What WHO grade are spinal ependymomas?
Intramedullary spinal ependymomas are grade II lesions. Anaplastic grade III lesions are encountered. Myxopapillary ependymomas, virtually always located below the conus and best thought of as separate entities, are grade I.
What features may be evident on plain films?
Scoliosis and evidence of mass effect (these are slowly growing masses): spinal canal widening, vertebral body scalloping, pedicle erosion and laminar thinning.
A mass ( * ) located centrally within the cord (note displaced 'normal' cord around the lesion (green arrows)) is of high T2 signal and demonstrates moderate contrast enhancement. At either end multiple cystic regions are demonstrated (blue arrows) most of which do not have any solid enhancing component and thus probably represent tumour syrinx rather than intra-tumoral cysts. Best seen inferiorly is a region of signal drop out (yellow arrow) which probably represents blood product (a poorly formed hemosiderin cap).