Cellular Ependymoma

KEY FACTS

Terminology

• Neoplasm arising from ependyma lining spinal cord central canal

Imaging

• Circumscribed, enhancing hemorrhagic cord mass with surrounding edema

• Associated cysts common

• Cervical > thoracic > conus

• T1WI: Isointense or slightly hypointense to spinal cord

• T2WI: Hyperintense relative to spinal cord

• Cap sign: Hemosiderin at cranial or caudal margin

• Most tumors enhance

• Peripheral enhancement of tumoral cysts

Top Differential Diagnoses

• Astrocytoma

• Hemangioblastoma

• Demyelinating disease

• Idiopathic transverse myelitis

Pathology

• Arises from ependymal cells of central cord canal

  • Most intramedullary

  • Rarely can be intradural extramedullary

• Most WHO grade II

• Rarely WHO grade III

  • Anaplastic ependymoma

• Association with neurofibromatosis type 2

Clinical Issues

• Most common presentation

  • Neck or back pain

• Other presentations

  • Progressive paraparesis, paresthesias

Diagnostic Checklist

• Spinal cord neoplasm with associated peripheral hemorrhage suggestive of cellular ependymoma

TERMINOLOGY