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Benomar A, Khellaf A, Kadi L, Ferreira J, Lavergne P, Bergeron F, Laroche M. Giant metastatic mixed-type spinal ependymoma presenting with hydrocephalus. Radiol Case Rep 2024; 19:4751-4754. [PMID: 39228951 PMCID: PMC11366887 DOI: 10.1016/j.radcr.2024.07.127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2024] [Revised: 07/21/2024] [Accepted: 07/22/2024] [Indexed: 09/05/2024] Open
Abstract
Ependymomas are rare nervous system tumors that can arise anywhere in the neuraxis. While having a high propensity for leptomeningeal dissemination, retrograde dissemination (from the spine to the CNS) remains infrequent. We describe the case of a 31-year-old female who presented with hydrocephalus secondary to an intracranial leptomeningeal metastasis of a giant spinal ependymoma with mixed (classic and myxopapillary) histopathologic features, successfully treated with surgical resection and radiotherapy of the entire neuraxis. This case highlights the importance of including ependymomas in the differential diagnosis for lesions in atypical extra-axial locations, of systematically obtaining imaging of the entire neuraxis when suspecting it, and of considering retrograde dissemination when both intracranial and spinal lesions are present.
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Affiliation(s)
- Anass Benomar
- Department of Radiology, Radiation Oncology and Nuclear Medicine, Centre Hospitalier de l'Université de Montréal (CHUM), Montréal, Quebec, Canada
| | - Abdelhakim Khellaf
- Department of Anatomical Pathology, Centre Hospitalier de l'Université de Montréal (CHUM), Montréal, Quebec, Canada
| | - Lynda Kadi
- Department of Radiology, Radiation Oncology and Nuclear Medicine, Centre Hospitalier de l'Université de Montréal (CHUM), Montréal, Quebec, Canada
| | - José Ferreira
- Department of Anatomical Pathology, Maisonneuve-Rosemont Hospital, Montréal, Quebec, Canada
| | - Pascal Lavergne
- Division of Neurosurgery, Department of Surgery, Sacré-Coeur Hospital, Montréal, Quebec, Canada
| | - François Bergeron
- Department of Radiology, Sacré-Coeur Hospital, Montréal, Quebec, Canada
| | - Mathieu Laroche
- Division of Neurosurgery, Department of Surgery, Sacré-Coeur Hospital, Montréal, Quebec, Canada
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Karita H, Koiso T, Muroi A, Sakamoto N, Zaboronok A, Ishikawa E. Preoperatively difficult-to-diagnose medulla oblongata germinoma: A case report and literature review. Surg Neurol Int 2023; 14:366. [PMID: 37941640 PMCID: PMC10629303 DOI: 10.25259/sni_682_2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 09/22/2023] [Indexed: 11/10/2023] Open
Abstract
Background Intracranial germinomas are rare tumors, accounting for 0.5-2% of primary intracranial neoplasms. While they typically occur in the pineal gland, suprasellar region, basal ganglia, and thalamus, germinomas arising in the medulla oblongata are exceptionally rare. Diagnosis of medulla oblongata germinoma is challenging, potentially leading to misdiagnosis and poor prognosis. Case Description We present a case of a 29-year-old man complaining of left leg numbness. Radiological findings revealed a contrast-enhanced lesion in the medulla oblongata. The patient underwent tumor biopsy, and intraoperative pathological diagnosis (IOD) suspected the diagnosis of medulla oblongata germinoma. He underwent chemoradiotherapy after confirming the diagnosis of germinoma. Intracranial germinoma arising in the medulla oblongata differs from germinomas in other locations due to its higher incidence in individuals in their 20s and a slight female predominance. Conclusion When encountering lesions in the medulla oblongata, germinoma should be considered as one of the differential diagnoses, and surgical strategies including IOD should be planned accordingly.
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Affiliation(s)
- Hiroki Karita
- Department of Neurosurgery, University of Tsukuba, Tsukuba, Japan
| | - Takao Koiso
- Department of Neurosurgery, University of Tsukuba, Tsukuba, Japan
| | - Ai Muroi
- Department of Neurosurgery, University of Tsukuba, Tsukuba, Japan
| | | | | | - Eiichi Ishikawa
- Department of Neurosurgery, University of Tsukuba, Tsukuba, Japan
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Makino Y, Kawanabe Y, Fujimoto M, Sato T, Hoshimaru M. A Case of Spinal Ependymoma Developed in the Extramedullary Location: A Case Report and Literature Review. NMC Case Rep J 2022; 8:601-608. [PMID: 35079523 PMCID: PMC8769463 DOI: 10.2176/nmccrj.cr.2020-0354] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2020] [Accepted: 03/17/2021] [Indexed: 11/20/2022] Open
Abstract
Intradural extramedullary (IDEM) ependymoma except for tumors originated from the filum terminale or conus medullaris is rare. The present study showed a case of IDEM ependymoma. A 16-year-old boy was referred to our hospital with a complaint of right hypochondriac pain and motor weakness in his right leg. MRI revealed a solitary intradural tumor at Th5–8 level with syringomyelia at Th2–4 level. Microscopic total tumor resection was performed with right hemi-laminectomy of Th4–9. Histological diagnosis was ependymoma (WHO grade 2). Although his leg weakness was worsened transiently, he showed improvement in leg weakness being able to go up and down the stairs 1 month after the surgery. There was no tumor recurrence until now, 7 years after the surgery, without any adjunctive therapies. A total of 44 cases of IDEM ependymoma had been reported in the past literatures. They are thought to arise from ependymal cells which remained during the process of neural tube closure. Like intramedullary ependymomas, most of the IDEM ependymomas have clear border to surrounding tissue and often removed completely. However, a small number of recurrences and malignant transformations had been reported after complete resections despite benign histological features tumors. In the case of totally resected low grade IDEM ependymoma, it is thought to be reasonable to perform long-term periodical radiographic follow-up without postoperative adjunctive therapy.
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Affiliation(s)
- Yasuhide Makino
- The Department of Neurosurgery, Shizuoka General Hospital, Shizuoka, Shizuoka, Japan
| | - Yoshifumi Kawanabe
- The Department of Neurosurgery, Shizuoka General Hospital, Shizuoka, Shizuoka, Japan
| | - Motoaki Fujimoto
- The Department of Neurosurgery, Shizuoka General Hospital, Shizuoka, Shizuoka, Japan
| | - Tsukasa Sato
- The Department of Neurosurgery, Shizuoka General Hospital, Shizuoka, Shizuoka, Japan
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Mishra A, Sadashiva N, Krishna U, Konar S, Nandeesh BN, Santosh V, Gowda A, Devi BI. Disseminated Craniospinal Myxopapillary Ependymoma Treated with Biopsy and Adjuvant Radiation Therapy: A Case Report and Review of Literature. Neurol India 2021; 69:500-504. [PMID: 33904488 DOI: 10.4103/0028-3886.314566] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Ajit Mishra
- Department of Neurosurgery, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India
| | - Nishanth Sadashiva
- Department of Neurosurgery, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India
| | - Uday Krishna
- Department of Radiation Oncology, Kidwai Memorial Institute of Oncology, Bangalore, Karnataka, India
| | - Subhas Konar
- Department of Neurosurgery, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India
| | - B N Nandeesh
- Department of Neuropathology, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India
| | - Vani Santosh
- Department of Neuropathology, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India
| | - Aravind Gowda
- Department of Neuroimaging and Interventional Radiology, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India
| | - Bhagavatula Indira Devi
- Department of Neurosurgery, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India
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Marco Del Pont F, Villamil F, Lorefice E, Caffaratti G, Centeno TR, Ruella M, Mormandi R. Cervicodorsal extramedullary anaplastic ependymoma with intracranial metastasis. Neurochirurgie 2020; 67:523-525. [PMID: 33189738 DOI: 10.1016/j.neuchi.2020.10.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Accepted: 10/31/2020] [Indexed: 10/23/2022]
Affiliation(s)
- F Marco Del Pont
- Department of Neurosurgery, FLENI, 520 Quintana St. 7th floor, C1060DDG Buenos Aires, Argentina.
| | - F Villamil
- Department of Neurosurgery, FLENI, 520 Quintana St. 7th floor, C1060DDG Buenos Aires, Argentina
| | - E Lorefice
- Department of Neurosurgery, FLENI, 520 Quintana St. 7th floor, C1060DDG Buenos Aires, Argentina
| | - G Caffaratti
- Department of Neurosurgery, FLENI, 520 Quintana St. 7th floor, C1060DDG Buenos Aires, Argentina
| | - T R Centeno
- Department of Neurosurgery, FLENI, 520 Quintana St. 7th floor, C1060DDG Buenos Aires, Argentina
| | - M Ruella
- Department of Neurosurgery, FLENI, 520 Quintana St. 7th floor, C1060DDG Buenos Aires, Argentina
| | - R Mormandi
- Department of Neurosurgery, FLENI, 520 Quintana St. 7th floor, C1060DDG Buenos Aires, Argentina
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Guo Z, Wan J, Zhao B. Extensive craniospinal disseminated metastasis after the resection of intradural extramedullary ependymoma in the craniocervical junction: a case report and literature review. Int J Neurosci 2020; 131:919-926. [PMID: 32316808 DOI: 10.1080/00207454.2020.1759585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
PURPOSE/AIM Intradural extramedullary (IDEM) ependymomas are very rare, and IDEM ependymomas with craniospinal disseminated metastasis are exceptionally rare; only 2 preoperative cases have been confirmed, and postoperative cases have not been reported. CASE REPORT We present a case of a 21-year-old female with an IDEM ependymoma of the craniocervical junction who experienced head and neck pain for more than 1 month. Magnetic resonance imaging (MRI) of the cervical spine revealed a large IDEM cystic lesion located in the medulla oblongata and the upper cervical spinal cord. The patient underwent surgery without complications, and the tumor was completely removed. Histopathological examination revealed a diagnosis of aplastic ependymoma, World Health Organization (WHO) grade III. The patient failed to follow-up with radiotherapy for one month after discharge. Nearly three months after surgery, craniospinal disseminated metastasis was found in the patient; subsequently, chemoradiotherapy was administered to prolong the survival time of the patient. Unfortunately, the patient underwent radiotherapy and chemotherapy for only 7 days; then, the patient gave up treatment and died 5 months later. CONCLUSIONS To the best of our knowledge, no other cases of craniocervical junction anaplastic ependymomas with craniospinal disseminated metastasis have been reported in the literature. Total resection does not completely prevent recurrence and metastasis, and MRI of the entire neuraxis and timely postoperative craniospinal radiotherapy are necessary for the treatment of this disease.
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Affiliation(s)
- Zhifei Guo
- Department of Neurosurgery, The Second Affiliated Hospital of Anhui Medical University, Cerebral Vascular Disease Research Centre, Anhui Medical University, Hefei, China
| | - Jinghai Wan
- Department of Neurosurgery, Cancer Hospital, National Cancer Centre of China, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Bing Zhao
- Department of Neurosurgery, The Second Affiliated Hospital of Anhui Medical University, Cerebral Vascular Disease Research Centre, Anhui Medical University, Hefei, China
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