Abstract
Introduction
Of the 23 cases of spinal intradural-extramedullary ependymomas which have been reported to date, 11 were diagnosed as anaplastic. Here we present a very rare case of a thoracic intradural-extramedullary (not intramedullary) anaplastic ependymoma in an adult along with a literature review.
Case presentation
A 29-year-old man presented with rapidly progressive gait disturbance, a sensory-deficit below the trunk and urination disorders that had begun a few months earlier. Magnetic resonance imaging of his thoracic spine revealed a dorsal-located intradural-extramedullary tumor at T4-5. The rapid deterioration of his symptoms within several months led him to refer to our department for surgery. Within one month the size of tumor increased to involve the T4-6 level, consequently worsening his gait disturbance. He underwent surgery and tumor mass was resected. However, there was leptomeningeal dissemination of the tumor cells on the surface of cord. A near-total resection was therefore achieved. Histopathology revealed the resected specimen had immunoreactivity for EMA/Vimentin/CD56/CD99/S-100/GFAP, with a Ki-67 index of ~35%. These factors led to the diagnosis of anaplastic ependymoma. Seven weeks postoperatively he received adjuvant radiotherapy to the whole brain and the whole spinal cord. He recovered as an independent ambulator without recurrence 1 year postoperatively.
Discussion
Because of their rarity, there are no clear treatment or adjuvant therapy guidelines for spinal anaplastic ependymoma. Adjuvant radiotherapy to the whole brain and spinal cord was necessarily indicated after near-total resection. Although the patient’s condition has not recurred 1 year after surgery, careful and serial follow-up is necessary for this individual.
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Acknowledgements
We thank for Dr. Kota Kojima and Dr. Yuki Miwa for their critical advice. We also thank for Ms Makiko Miyazaki, Ms Yukari Yamanishi, and Ms Kaoru Yasumuro for their assistance.
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Writing – original draft: SA and OT. Writing – review and editing: NN, SN, SS, EO, MY, and KW. Data curation – SA, OT, MN, and MM. Pathological analyses – RI. OT was responsible for all working related to this submission as corresponding author. Also, all authors approved the final version manuscript and agreed to be accountable for all aspects of the work.
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Ando, S., Tsuji, O., Nagoshi, N. et al. Grade III intradural extramedullary anaplastic ependymoma managed with near-complete resection and adjuvant radiotherapy: a case report. Spinal Cord Ser Cases 7, 1 (2021). https://doi.org/10.1038/s41394-020-00367-1
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DOI: https://doi.org/10.1038/s41394-020-00367-1
