Myxopapillary ependymoma of the sacrum

Excerpt

A 22-year-old woman with a history of obesity and gastric bypass surgery was admitted to the emergency department with cholelithiasis-like symptoms including intermittent epigastric pain and nausea. CT of the abdomen did not show any significant intra-abdominal abnormalities related to the symptoms. As an incidental finding, however, a sausage-shaped mass was seen in the sacrum, located centrally in the sacral spinal canal and causing scalloping of the sacral bone (Fig. 1a). The patient’s gastro-intestinal symptoms resolved spontaneously, and an MRI of the sacrum was obtained for further work-up of the sacral mass. A well-defined rather homogeneous T2 hyperintense mass was found, extending from S1 to S4, with minor expansion, but without bone destruction, and with extra-sacral extension through the right S4-neuroforamen (Fig. 1b). T1-Weighted images showed a mildly hypointense, markedly enhancing mass (Fig. 2a, b). The radiological characteristics of the lesion were suggestive of a slow growing process. Radiological differential diagnosis consisted of giant schwannoma and myxopapillary ependymoma. Lymphoma end primary bone tumor was considered unlikely. A biopsy was carried out and diagnosed the lesion as a myxopapillary ependymoma, WHO 1.

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