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Classic 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

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

Coronal graphic depicts an intramedullary ependymoma mildly expanding the cervical cord. Cranial and rostral cysts
, as well as hemorrhagic products
, are associated with this mass.

Sagittal T1WI C+ MR demonstrates a cervical intramedullary mass with solid and cystic components causing fusiform cord expansion. There are 2 areas of enhancing solid components
and rostral cyst
extending cephalad into brainstem. The adjacent solid portion shows little enhancement
.

Axial T1WI C+ MR reveals an expansile intramedullary ependymoma
with robust enhancement pattern.

Sagittal T2WI MR illustrates the mixed cystic and solid appearance of cervical ependymomas
in a patient with neurofibromatosis type 2. In addition, there is a dural-based intradural extramedullary meningioma
.

TERMINOLOGY

Synonyms

  • Spinal ependymoma

Definitions

  • Neoplasm arising from ependyma lining spinal cord central canal

IMAGING

General Features

  • Best diagnostic clue

    • Circumscribed, enhancing hemorrhagic cord mass

  • Location

    • Cervical > thoracic > conus

  • Size

    • Multisegmental: Typically 3-4 segments

  • Morphology

    • Symmetric cord expansion

    • Well circumscribed

    • ± exophytic component

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