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Myxopapillary Ependymoma

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I've referred to the ependymomas of the

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intradural extramedullary space.

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These are typically called the filum terminale

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ependymomas or myxopapillary ependymomas.

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And they are not in the spinal cord,

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but in the little fibrous tissue at the end

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of the spinal canal, the filum terminale.

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These are grade 1, low-grade tumors,

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generally considered benign,

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that can be removed surgically.

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There's a slight male predilection.

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They're very slow growing.

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These may have calcification or hemorrhage

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or cystic change within them.

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This lesion looks almost exactly like our cystic

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schwannoma that we referred to previously.

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However, this was a myxopapillary ependymoma.

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The features of it that would be suggestive of that

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are the cystic nature of the lesion, as well as

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its occurrence here at the filum terminale.

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So the filum terminale lesions generally are more

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centrally located than nerve root lesions.

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Nerve roots are going to be in the

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periphery of the thecal sac.

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The filum terminale would be in the center of the thecal sac.

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It is not uncommon for them to have mixed signal

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intensity because of the possibility of cysts or

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hemorrhage, or occasionally even calcification.

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The location in the center of the thecal sac, as opposed to

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the periphery, would also be a feature that would

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suggest a filum terminale ependymoma.

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These lesions are very slow growing.

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They may remodel bone. And in point of fact, on this sagittal scan,

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you might wonder about whether there's a little bit of

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posterior scalloping of L4 associated with

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the ependymoma. Most of these ependymomas,

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when they're discovered,

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are large lesions because they are relatively

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asymptomatic and they're slow growing tumors.

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Sometimes you will see them erode through the bone and

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infiltrate the sacrum quite widely

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and, actually, extend extradurally.

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So this is yet another of the intradural extramedullary

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tumors that can occasionally become extradural

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outside the thecal sac. And here's an example.

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This is a myxopapillary ependymoma, and frankly,

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it looks very aggressive, right?

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So let's look at this T1-weighted scan in the center here.

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Notice that there is scalloping of the bone.

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So, it's maybe some features that suggest slow growing.

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But look at the sacrum.

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This is the S1 bone and this is the S2 bone.

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So this is an example of an intradural extramedullary

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benign tumor that is infiltrating the sacrum

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in a very aggressive fashion.

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You can see the...

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actually, on the T2-weighted scan, this bright signal intensity

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of sacral bone invasion by a benign

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myxopapillary ependymoma.

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And you see also that it does show contrast enhancement.

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So an intradural extramedullary lesion that is growing

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extradurally and is yet a benign tumor.

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On the axial scan,

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you can see that there also was growth posteriorly

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through the posterior elements,

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which you're seeing here by this mass.

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Now, this mass presented at this size.

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So, it just goes to show how these lesions are relatively

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asymptomatic slow growing and present

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as a very large lesion.

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This lesion is going to be still operated on surgically

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because it can still be resected and

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have a relatively good outcome.

Report

Description

Faculty

David M Yousem, MD, MBA

Professor of Radiology, Vice Chairman and Associate Dean

Johns Hopkins University

Tags

Spine

Neuroradiology

Neoplastic

Musculoskeletal (MSK)

MRI

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