Presentation
Bilateral lower limb weakness.
Patient Data
Lumbar intra-spinal well-defined oblong-shaped intradural mass lesion within the thecal sac extending from inferior endplate of D12 to L3 vertebrae. The mass elicits a low signal on T1 and a high signal on T2 WI with vivid post-contrast enhancement. It causes significant spinal canal stenosis and severe compression/displacement of cauda-equina nerve roots at respected levels. Mild scalloping of the posterior cortex of L1and L2 vertebrae. No neuroforaminal extension. No paravertebral soft tissue components.
This is associated with:
- prominent vasculature around the spinal cord and the conus that appear as serpiginous vascular structures eliciting signal void on T2 WI and post-contrast enhancement
- lower sacral intraspinal hematoma showing an upper concave border (layering) and eliciting a high signal on T1 and T2 WI with no post-contrast enhancement
Findings are suggestive of myxopapillary ependymoma (MPE). Paraganglioma was another possibility because of the prominent peritumoral and periconal flow voids.
The patient was operated on with complete excision of this lesion and sent for histopathological analysis. Histopathology revealed myxopapillary ependymoma (MPE).
Photo shows an intradural mass elicits low signal on T1 and T1 fat sat, high signal on T2 and STIR and shows vivid post-contrast enhancement. Associated with lower sacral intraspinal layered hemorrhage.
Case Discussion
In this case, differential possibilities were myxopapillary ependymoma as this is the most common tumor of the conus and filum. Also, it shows intense post-contrast enhancement and is associated with intraspinal hemorrhage, and paraganglioma is a second possibility because of the intense enhancement and the prominent peritumoral and periconal flow voids.
The patient was operated on with complete excision of this lesion and sent for histopathological analysis. Histopathology revealed myxopapillary ependymoma (MPE).
Myxopapillary ependymomas are a variant type of ependymoma that occurs predominantly in the filum terminale and/or conus medullaris. It usually occurs at a young age with a mean age of 35 years.
Radiological findings include an oblong-shaped intra-spinal intradural mass lesion in the lumbosacral region. They may be associated with hemorrhage, calcifications, or cystic degeneration. They show intense post-contrast enhancement.
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