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Lien BV, Brown NJ, Himstead AS, Ball BZ, Guillen A, Acharya N, Yi Yang C, Sahyouni R, Perez-Rosendahl M, Stitzlein RN, Hsu FPK. Surgical management of a rare myxopapillary ependymoma of the gluteal region: A case report. Surg Neurol Int 2021; 12:130. [PMID: 33880235 PMCID: PMC8053468 DOI: 10.25259/sni_768_2020] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Accepted: 02/25/2021] [Indexed: 11/21/2022] Open
Abstract
Background: Ependymomas are rare tumors originating from neuroepithelial cells lining the wall of the ventricles or central canal of the spinal cord. While these tumors mainly occur within the central nervous system (CNS), there are occasional reports in children and young adult patients with a primary tumor occurrence outside of the CNS. Ependymomas of the sacrococcygeal region have been infrequently described in the literature with no standard of care established. We present a case report and review of the literature regarding this rare entity. Case Description: A 24-year-old woman presented with right gluteal pain worsened by sitting and a palpable soft tissue mass of the sacrococcygeal region. Magnetic resonance imaging revealed a 3.7 cm cystic mass centered in the right gluteal region. She underwent a biopsy at an outside institution, with histology revealing myxopapillary ependymoma. The patient was referred to our hospital and underwent an interdisciplinary neurosurgical and orthopedic oncology en bloc resection of the ependymoma, which intraoperatively appeared to originate from the coccygeal nerve. Conclusion: In the present report, the authors demonstrate that a myxopapillary ependymoma may present as an isolated gluteal mass attached to the coccygeal nerve, without frank CNS involvement. Furthermore, an interdisciplinary approach to surgical resection of this lesion appears to represent an effective treatment modality.
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Affiliation(s)
- Brian V Lien
- Department of Neurological Surgery, University of California, UCI Medical Center, Orange, United States
| | - Nolan J Brown
- Department of Neurological Surgery, University of California, UCI Medical Center, Orange, United States
| | - Alexander S Himstead
- Department of Neurological Surgery, University of California, UCI Medical Center, Orange, United States
| | - Benjamin Z Ball
- Department of Neurological Surgery, University of California, UCI Medical Center, Orange, United States
| | - Aileen Guillen
- Department of Neurological Surgery, University of California, UCI Medical Center, Orange, United States
| | - Nischal Acharya
- Department of Neurological Surgery, University of California, UCI Medical Center, Orange, United States
| | - Chen Yi Yang
- Department of Neurological Surgery, University of California, UCI Medical Center, Orange, United States
| | - Ronald Sahyouni
- Department of Neurosurgery, UC San Diego School of Medicine, La Jolla, United States
| | - Mari Perez-Rosendahl
- Department of Pathology, University of California, UCI Medical Center, Orange, California, United States
| | - Russell N Stitzlein
- Department of Orthopedic Surgery, University of California, UCI Medical Center, Orange, California, United States
| | - Frank P K Hsu
- Department of Neurological Surgery, University of California, UCI Medical Center, Orange, United States
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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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Kelly A, Nally D, Crowther S, Kavanagh D. Subcutaneous sacrococcygeal myxopapillary ependymoma misdiagnosed as pilonidal disease. BMJ Case Rep 2020; 13:e231639. [PMID: 31900294 PMCID: PMC6954808 DOI: 10.1136/bcr-2019-231639] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/20/2019] [Indexed: 01/25/2023] Open
Abstract
Ependymomas are neoplasms which arise from the radial glial cells, which many recent studies have proposed are neural stem cells. Extracranial ependymomas are rare. We present the case report and supporting multimedia of a 37-year-old man who presented with a painless intergluteal swelling which was diagnosed clinically as a pilonidal cyst. However, on excision, he was found to have a subcutaneous sacrococcygeal myxopapillary ependymoma based on histological findings. His management and follow-up are presented and discussed. Given the rare nature of this condition, there is a lack of published guidelines on management and follow-up protocols. Supporting evidence is limited to sporadic case reports. This case highlights the diagnostic challenges and management strategies adopted supported by the best available evidence.
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Affiliation(s)
- Aisling Kelly
- Department of Surgery, Tallaght University Hospital, Dublin, Ireland
| | - Deirdre Nally
- Department of Surgery, Tallaght University Hospital, Dublin, Ireland
| | - Stephen Crowther
- Department of Pathology, Tallaght University Hospital, Dublin, Ireland
| | - Dara Kavanagh
- Department of Surgery, Tallaght University Hospital, Dublin, Ireland
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