Spinal myxopapillary ependymoma with interval drop metastasis presenting as cauda equina syndrome: case report and review of literature

Abstract

Myxopapillary ependymoma is a benign slow-growing tumour, arising predominantly in the region of the filum terminale. It has been designated histologically as grade I neoplasm according to the 2007 WHO classification. Despite this benign character dissemination and metastasis along the cerebrospinal axis and metastasis to distant sites have occasionally been reported. There have been previously reported cases of drop metastasis from MPE, however in three of these cases the drop metastasis was diagnosed with concurrent primary spinal MPE. There has been only one previously published case of interval drop metastasis in a case of operated spinal MPE in literature. We hereby present the second case of interval drop metastasis in a case of conus MPE, with history of having undergone a subtotal resection and post operative adjuvant radiotherapy prior to second surgery. The patient presented months after the primary surgery with symptoms of cauda equina syndrome attributable to the drop metastasis.

Keywords: Myxopapillary ependymoma; adjuvant radiotherapy; cauda equina syndrome; drop metastasis.

Figure 1

Initial pre-operative MRI T2 sagittal showing initial lesion at L1–L2 level.

Figure 2

Histopathological image suggestive of myxopapillary ependymoma (40×).

Figure 3

Post-operative sagittal MRI scan showing residual lesion at L1–L2 level as seen on (A) (T2W image), (B) (T1W image) & (C) (post contrast image).

Figure 4

Present pre-operative sagittal MRI scans showing residual lesion at l1-l2 level and a new lesion is seen at L5–S2 level with involvement of vertebral bodies and drop metastasis on, (A) (T2W image), (B) (T1W image) & (C) (post contrast image).

Figure 5

Present post-operative sagittal MRI scans showing involvement of lower dorsal d11-d12, lumbar and sacral vertebral bodies with multiple nodular lesions within spinal canal from lumbar to sacral region suggestive of metastatic deposits on (A) (T2W image), (B) (T1W image) & (C) (post contrast image).