Presentation
History of MS. Gradual lower limb weakness, now unable to walk.
Patient Data
There is an ovoid mass seen within the lumbar canal centered at the L1 level but extending to the lower aspect of the T12 vertebral body and the upper aspect of L2 vertebral body. The lesion is separate and eccentric to the conus which is distorted and compressed left laterally. T2 signal abnormality is evident with conus. The mass demonstrates reasonably homogeneous enhancement other than a central irregular area of non-enhancement. The mass has heterogeneous, predominantly bright signal on T2-weighted images and intermediate signal on T1-weighted images. No evidence of other enhancing nodules within the lumbar canal. No definite flow-voids are identified.
There is a dextroscoliosis of the lumbar spine. Moderately severe degenerative disc disease is seen at L5/S1 and L2/3. Multilevel facet degenerative disease.
Conclusion:
Intradural, extramedullary mass centered at the L1 level, compressing the conus. A myxopapillary ependymoma is the favored etiology of the mass. Less likely differential diagnoses include neurogenic tumor and less likely paraganglioma.
Case Discussion
The patient went on to have a resection which confirmed the diagnosis of myxopapillary ependymoma (WHO Grade I).
Histology
MACROSCOPIC DESCRIPTION:
An ovoid piece of rubbery to gelatinous tan and dark brown tissue 24x19x17mm.
MICROSCOPIC DESCRIPTION:
Paraffin sections show a moderately hypercellular glial tumor. Tumor cells have uniform round and oval nuclei with finely granular chromatin and coarse fibrillary processes. There is discernible perivascular pseudo-rosette formation thoughout the tumor with mucinous/myxoid material within many pesudo-rosettes. Areas with prominent microcyst formation are also present with cysts also filled with mucinous/myxoid material. No mitotic figures are identified. There is no microvascular proliferation. A geographic area of necrosis is noted in specimen 2. The features are of myxopapillary ependymoma (WHO Grade I)
DIAGNOSIS:
Myxopapillary ependymoma (WHO Grade I)
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