We describe a 29-year-old woman who presented with progressive neck pain, sensory deficit and weakness in both arms. Magnetic resonance imaging (MRI) of the cervical spine revealed an extramedullary tumor with severe spinal cord compression. During surgery an intradural extramedullary tumor was found. Further imaging showed a second lumbar spinal tumor. Microscopy of both tumors showed that both tumors were anaplastic ependymomas, which almost never present as extramedullary tumors. Two years after surgery, an intracranial extracerebral metastasis was found, without evidence of spinal recurrence.

International audienceElderly patients with primary CNS lymphoma (PCNSL) do not tolerate treatment with combined radio-chemotherapy well because of leuko-encephalopathy and are usually treated initially with chemotherapy or radiotherapy alone. Little is known about efficacy and toxicity of these treatments outside clinical studies. Methods: retrospective analysis of all patients aged 60 or over admitted with PCNSL to one of 5 Dutch centers between 1998 and 2007. Results: 74 patients were identified. 29 were treated with radiotherapy only (group A), in 36 intended treatment was chemotherapy alone (group B), in 9 intended treatment was chemotherapy followed by radiotherapy (group C). Median OS was 20 months;.4 months in patients with KPS < 70, 25 months in patients with KPS  70 (p<0.001). Treatment modality was not an independent prognostic factor. Forty patients were treated with MTX 3g/m2: there were 2 toxic deaths. Ten patients discontinued chemotherapy because of toxicity. Delayed encephalopathy was reported in 10 patients. Conclusion: Community hospitals still utilize WBRT frequently in elderly PCNSL patients, though a majority tolerates chemotherapy well. Performance status was the most important variable determining prognosis. Short and long term toxicities must be weighed against possible clinical benefits of each treatment, making treatment decisions a highly individualized process