Age / Sex : 27 / F

Chief complaint: lower back pain with pain & tingling sensation of both legs for 2 years

1) What is your impression?

Two weeks later, you can see the final diagnosis with a brief discussion of this case.

(Quiz는 quiz일 뿐이오니 답안은 한개만 보내주시기 바라오며, 복수의 답안을 보내주시는 분은 정답이 포함되어 있더라도 부득이 semi-correct answer로 처리토록 하겠습니다.)

Myxopapillary ependymoma

Discussion

Findings:

ú   T1WI: iso SI relative to the normal cord

       Heterogeneity and hyperintensity : hemorrhagic component

ú   T2WI: hyper SI relative to the normal cord

ú   Homogeneously and intensely enhancement with well-defined borders

Differential Diagnosis:

ú   Hemangioblastomas

       Prominent vascularity, as well as large reactive cysts

       SI of MRI: similar to ependymomas

       Tumor nodule: more intense enhancement than ependymoma

       Local edema of the cord: more impressive

       Flow voids: often visible

ú   Astrocytomas

       Infiltrative, less sharp margin

       Less prone to hemorrhage

       Eccentric in location

Diagnosis: Myxopapillary ependymoma

Discussion:

• Ependymomas

ú   60% of all primary neoplasm of the spinal cord and filum terminale

ú   Intraspinal ependymomas

       Intramedullary lesions, myxopapillary ependymomas, and metastases from an intracranial origin

       50%: occur at the cauda equina

   Predominantly of the myxopapillary subtype

References:

1.     J neuropathology Exp Neurol 2003; 62:927-935

2.     J Neuroimaging 2003; 13:346-351