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Presented by George Netto, M.D. and prepared by Priya Banerjee, M.D.
Case 5: A 41 year old woman was found to have a 4 cm presacral mass during a work up for back pain.
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1. Question
Week 362: Case 5
A 41 year old woman was found to have a 4 cm presacral mass during a work up for back pain.images/8_18_08 5a.jpg
images/8_18_08 5b.jpg
images/8_18_08 5c.jpgCorrect
Answer: Myxopapillary ependymoma
Histology: The lesion demonstrates a characteristic collar of mucinous depositions surrounding vascular structures at the core of papillae.
Discussion: The “vacuolated” mucinous appearance may bring up Chordoma to the differential diagnosis. Lack of GFAP staining in chordomas and their usual strong positivety for low molecular weight cytokeratin and EMA staining should help resolve the differential.
Like in our example, rarely, myxopapillary ependymomas can arise extradurally from presumed ectopic ependymal elements in parasacral and sacral locations. Such lesions are potentially more aggressive compared to their intradural counterparts.
Incorrect
Answer: Myxopapillary ependymoma
Histology: The lesion demonstrates a characteristic collar of mucinous depositions surrounding vascular structures at the core of papillae.
Discussion: The “vacuolated” mucinous appearance may bring up Chordoma to the differential diagnosis. Lack of GFAP staining in chordomas and their usual strong positivety for low molecular weight cytokeratin and EMA staining should help resolve the differential.
Like in our example, rarely, myxopapillary ependymomas can arise extradurally from presumed ectopic ependymal elements in parasacral and sacral locations. Such lesions are potentially more aggressive compared to their intradural counterparts.
