnification ×20. b Fibrillary matrix showing immunopositivity for grail fibrillary acidic protein. Original magnification ×20. c Intracellular dot-like positive staining for epithelial membrane antigen showing ependymal cell origin