Yeungnam Univ J Med.  2020 Apr;37(2):128-132. 10.12701/yujm.2019.00367.

Extramedullary tanycytic ependymoma of the lumbar spinal cord

• Kim DJ
• Han MH
• Lee S

• KMID: 2501420
• DOI: http://doi.org/10.12701/yujm.2019.00367

Abstract

Tanycytic ependymoma is a rare variant of ependymoma that commonly affects the cervical and thoracic spinal cord. It usually arises as intramedullary lesions, and extramedullary cases are extremely rare. We report a case of a 44-year-old woman who was diagnosed with tanycytic ependymoma in her lumbar spine at level 2-3. The tumor mass developed in an intradural extramedullary location. Histopathologically, tanycytic ependymoma can be misdiagnosed as schwannoma or pilocytic astrocytoma. Immunohistochemical findings such as strong positivity for glial fibrillary acidic protein, perinuclear dot-like positive patterns for epithelial membrane antigen, and focal positivity for S-100 are helpful in diagnosing tanycytic ependymoma. It is important to be aware of this rare tumor to ensure appropriate patient management and accurate prognosis.

Keyword

Ependymoma; Glial fibrillary acidic protein; Lumbar vertebrae; Spinal cord neoplasms

Figure

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  Fig. 1. Magnetic resonance imaging (MRI) findings. (A) Sagittal T2-weighted MR image of the lumbar spine showing a well-demarcated low-to-intermediate signal mass at lumbar level 2-3 spine (arrow). (B) Sagittal T1-weighted image showing high signal intensity (arrow). (C) No evidence of recurrence is visible in follow-up T1-weighted enhanced MRI.

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  Fig. 2. Intraoperative findings. A well-demarcated tumor mass is visible upon opening of the dura (arrow). The nerve root is close to the mass but can be separated from the tumor surface.

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  Fig. 3. Microscopic features. (A) Histopathologic analysis showing a moderately cellular neoplasm composed of short fascicles of elongated cells. The tumor cells have bland nuclei with no mitotic figures. The elongated cells are rich fibrillary processes (hemtoxylin and eosin stain, x200). (B) Hyalinized blood vessels and pseudorosettes are seen (hemtoxylin and eosin stain, x400).

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  Fig. 4. (A) The tumor cells show strong and uniform positivity for glial fibrillary acidic protein (immunohistochemical stain, x 200). (B) Focal positivity for S100 protein (immunohistochemical stain, x200). (C) Epithelial membrane antigen staining showing perinuclear dot-like or ring-like patterns (immunohistochemical stain, x200).

Reference

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