case_images: PMC6169347_01
case_images: (a) Contrast enhanced sagittal T1-weighted magnetic resonance imaging demonstrates a homogeneously enhancing mass centered on L2-3 as well as a small sacra drop metastasis in the sacrum (arrowhead). Axial T1 contrast enhanced MRI demonstrates bilateral enhancement in the internal auditory canals, and a small enhancing focus was identified in the region of the left tectum (panels b and c, respectively)
case_images: SNI-9-191-g001.jpg
case_images: PMC6169347_01_SNI-9-191-g001.jpg
case_images: F1
case_images: Magnetic resonance imaging (MRI) of the lumbar spine with and without contrast demonstrated an enhancing mass occupying the majority of the spinal canal from L2-L3 [Figure 1a]. These demonstrated additional lesions at the time of diagnosis, including bilateral internal auditory canal enhancement, a small focus of enhancement in the left tectum, and an apparent drop metastasis to the sacrum [Figure 1a-c].
case_images: Low magnification view (panel a) demonstrating typical low-grade myxopapillary ependymoma including papillary appearance and fibrovascular cores. Other areas of tumor (panel b, shown under high magnification) demonstrate anaplasia and cellular atypia typical of high-grade tumor. Tumor specimen was diffusely positive for GFAP staining, indicating a neuronal differentiation, and demonstrated a high Ki-67 index (panels c and d, respectively)
case_images: SNI-9-191-g002.jpg
case_images: PMC6169347_01_SNI-9-191-g002.jpg
case_images: F2
case_images: Low-grade areas of tumor [Figure 2a] have classic histology of ependymal cells surrounding blood vessels producing a somewhat papillary appearance. High-grade anaplastic areas of tumor [Figure 2b] show hypercellularity, brisk mitotic rate, and vascular proliferation. Immunohistochemical profile is as follows: Positive for vimentin and GFAP [Figure 2c]; Negative for EMA, CAM5.2, CK7, CK20 (not shown); MIB-1 index (Ki-67) 8-38% [Figure 2d].
case_images: Axial and sagittal contrast enhanced T1-weighted MRI showing large enhancing mass within the thoracic spine causing compression of the thoracic spinal cord (a and b, respectively). Postoperative sagittal MRI demonstrates gross total resection of enhancing mass (panel c) MRI, magnetic resonance imaging
case_images: SNI-9-191-g003.jpg
case_images: PMC6169347_01_SNI-9-191-g003.jpg
case_images: F3
case_images: At 18 months postoperation from her initial surgery, the patient underwent thoracic laminectomy for a large metastasis at T6 and T8 [Figure 3].