Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Case Reports
. 2021 Jun;19(2):94-98.
doi: 10.3121/cmr.2021.1561. Epub 2021 May 13.

Incidental Discovery of a Presacral Extradural Myxopapillary Ependymoma

Roshini Ramwani  1 , Deepa Bassi  2 , Alfonso Velasco  3
Affiliations
Case Reports

Incidental Discovery of a Presacral Extradural Myxopapillary Ependymoma

Roshini Ramwani et al. Clin Med Res. 2021 Jun.

Abstract

Ependymoma is a malignant central nervous system tumor arising from the lining of the ventricles or central canal of the spinal cord. Extradural spinal ependymomas arise from heterotopic ependymal cells or the coccygeal medullary vestige and are extremely infrequent. We present a rare case of presacral extradural ependymoma. Extradural ependymomas typically demonstrate an extraneural spread and, thus, surveillance of the entire central nervous system is not typically recommended. A radiograph of the chest, liver profile, and attention to palpable lymphadenopathy (especially inguinal) on physical examination are vital for surveillance. Obtaining an R0 resection is the most important prognostic factor in survival and local recurrence.

Keywords: Extradural spinal ependymoma; Myxopapillary ependymoma; Presacral tumor.

PubMed Disclaimer

Figures

Figure 1.
Figure 1.
Non-contrasted CT showing (a) 3 mm stone in the left proximal ureter (red arrow) and (b) a lobulated rounded mass in the retrorectal space (green arrow).
Figure 2.
Figure 2.
MR images showing a precoccygeal multiloculated cystic mass abutting the posterior wall of distal rectum. (a) Axial T2- weighted (b) Sagittal T2- weighted (c) T1- weighted axial images showing some small internal enhancing areas of soft tissue nodularity (arrow).
Figure 3.
Figure 3.
(A) Positioning for posterior approach. (B) Coccygectomy. (C) Digital rectal examination to facilitate dissection. From Hassan I & Wietfeldt ED. Presacral tumors: diagnosis and management. Clin Colon Rectal Surg. 2009;22(2):84-9311; used with permission of Mayo Foundation for Medical Education and Research, all rights reserved.
Figure 4.
Figure 4.
Intraoperative gross image of 7.6 x 4.0 x 3.0 cm bilobed mass resected in its entirety.
Figure 5.
Figure 5.
Subcutaneous myxopapillary ependymoma with GFAP, S-100 stain positive. EMA shows rare positivity. (a) Myxopapillary ependymoma has a distinctive appearance consisting of cuboidal, columnar and spindle cells with papillary arrangement around hyalinized blood vessels (black arrows). (b) Collagen balls identified within the tumor (blue arrows). (c) S100- positive stain. (d) GFAP positive stain.
Figure 6.
Figure 6.
T2-weighted MR images post interval resection of presacral ependymoma with small residual fluid collection likely a seroma. No obvious recurrent disease.
See this image and copyright information in PMC

References

    1. Fassett DR, Schmidt MH.. Lumbosacral ependymomas: a review of the management of intradural and extradural tumors. Neurosurg Focus. 2003;15(5):E13. - PubMed
    1. Oh MC, Kim JM, Kaur G, et al. . Prognosis by tumor location in adults with spinal ependymomas. J Neurosurg Spine. 2013;18(3):226-235. - PubMed
    1. Khalid SI, Adogwa O, Kelly R, et al. . Adult spinal ependymomas: an epidemiologic study. World Neurosurg. 2018;111:e53-e61. - PubMed
    1. Campen CJ, Fisher PG.. Ependymoma: an overview. In: Hayat MA, ed. Tumors of the central nervous system. 1st ed. Dordrecht, Netherlands: Springer Science+Business Media; 2012. 269-277.
    1. Shors SM, Jones TA, Jhaveri MD, Huckman MS.. Best cases from the AFIP: myxopapillary ependymoma of the sacrum. Radiographics. 2006;26 Suppl 1:S111-S116. - PubMed

Publication types

LinkOut - more resources