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Fernández-de Thomas RJ, Amaral-Nieves N, De Jesus O, Pastrana EA. Rare sacral extradural grade II ependymoma: a comprehensive review of literature. BMJ Case Rep 2021; 14:e246540. [PMID: 34753734 PMCID: PMC8578964 DOI: 10.1136/bcr-2021-246540] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/13/2021] [Indexed: 11/03/2022] Open
Abstract
Sacral spinal cord ependymoma is an uncommon pathology. Most of the reported cases are consistent with a myxopapillary ependymoma histopathologic subtype. Non-myxopapillary ependymomas rarely occur in the sacral region. Most lesions are intradural; however, rare extradural cases can occur. We present the case of a 46-year-old female patient diagnosed with a grade II sacral extradural ependymoma, emphasising the importance of an interdepartmental case approach for diagnosis and management. Even though grade II ependymomas are considered low grade, the potential for recurrence and metastatic disease has been reported. There are no treatment guidelines for these rare tumours besides gross total resection.
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Affiliation(s)
| | - Natalie Amaral-Nieves
- Neurosurgery, University of Puerto Rico Medical Sciences Campus, San Juan, Puerto Rico
| | - Orlando De Jesus
- Neurosurgery, University of Puerto Rico Medical Sciences Campus, San Juan, Puerto Rico
| | - Emil A Pastrana
- Neurosurgery, University of Puerto Rico Medical Sciences Campus, San Juan, Puerto Rico
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2
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Thejeel B, Rajakulasingam R, Balogh P, Saifuddin A. Diagnosis: subcutaneous myxopapillary ependymoma. Skeletal Radiol 2020; 49:1175-1176. [PMID: 32172345 DOI: 10.1007/s00256-020-03408-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Affiliation(s)
- Bashiar Thejeel
- Department of Radiology and Diagnostic Imaging, University of Alberta, 16 & 85 Ave, Edmonton, AB, T6G 2R3, Canada.
| | - Ramanan Rajakulasingam
- Department of Radiology, Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, HA7 4LP, UK
| | - Petra Balogh
- Department of Histopathology, Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, HA7 4LP, UK
| | - Asif Saifuddin
- Department of Radiology, Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, HA7 4LP, UK
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Strojnik T, Bujas T, Velnar T. Invasive myxopapillary ependymoma of the lumbar spine: A case report. World J Clin Cases 2019; 7:1142-1148. [PMID: 31183345 PMCID: PMC6547326 DOI: 10.12998/wjcc.v7.i10.1142] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2018] [Revised: 04/23/2019] [Accepted: 05/02/2019] [Indexed: 02/05/2023] Open
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.
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Affiliation(s)
- Tadej Strojnik
- Department of Neurosurgery, University Medical Centre Maribor, Maribor 2000, Slovenia
- Faculty of Medicine, University of Maribor, Maribor 2000, Slovenia
| | - Tatjana Bujas
- Department of Pathology, University Medical Centre Maribor, Maribor 2000, Slovenia
| | - Tomaz Velnar
- Department of Neurosurgery, University Medical Centre Ljubljana, Ljubljana 1000, Slovenia
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Ajler P, Landriel F, Goldschmidt E, Campero A, Yampolsky C. [Giant osteolitic sacral myxopapillary ependymoma]. Surg Neurol Int 2014; 5:S256-9. [PMID: 25165615 PMCID: PMC4138816 DOI: 10.4103/2152-7806.137952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2014] [Accepted: 04/10/2014] [Indexed: 12/03/2022] Open
Abstract
Objetivo: la presentación de un caso de una paciente con un ependimoma sacro con extensa infiltración y destrucción ósea local. Descripción del caso: una mujer de 53 años acudió a la consulta por dolor lumbosacro y alteraciones sensitivas perineales y esfinterianas. La imágenes por Resonancia Magnética (IRM) y la Tomografía Axial Computada (TAC) mostraron una lesión expansiva gigante a nivel S2-S4 con extensa osteólisis e invasión de tejidos adyacentes. Se realizó una exéresis tumoral completa con mejoría del estatus funcional. La anatomía patológica informó ependimoma mixopapilar. Discusión: la extensión de la resección quirúrgica es el mejor predictor de buen pronóstico. El tratamiento radiante se reserva como opción adyuvante para las resecciones incompletas y recidiva tumoral. La quimioterapia sólo debería utilizarse en casos en que la cirugía y la radioterapia estén contraindicadas. Conclusión: Los ependimomas mixopapilares sacros con destrucción ósea y presentación intra y extradural son muy infrecuentes y deben ser tenidos en cuenta entre los diagnósticos diferenciales preoperatorios. Su resección total, siempre que sea posible, es la mejor alternativa terapéutica.
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Affiliation(s)
- Pablo Ajler
- Servicio de Neurocirugía, Hospital Italiano de Buenos Aires, Argentina
| | - Federico Landriel
- Servicio de Neurocirugía, Hospital Italiano de Buenos Aires, Argentina
| | | | - Alvaro Campero
- Servicio de Neurocirugía, Hospital Ángel Padilla, Tucumán, Argentina
| | - Claudio Yampolsky
- Servicio de Neurocirugía, Hospital Italiano de Buenos Aires, Argentina
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Hayashi T, Haba R, Kushida Y, Kadota K, Katsuki N, Bando K, Shibuya S, Matsunaga T. Cytopathologic characteristics and differential diagnostic considerations of osteolytic myxopapillary ependymoma. Diagn Cytopathol 2013; 42:778-83. [PMID: 23913845 DOI: 10.1002/dc.23033] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2013] [Revised: 04/12/2013] [Accepted: 06/11/2013] [Indexed: 11/09/2022]
Abstract
Myxopapillary ependymoma (MPE) is a rare variant of conventional ependymoma found predominantly in the sacrococcygeal region in young adults and characterized by its distinct epithelial and stromal components (WHO grade I designation). MPE with extensive osteolysis is extremely uncommon and only up to 40 cases have been documented. A case is presented here in which imprint smears of a sacral tumor in an 18-year-old man revealed complex papillary structures, small loose clusters, or cord-like structures of bland tumor cells embedded in a myxoid or mucinous background. The tumor cells possessed uniformly round nuclei with a smooth nuclear outline, fine granular chromatin, and small nucleoli. Slender cytoplasmic fibrillary processes and occasional intracytoplasmic vacuoles were observed. A cytologic diagnosis of a MPE was suggested and histochemical and immunohistochemical studies were conducted on formalin-fixed, paraffin-embedded material. Immunohistochemically, the tumor cells showed diffuse and strong membranous and cytoplasmic staining for cytokeratin AE1/AE3, glial fibrillary protein, and S-100 protein, but negative for epithelial membrane antigen, pan-neuroendocrine markers (i.e., NSE, chromogranin A, synaptophysin), or brachyury. The proliferative index with MIB-1 was around 10%. The diagnosis of osteolytic MPE was confirmed based on cytopathologic, histopathological, immunohistochemical results, radiologic findings, and the location of the tumor. We demonstrated here the cytopathological features of osteolytic MPE with emphasis on differential diagnostic considerations.
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Affiliation(s)
- Toshitetsu Hayashi
- Department of Diagnostic Pathology, Faculty of Medicine, Kagawa University, Kagawa, Japan
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Quraishi NA, Wolinsky JP, Bydon A, Witham T, Gokaslan ZL. Giant destructive myxopapillary ependymomas of the sacrum. J Neurosurg Spine 2010; 12:154-9. [DOI: 10.3171/2009.9.spine08968] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Myxopapillary ependymomas rarely present as a primary intrasacral lesion, and extensive sacral osteolysis is unusual. The authors report a case series of 6 patients with these complex tumors causing extensive sacral destruction, who underwent resection, lumbopelvic reconstruction, and fusion. The operative procedure, complications, and outcome are summarized after a mean follow-up of 3.55 years (range 18–80 months).
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Affiliation(s)
- Nasir A. Quraishi
- 1Centre for Spine Studies & Surgery, Queens Medical Centre, Nottingham, United Kingdom; and
| | - Jean-Paul Wolinsky
- 2Department of Neurosurgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Ali Bydon
- 2Department of Neurosurgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Timothy Witham
- 2Department of Neurosurgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Ziya L. Gokaslan
- 2Department of Neurosurgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland
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7
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Sacral myxopapillary ependymoma with extensive osteolysis. J Neurooncol 2007; 86:349-52. [PMID: 17952371 DOI: 10.1007/s11060-007-9482-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2007] [Accepted: 10/11/2007] [Indexed: 10/22/2022]
Abstract
Myxopapillary ependymoma rarely presents as a primary intra-sacral lesion and extensive bony destruction is unusual. Radiological features do not help in distinction from other commoner sacral tumors, like chordoma. Hence, histopathology serves as the best diagnostic modality for this differentiation. We report the case of a 42-year-old man with a primary intra-sacral myxopapillary ependymoma causing extensive osteolysis.
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8
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Shors SM, Jones TA, Jhaveri MD, Huckman MS. Best cases from the AFIP: myxopapillary ependymoma of the sacrum. Radiographics 2007; 26 Suppl 1:S111-6. [PMID: 17050509 DOI: 10.1148/rg.26si065020] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Affiliation(s)
- Stephanie M Shors
- Department of Diagnostic Radiology and Nuclear Medicine and the Department of Pathology, Rush University Medical Center, 1653 W Congress Pkwy, Chicago, IL 60612, USA.
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Cihangiroglu M, Hartker FW, Lee M, Sehgal V, Ramsey RG. Intraosseous sacral myxopapillary ependymoma and the differential diagnosis of sacral tumors. J Neuroimaging 2001; 11:330-2. [PMID: 11462306 DOI: 10.1111/j.1552-6569.2001.tb00058.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Although involvement of other regions of the spinal cord and brain stem is seen, myxopapillary ependymoma is most commonly found at the filum terminale or cauda equina. Less commonly, myxopapillary ependymoma may occur outside the central nervous system from direct metastatic extension of an intrathecal tumor, and rarely it may present as a primary tumor outside the thecal sac. The authors present a case of primary sacral myxopapillary ependymoma, which was first diagnosed as a chordoma. They then discuss the magnetic resonance imaging findings of this and other sacral tumors. Myxopapillary ependymoma should be considered in the differential diagnosis for a primary expansile sacral mass along with other lesions such as chordoma, aneurysmal bone cyst, and giant cell tumor.
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Affiliation(s)
- M Cihangiroglu
- University of Chicago, Department of Diagnostic Radiology, MC-2026, 5841 South Maryland Avenue, Chicago, IL 60637-1470, USA
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Fourney DR, Fuller GN, Gokaslan ZL. Intraspinal extradural myxopapillary ependymoma of the sacrum arising from the filum terminale externa. Case report. J Neurosurg 2000; 93:322-6. [PMID: 11012069 DOI: 10.3171/spi.2000.93.2.0322] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Extradural ependymomas of the sacrococcygeal region are very rare, with most arising from the soft tissues of the presacral area or from the regions dorsal to the sacrum. In even rarer circumstances, the tumor may arise within the sacral canal, likely as a result of ependymal cells of the extradural filum terminale. Because of bone erosion caused by extension of the tumor into the pelvis or dorsal to the sacrum, a truly intraspinal extradural ependymoma in this region has until now never been clearly demonstrated. The authors present a patient with a myxopapillary ependymoma arising from the filum terminale externa in which there was no involvement of the intradural filum or extension outside the sacral canal. A review of the literature is presented, with emphasis on the pathogenesis and clinical management of these rare tumors.
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Affiliation(s)
- D R Fourney
- Department of Neurosurgery, The University of Texas M.D. Anderson Cancer Center, Houston 77030, USA
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