Thoracic Intradural Extramedullary Ependymoma with Anaplastic Transformation: Case Report and Discussion

World Neurosurg. 2020 Feb:134:549-554. doi: 10.1016/j.wneu.2019.11.122. Epub 2019 Nov 28.

Abstract

Background: Intradural extramedullary spinal ependymomas arising from outside the region of the conus medullaris are rare clinical entities, and anaplastic transformation of these lesions is even more exceptional.

Case description: We report on a case of an intradural extramedullary T5-T6 ependymoma that underwent gross total resection. Histologic analysis of the initial tumor revealed a World Health Organization grade 2 ependymoma. Two years after initial surgical resection, there was radiologic recurrence and a re-do resection was performed with subsequent spinal stabilization. Histologic analysis of the recurrent tumor revealed a World Health Organization grade 3 ependymoma. After surgery the patient received radiotherapy, and he remains disease free at 2 years following his second surgery. In addition, we employed carbon fiber screws and rods for stabilization in his second operation to reduce artefact on follow-up imaging.

Conclusions: We advocate that primary spinal ependymomas should be within the differential of intradural extramedullary lesions arising outside the region of the conus medullaris.

Keywords: Anaplastic; Ependymoma; Extramedullary; Intradural.

Publication types

  • Case Reports

MeSH terms

  • Ependymoma / diagnosis
  • Ependymoma / surgery*
  • Humans
  • Magnetic Resonance Imaging / methods
  • Male
  • Middle Aged
  • Neoplasm Recurrence, Local / complications
  • Neoplasm Recurrence, Local / diagnosis
  • Neoplasm Recurrence, Local / surgery*
  • Spinal Cord / pathology
  • Spinal Cord Compression / surgery
  • Spinal Cord Neoplasms / diagnosis
  • Spinal Cord Neoplasms / surgery*
  • Spine / pathology
  • Spine / surgery

Supplementary concepts

  • Familial ependymoma