Primary Seeding of Myxopapillary Ependymoma: Different Disease in Adult Population? Case Report and Review of Literature

Myxopapillary Ependymoma of the Spinal Cord in Adults: a Report of Personal Series and Review of Literature

“…The same happened with the patients from this series where no surgical morbidity and no tumor relapse or dissemination was observed. Accordingly, Klekamp et al report that gross total tumor resection was achieved in 77.7% of their patients 7 , while several studies suggest that it must be combined with high-dose radiotherapy in order to improve the outcome [24][25][26] , and to avoid recurrence, as well as primary and secondary seeding, which remains under-recognized in adults 1,27 . Although tumor benign histologic features are commonly preserved in case of dissemination 28 , rostral neuro-axial spread mostly affects the thoracic and cervical spine 29,30 .…”

“…Therefore, the need for repeat surgery or adjuvant therapy was not established and no tumor relapse or dissemination was recorded. Nonetheless, one should still remember the possibility of tumor relapse, primary seeding, and drop metastases; one should also consider the entire craniospinal neuroimaging as part of both the preoperative work-up and postoperative follow-up 1 . Therefore, long-term or lifelong MRI surveillance should be advised 1,16 , which is also part of our patient protocol.…”

“…Spinal cord myxopapillary ependymoma (MPE) derives from the filum terminale 1 , representing the most common tumor of the medullary conus and ac-counts for nearly 13% of all ependymomas [2][3][4] . According to the World Health Organization (WHO) classification 5,6 , MPE is a slow-growing grade I tumor, which is most often found in adults aged 30-50 years 7 .…”

“…Although such a tumor is mainly situated in the lumbar spine just below the medullary conus, it may also spread to the thoracic spine, and sacrum 8 . Some of these tumors may become aggressive in spite of their benign histopathology, and they may metastasize along the neural axis to distant cranial and spinal locations, or to local spots after surgery 1,9 . Therefore, gross total tumor resection, accompanied by intraoperative neuromonitoring, remains the best surgical management option available [9][10][11] , while patients undergoing partial (subtotal) resection typically require adjuvant high-dose radiotherapy 12,13 .…”

Freiburg Neuropathology Case Conference

“…Clinical symptoms can mimic disc herniation and, depending on the size of the tumor, reach a fully developed cauda equina syndrome. Tumor spreading may occur predominantly in the pediatric population [3].…”