Multifocal intradural extramedullary myxopapillary ependymoma of the spine.
Oday Atallah, Majd Oweidat, Sarah Teuber-Hanselmann et al.
✦ AI-curated · Sources linked
Case in brief
A 34-year-old man presented with sudden severe non-radicular low-back pain but no neurological deficit. MRI showed multiple enhancing intradural extramedullary lesions from T12-L1 to S1; the dominant T12-L1 lesion compressed the conus and proximal cauda equina. Resection confirmed myxopapillary ependymoma, WHO grade 2, with Ki-67 ≤ 2-3%. After later pain, paresthesias, and enlargement of two lesions, these were also resected; stable lesions were observed. He subsequently received radiotherapy, and the residual lesions were unchanged at 3 months.
What made this case unusual
Multiple spinal lesions were present at initial diagnosis, rather than the usual solitary lesion, creating a need to balance decompression and diagnosis against morbidity from multilevel surgery.
Diagnostic / clinical pearl
In multifocal spinal myxopapillary ependymoma, MRI can define the distribution and identify a dominant compressive lesion; histopathology establishes the diagnosis. Management may be staged, with symptomatic or compressive lesions prioritized.
Why it matters
Residual lesions may remain after surgery; this case supports continued imaging and CSF surveillance and evaluation for radiotherapy, as described by the authors.