Intradural extramedullary double primary ependymoma and meningioma rare condition: Case report and literature review

Abstract

Rationale: Ependymomas are commonly prevalent intramedullary neoplasms in adults, with hardly any cases of exophytic extramedullary ependymoma being reported. Meningiomas, on the contrary, are one of the most common intradural extramedullary (IDEM) tumors. However, the occurrence of both IDEM tumors simultaneously is extremely rare.

Patient concerns: A 63-year-old female who presented with pain and numbness in both lower limbs, and symptoms rapidly progressed over the past 5 months.

Diagnosis: Based on the patient's clinical symptoms and imaging features, we conducted pathological examination and genetic testing, ultimately confirming that the patient had IDEM double primary ependymoma and meningioma.

Interventions: Surgery was performed to remove double spinal tumors, decompress spinal nerve roots, and perform laminectomy, and she was treated with electrocardiogram monitoring, antibiotics, hemostasis, and antiedema therapy.

Outcomes: Histopathology confirmed World Health Organization grade II ependymoma at L2 and World Health Organization grade I meningioma at T12-L1. MYCN amplification and other genetic alterations were absent. Postoperative recovery was favorable, with no recurrence at 6-month follow-up.

Lessons: This is the first reported case of IDEM double primary ependymoma and meningioma, highlighting the rarity of such cases and the importance of thorough diagnostic workup and surgical excision for IDEM tumors. Genetic analysis adds to the understanding of these rare tumors and guides management strategies.

Figure 1.

Preoperative sagittal MRI demonstrated 2 intradural extramedullary lesions in thoracic and lumbar levels (A–D).

Figure 2.

Histologic description of ependymomas (World Health Organization grade II). (A) Perivascular pseudo-rosettes (hematoxylin and eosin, original magnification × 40). (B) Tumor cells were positive for glial fibrillary acidic protein staining (original magnification × 40). (C) Tumors were positive for S-100 protein (original magnification × 40). (D) The Ki-67 labeling index was <2% (original magnification × 40).

Figure 3.

Histologic description of meningioma (World Health Organization grade I). (A) syncytial growth of tumor cells with sparse psammoma bodies (hematoxylin and eosin, original magnification × 40). (B) Tumor cells were positive for epithelial membrane antigen staining (original magnification × 40). (C) Tumors were positive for progesterone receptor protein (original magnification × 40). (D) The Ki-67 labeling index was about 5% (original magnification × 40).