Spinal drop metastasis in myxopapillary ependymoma: a case report and a review of treatment options

Abstract

Myxopapillary ependymoma (MPE) is a World Health Organization grade I ependymoma that is quite rare and generally thought to be benign. Possible drop metastasis from MPE has been reported three times in the literature; in each case there were cotemporaneous additional MPE lesions. We report the case of a man who had a piecemeal gross total resection of a MPE at L1-L3 followed by adjuvant external beam radiotherapy (EBRT) who presented sixteen months later with a lesion in the thecal sac consistent with drop metastasis. A subtotal resection and adjuvant EBRT were performed. The patient has been disease-free in follow-up 27 months from the second surgery. A review of the literature regarding the treatment for MPE showed that gross total resection is optimal initial management. Several retrospective studies supported the role of adjuvant radiotherapy in enhancing local control and progression-free survival. Chemotherapy has a minimal role in the management of MPE.

Keywords: adjuvant radiotherapy; drop metastasis; ependymoma; myxopapillary.

Figure 1.

A) Sagittal T2 magnetic resonance imaging (MRI) without contrast of initial lesion from L1-L3 prior to surgery. B) Sagittal T2 MRI without contrast 16 months after completion of initial radiotherapy showing new lesion at S1-S2 level.

Figure 2.

Hematoxylin and eosin-stained photomicrograph showing perivascular pseudorosettes containing bluish myxoid material characteristic of myxopapillary ependymoma.