Spinal ependymoma occupies 40-60% of primary spinal cord tumors and has a feature of intramedullary tumor. The tumor most commonly arises from the central canal of the spinal cord, the conus medullaris or the filum terminale and its pathological features are usually benign. Unlike above characteristics, intra and extramedullary ependymomas are reported very rarely and have wide variety of histological features. We present a rare case of spinal anaplastic ependymoma with an accompanied exophytic lesions extramedullary as well. The tumor was poorly delineated between a spinal cord and the extramedullary components in operative view. After we had confirmed the frozen biopsy as anaplastic ependymoma, the remnant mass embedded in the spinal cord was remained because of its unclear resection margin and the risk of neurological deterioration. She underwent radiotherapy with 50.4 Gy, and there were newly developed mass lesions at the lumbosacral region on the MRI, 14 months postoperatively.
Study design: Case report. Objective: To report on an uncommon patient of cervical spinal cord sarcoidosis. Setting: New York, USA. Methods: A 47-year-old man was evaluated for heaviness of his legs, difficulty walking and numbness of arms and feet for 6 months. Contrast enhanced MRI scan showed a strongly enhancing nodular lesion, suggestive of a spinal cord tumor, which was initially considered for neurosurgical biopsy and treatment. Investigations unexpectedly revealed mediastinal lymphadenopathy and elevated angiotensin converting enzyme levels and the diagnosis of sarcoidosis was confirmed by a transbronchial lung biopsy. Result: Prompt treatment with steroids resulted in complete clinical and radiological resolution of the spinal cord lesion within 4 weeks. This improvement was maintained over a 18 month follow-up period. Conclusion: Isolated spinal cord intramedullary enhancing lesions, even when the appearance is suggestive of a tumor, should be rigorously investigated for sarcoidosis and a trial of steroid therapy considered to avoid unnecessary surgery.
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