Age / Sex : 22 / F

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


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Two weeks later, you can see the final diagonosis with a brief discussion of this case (Please submit only one answer).

Courtesy: 강병성 (Byeong Seong Kang, M.D.), 울산대학교병원 (Department of Radiology, University of Ulsan College of Medicine, Ulsan University Hospital, Ulsan, Korea)

Myxopapillary ependymoma

Discussion

Findings:

MR: A midline intradural extramedullary mass at L3 level

- Axial and sagittal T2-WI: heterogeneous hyperintensity

- Sagittal T1-WI: isosignal intensity relative to spinal cord

- Axial and sagittal fat-suppressed contrast-enhanced T1-WI: intense and heterogeneous enhancement

Differential Diagnosis: Myxopapillary ependymoma / Neurogenic tumor

Diagnosis: Myxopapillary ependymoma

Discussion:

Myxopapillary ependymomas tend to have an earlier clinical presentation (mean age, 35 years) and are more commonly seen in male patients. They have a distinct predilection for the conus medullaris or filum terminale and are thought to arise from the ependymal glia of the filum terminale. These tumors have a nonspecific radiologic appearance and are typically isointense relative to the spinal cord on T1-weighted MR images and hyperintense on T2-weighted MR images. Hyperintensity on both T1- and T2-weighted images may be noted occasionally, a finding that reflects mucin content or hemorrhage. Enhancement is virtually always seen after the intravenous administration of contrast material. The predilection of these tumors for the conus medullaris should be suggestive of the diagnosis.

References

1. Koeller KK, Rosenblum RS, Morrison AL. Neoplasms of the spinal cord and filum terminale: radiologic-pathologic correlation. Radiographics. 2000;20:1721-49.


2. Koeller KK, Shih RY. Intradural extramedullary spinal neoplasms: radiologic-pathologic correlation. Radiographics. 2019;39:468-90.