Primary seeding of a myxopapillary ependymoma: Is it a different disease in an adult population? Case report and review of the literature
World neurosurgery | 4 Jan 2017
NR Khan, M VanLandingham, T O'Brien, FA Boop and K Arnautović
Myxopapillary ependymoma (MPE) is a slow-growing tumor occurring most often in adults. It originates from the filum terminale in the area of the conus medullaris and cauda equina, and is considered a benign lesion. Despite this classification, however, recurrence after both partial and gross total resection is well known. In the pediatric population, primary MPE seeding is well documented and treated through gross total resection, followed by irradiation. In adults, however, primary MPE seeding is not recognized. Only one prior report describes primary drop metastases into multiple spinal locations in an adult before resection of an MPE, and there are only 3 reports of such an occurrence cranially. The reason for this difference between pediatric and adult MPE remains unclear. We present here the case of a 32-year-old man with primary seeding of an MPE into multiple lumbosacral areas. The patient underwent gross total resection of the lesions and had an uneventful postoperative course. Primary seeding could be a sign of aggressive behavior in this tumor. Complete craniospinal magnetic resonance imaging (MRI) studies should be done before and after surgery in patients who present with a multifocal primary MPE. Furthermore, patients with a history of primary tumor seeding of MPE should be thoroughly evaluated radiologically. Unlike in pediatric population, the need for postoperative irradiation in adults is unclear, and further studies, particularly genetic ones, are warranted.
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