Invasive myxopapillary ependymoma of the lumbar spine: A case report

Abstract

Background: Myxopapillary ependymomas are rare spinal tumours. Although histologically benign, they have a tendency for local recurrence.

Case summary: We describe a patient suffering from extra- and intradural myxopapillary ependymoma with perisacral spreading. He was treated with subtotal resection and postoperative radiation therapy. After treatment, he experienced slight sphincter disorders and lumboischialgic pain with no motor or sensory disturbances. Eight months later, a tumour regression was documented. The patient is still followed-up regularly.

Conclusion: Lumbar myxopapillary ependymomas may present with lumbar or radicular pain, similar to more trivial lesions. Magnetic resonance imaging (MRI) is the primary modality for diagnosis. The treatment aim is to minimize both tumour and therapy-related morbidity and to involve different treatment modalities.

Keywords: Case report; Lumbar pain; Myxopapillary ependymoma; Spinal tumour; Surgery.

Figure 1

The first magnetic resonance imaging of the lumbosacral spine in 2007 showing only slight degenerative changes.

Figure 2

An extensive tumorous lesion was seen in 2014, located intramedullary, extending from the Th11, invading the conus medullaris and encompassing the entire sacral and lumbar canal to the S2 level, invading the vertebrae and spreading to perispinal muscles. Homogenous contrast enhancement is evident.

Figure 3

Histological examination results. A: Myxopapillary ependymomas display a variable papillary architecture with cuboid to elongated glial cells radially arranged in myxoid stroma with a central blood vessel; B: The tumour cells are immunoreactive for vimentin and GFAP; C: Immunoreactivity for cytokeratins is typically absent.

Figure 4

The control magnetic resonance imaging showing no progression of the tumour.