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Multicentric extramedullary myxopapillary ependymomas: Two case reports and literature review.

Landriel F, Ajler P, Tedesco N, Bendersky D, Vecchi E - Surg Neurol Int (2012)

Bottom Line: Magnetic resonance imaging (MRI) showed multiple intradural extramedullary lesions with homogeneous enhancement after gadolinium injection at C7, D2, D4, D5, D8, D10, D11, L1, L3, L5, S1, and S2.Complete tumor resection of the approached tumors was archived in both cases.Patient's neurologic outcome was good and no residual tumor was present at MRI control at 10 years in case 1 and 12 months in case 2.

View Article: PubMed Central - PubMed

Affiliation: Neurosurgical Department of the Hospital Italiano de Buenos Aires. J.D. Perón, CH - Buenos Aires - Argentina.

ABSTRACT

Background: Ependymoma has been described typically as an intramedullary tumor derived from ependymal cells. Intradural extramedullary presentation is rarely described and almost always as a unique lesion. Myxopapillary ependymoma is a histological variant that distinguishes from the ordinary type of ependymoma because of its generally better prognosis. We present two cases of multicentric extramedullary myxopapillary ependymomas.

Case description: Case 1 was a 30-year-old man with progressive paresthesia and paresis in the lower limbs, urinary sphincter disturbances, gait instability, ataxia, and chronic low back pain with multiple intradural extramedullary lesions at C2-C3, D2-D4-D5, and D12-L1. Case 2 was a 32-year-old man, presented with low back pain and mild paresthesia in the right lower limb. Magnetic resonance imaging (MRI) showed multiple intradural extramedullary lesions with homogeneous enhancement after gadolinium injection at C7, D2, D4, D5, D8, D10, D11, L1, L3, L5, S1, and S2. Complete tumor resection of the approached tumors was archived in both cases. Histological studies confirm myxopapillary ependymomas. Patient's neurologic outcome was good and no residual tumor was present at MRI control at 10 years in case 1 and 12 months in case 2.

Conclusions: We report the first two cases of multicentric extramedullary myxopapillary ependymomas, this etiology must be taken into account in the differential diagnosis of intradural extramedullary tumors.

No MeSH data available.


Related in: MedlinePlus

(a) Neoplastic proliferation of ependymal cells, eosinophilic cytoplasm and hyperchromatic nuclei with mild anisokaryosis and papillary structures. (b) Abundant myxoid matrix. (c and d) Immunohistochemistry were performed with antigen retrieval methods informing positive stain to GFAP and S-100 protein
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Figure 3: (a) Neoplastic proliferation of ependymal cells, eosinophilic cytoplasm and hyperchromatic nuclei with mild anisokaryosis and papillary structures. (b) Abundant myxoid matrix. (c and d) Immunohistochemistry were performed with antigen retrieval methods informing positive stain to GFAP and S-100 protein

Mentions: A 32-year-old man, presented with a 6-month history of low back pain and mild paresthesia in the right lower limb without dorsalgia or radicular pain. Neurological examination showed bilateral hypoesthesia at the T-8 level and hyperreflexia in lower limbs (right greater than left). MRI showed multiple intradural extramedullary lesions with homogeneous enhancement after gadolinium injection at C7, D2, D4, D5, D8, D10, D11, L1, L3, L5, S1, and S2 [Figure 2]. D10 tumor was “C” shaped occupying 60% of the spinal canal without foramen invasion or bone destruction. The tumor compresses anteriorly, right-lateral and posteriorly the spinal cord. Cranial MRI was normal. The tumor was approached through a D9-D10 laminectomy. Surgical findings include partially encapsulation, soft discretely hemorrhagic consistence with a well delimitated cleavage plane, and no medullary connection. The D10 right root was involved by the tumor but not infiltrated. After debulking complete tumor removal was archived under microscope magnification. Histological tumor diagnosis was also myxopapillary ependymoma [Figure 3]. Referred symptoms remainunchanged and control MRI at 12 months after surgery showed no recurrence or spinal cord damage. No adjuvant therapies were performed.


Multicentric extramedullary myxopapillary ependymomas: Two case reports and literature review.

Landriel F, Ajler P, Tedesco N, Bendersky D, Vecchi E - Surg Neurol Int (2012)

(a) Neoplastic proliferation of ependymal cells, eosinophilic cytoplasm and hyperchromatic nuclei with mild anisokaryosis and papillary structures. (b) Abundant myxoid matrix. (c and d) Immunohistochemistry were performed with antigen retrieval methods informing positive stain to GFAP and S-100 protein
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3475877&req=5

Figure 3: (a) Neoplastic proliferation of ependymal cells, eosinophilic cytoplasm and hyperchromatic nuclei with mild anisokaryosis and papillary structures. (b) Abundant myxoid matrix. (c and d) Immunohistochemistry were performed with antigen retrieval methods informing positive stain to GFAP and S-100 protein
Mentions: A 32-year-old man, presented with a 6-month history of low back pain and mild paresthesia in the right lower limb without dorsalgia or radicular pain. Neurological examination showed bilateral hypoesthesia at the T-8 level and hyperreflexia in lower limbs (right greater than left). MRI showed multiple intradural extramedullary lesions with homogeneous enhancement after gadolinium injection at C7, D2, D4, D5, D8, D10, D11, L1, L3, L5, S1, and S2 [Figure 2]. D10 tumor was “C” shaped occupying 60% of the spinal canal without foramen invasion or bone destruction. The tumor compresses anteriorly, right-lateral and posteriorly the spinal cord. Cranial MRI was normal. The tumor was approached through a D9-D10 laminectomy. Surgical findings include partially encapsulation, soft discretely hemorrhagic consistence with a well delimitated cleavage plane, and no medullary connection. The D10 right root was involved by the tumor but not infiltrated. After debulking complete tumor removal was archived under microscope magnification. Histological tumor diagnosis was also myxopapillary ependymoma [Figure 3]. Referred symptoms remainunchanged and control MRI at 12 months after surgery showed no recurrence or spinal cord damage. No adjuvant therapies were performed.

Bottom Line: Magnetic resonance imaging (MRI) showed multiple intradural extramedullary lesions with homogeneous enhancement after gadolinium injection at C7, D2, D4, D5, D8, D10, D11, L1, L3, L5, S1, and S2.Complete tumor resection of the approached tumors was archived in both cases.Patient's neurologic outcome was good and no residual tumor was present at MRI control at 10 years in case 1 and 12 months in case 2.

View Article: PubMed Central - PubMed

Affiliation: Neurosurgical Department of the Hospital Italiano de Buenos Aires. J.D. Perón, CH - Buenos Aires - Argentina.

ABSTRACT

Background: Ependymoma has been described typically as an intramedullary tumor derived from ependymal cells. Intradural extramedullary presentation is rarely described and almost always as a unique lesion. Myxopapillary ependymoma is a histological variant that distinguishes from the ordinary type of ependymoma because of its generally better prognosis. We present two cases of multicentric extramedullary myxopapillary ependymomas.

Case description: Case 1 was a 30-year-old man with progressive paresthesia and paresis in the lower limbs, urinary sphincter disturbances, gait instability, ataxia, and chronic low back pain with multiple intradural extramedullary lesions at C2-C3, D2-D4-D5, and D12-L1. Case 2 was a 32-year-old man, presented with low back pain and mild paresthesia in the right lower limb. Magnetic resonance imaging (MRI) showed multiple intradural extramedullary lesions with homogeneous enhancement after gadolinium injection at C7, D2, D4, D5, D8, D10, D11, L1, L3, L5, S1, and S2. Complete tumor resection of the approached tumors was archived in both cases. Histological studies confirm myxopapillary ependymomas. Patient's neurologic outcome was good and no residual tumor was present at MRI control at 10 years in case 1 and 12 months in case 2.

Conclusions: We report the first two cases of multicentric extramedullary myxopapillary ependymomas, this etiology must be taken into account in the differential diagnosis of intradural extramedullary tumors.

No MeSH data available.


Related in: MedlinePlus