MYXOPAPILLARY EPENDYMOMA WITH EXTENSIVE LOCAL INVASION AND DISTANT DISSEMINATION – THERAPEUTIC DILEMMA

Arturs Balodis, Marija Zavertjajeva, Raimonds Mikijanskis, Austra Breikša-Vaivode, Inese Briede

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Abstract

Objectives. Myxopapillary ependymomas (ME) are a group of glial tumours with predilection to the
lumbosacral region, typically affecting males in the 4th decade of life. ME develop from the ependymal
cells of the conus medullaris appearing as intradural, extramedullary mass on imaging studies. Due to slow
growth and scarce clinical presentation the diagnosis of ME is often delayed, when local tissue invasion
and dissemination have already occurred. Even though ME have low metastatic potential, they may exhibit
aggressive and recurrent clinical course and therefore are now classified as Grade II tumours, according to
the 2021 WHO classification of ependymal neoplasms.
Complete surgical resection is the therapy of choice. In case of extended dissemination adjuvant
radiotherapy is recommended.
This report presents a case of a 45-year-old man with a two-year history of nonspecific lower back pain.
Spine X-ray showed mild degenerative changes. Unenhanced MRI of the lumbar spine showed an intradural,
extramedullary, expansive tumour at the level L1-S4 with erosion of the sacral bone and invasion of presacral
tissue, that appeared hypointense on T1 and hyperintense on T2. Based on the typical localisation and
growth pattern ME was suspected. Contrast enhanced MRI showed heterogeneous enhancement, typical
for advanced ME. Biopsy confirmed the preliminary diagnosis. During biopsy remodelling and extreme
thinning of the sacral bone was identified, with high risk of pathological fracture resulting in unstable
pelvis, making partial tumour resection with laminectomy and laminoplasty necessary. Preoperative neural
axis MRI showed contrast enhancing lesions in cerebellum, cervical and thoracic spine – ME metastases,
therefore adjuvant radiotherapy was administered. Post-operative imaging showed gross reduction in lumbar
tumour, oedema of the nerve roots. Control MRI a year after operation showed increase in residual tissue in
the surgical bed as well as augmentation of size and number of metastases along the neural axis.
Original languageEnglish
Pages (from-to)272
Number of pages1
JournalMedicina (Kaunas)
Volume59
Issue numberSuppl.2
Publication statusPublished - 31 Mar 2023
EventRSU Research Week 2023: Research Week 2023 Rīga Stradiņš University - Riga Stradins University, Riga, Latvia
Duration: 27 Mar 202331 Mar 2023
https://rw2023.rsu.lv/general-information
https://rw2023.rsu.lv

Keywords*

  • Ependymoma
  • myxopapillary
  • magnetic resonance imaging (MRI)

Field of Science*

  • 3.2 Clinical medicine

Publication Type*

  • 3.4. Other publications in conference proceedings (including local)

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