Spinal Drop Metastasis in Myxopapillary Ependymoma: a Case Report and a Review of Treatment Options

Overview

Journal Rare Tumors

Publisher Sage Publications

Specialty Oncology

Date 2014 Jul 9

PMID 25002955

Citations 8

Authors

James E Bates

Carl R Peterson 3rd

Gabrielle A Yeaney

Kevin A Walter

Thomas Lundquist

Douglas Rosenzweig

Michael T Milano

Affiliations

Soon will be listed here.

Abstract

Myxopapillary ependymoma (MPE) is a World Health Organization grade I ependymoma that is quite rare and generally thought to be benign. Possible drop metastasis from MPE has been reported three times in the literature; in each case there were cotemporaneous additional MPE lesions. We report the case of a man who had a piecemeal gross total resection of a MPE at L1-L3 followed by adjuvant external beam radiotherapy (EBRT) who presented sixteen months later with a lesion in the thecal sac consistent with drop metastasis. A subtotal resection and adjuvant EBRT were performed. The patient has been disease-free in follow-up 27 months from the second surgery. A review of the literature regarding the treatment for MPE showed that gross total resection is optimal initial management. Several retrospective studies supported the role of adjuvant radiotherapy in enhancing local control and progression-free survival. Chemotherapy has a minimal role in the management of MPE.

Citing Articles

Outcomes and Pattern of Care for Spinal Myxopapillary Ependymoma in the Modern Era-A Population-Based Observational Study.

Wang C, Rooney M, Alvarez-Breckenridge C, Beckham T, Chung C, De B Cancers (Basel). 2024; 16(11).

PMID: 38893133 PMC: 11171081. DOI: 10.3390/cancers16112013.

Sacral ependymoma presents 20 years after initial posterior fossa lesion.

Nicely L, Baxter M, Banerjee S, Lord H BMJ Case Rep. 2023; 16(10).

PMID: 37857539 PMC: 10603451. DOI: 10.1136/bcr-2023-256611.

Multifocal lumbar myxopapillary ependymoma presenting with drop metastasis: a case report and review of the literature.

Tabor J, Ryu B, Schneider D, Sciubba D, Narayana A, Zlochower A Spinal Cord Ser Cases. 2022; 8(1):43.

PMID: 35459220 PMC: 9033832. DOI: 10.1038/s41394-022-00513-x.

Myxopapillary ependymoma with interval postoperative CSF seeding: A report of an unusual case.

Abdu A, Alshoabi S, Alshoaibi A, Hamid A, Jhaveri M Radiol Case Rep. 2021; 16(12):3838-3843.

PMID: 34691347 PMC: 8517289. DOI: 10.1016/j.radcr.2021.09.022.

A rare case of an intramedullary metastasis of a myxopapillary ependymoma.

Fonseca L, Cicuendez M, Martinez-Ricarte F, Martinez-Saez E, Cordero E, Bescos A Surg Neurol Int. 2019; 10:83.

PMID: 31528421 PMC: 6744754. DOI: 10.25259/SNI-96-2019.

References

Graf M, Blaeker H, Otto H . Extraneural metastasizing ependymoma of the spinal cord. Pathol Oncol Res. 1999; 5(1):56-60. DOI: 10.1053/paor.1999.0056. View

Davis C, BARNARD R . Malignant behavior of myxopapillary ependymoma. Report of three cases. J Neurosurg. 1985; 62(6):925-9. DOI: 10.3171/jns.1985.62.6.0925. View

Green R, Cloughesy T, Stupp R, DeAngelis L, Woyshner E, Ney D . Bevacizumab for recurrent ependymoma. Neurology. 2009; 73(20):1677-80. PMC: 2788805. DOI: 10.1212/WNL.0b013e3181c1df34. View

Pica A, Miller R, Villa S, Kadish S, Anacak Y, Abusaris H . The results of surgery, with or without radiotherapy, for primary spinal myxopapillary ependymoma: a retrospective study from the rare cancer network. Int J Radiat Oncol Biol Phys. 2009; 74(4):1114-20. DOI: 10.1016/j.ijrobp.2008.09.034. View

Fassett D, Pingree J, Kestle J . The high incidence of tumor dissemination in myxopapillary ependymoma in pediatric patients. Report of five cases and review of the literature. J Neurosurg. 2005; 102(1 Suppl):59-64. DOI: 10.3171/ped.2005.102.1.0059. View

Brandes A, Cavallo G, Reni M, Tosoni A, Nicolardi L, Scopece L . A multicenter retrospective study of chemotherapy for recurrent intracranial ependymal tumors in adults by the Gruppo Italiano Cooperativo di Neuro-Oncologia. Cancer. 2005; 104(1):143-8. DOI: 10.1002/cncr.21110. View

McGuire C, Sainani K, Fisher P . Incidence patterns for ependymoma: a surveillance, epidemiology, and end results study. J Neurosurg. 2008; 110(4):725-9. DOI: 10.3171/2008.9.JNS08117. View

Chakraborti S, Govindan A, Alapatt J, Radhakrishnan M, Santosh V . Primary myxopapillary ependymoma of the fourth ventricle with cartilaginous metaplasia: a case report and review of the literature. Brain Tumor Pathol. 2011; 29(1):25-30. DOI: 10.1007/s10014-011-0059-8. View

McLaughlin M, Marcus Jr R, Buatti J, McCollough W, Mickle J, Kedar A . Ependymoma: results, prognostic factors and treatment recommendations. Int J Radiat Oncol Biol Phys. 1998; 40(4):845-50. DOI: 10.1016/s0360-3016(97)00893-6. View

10.

Fakhrai N, Neophytou P, Dieckmann K, Nemeth A, Prayer D, Hainfellner J . Recurrent spinal ependymoma showing partial remission under Imatimib. Acta Neurochir (Wien). 2004; 146(11):1255-8. DOI: 10.1007/s00701-004-0374-5. View

11.

Wang M, Wang H, Zhou Y, Zhan R, Wan S . Myxopapillary ependymoma in the third ventricle area and sacral canal: dropped or retrograde metastasis?. Neurol Med Chir (Tokyo). 2013; 53(4):237-41. DOI: 10.2176/nmc.53.237. View

12.

Akyurek S, Chang E, Yu T, Little D, Allen P, McCutcheon I . Spinal myxopapillary ependymoma outcomes in patients treated with surgery and radiotherapy at M.D. Anderson Cancer Center. J Neurooncol. 2006; 80(2):177-83. DOI: 10.1007/s11060-006-9169-2. View

13.

Chao S, Kobayashi T, Benzel E, Reddy C, Stevens G, Prayson R . The role of adjuvant radiation therapy in the treatment of spinal myxopapillary ependymomas. J Neurosurg Spine. 2010; 14(1):59-64. DOI: 10.3171/2010.9.SPINE09920. View

14.

Milano M, Johnson M, Sul J, Mohile N, Korones D, Okunieff P . Primary spinal cord glioma: a Surveillance, Epidemiology, and End Results database study. J Neurooncol. 2009; 98(1):83-92. DOI: 10.1007/s11060-009-0054-7. View

15.

Reni M, Gatta G, Mazza E, Vecht C . Ependymoma. Crit Rev Oncol Hematol. 2007; 63(1):81-9. DOI: 10.1016/j.critrevonc.2007.03.004. View

16.

Armstrong T, Vera-Bolanos E, Bekele B, Aldape K, Gilbert M . Adult ependymal tumors: prognosis and the M. D. Anderson Cancer Center experience. Neuro Oncol. 2010; 12(8):862-70. PMC: 2940672. DOI: 10.1093/neuonc/noq009. View

17.

Fegerl G, Marosi C . Stabilization of metastatic myxopapillary ependymoma with sorafenib. Rare Tumors. 2012; 4(3):e42. PMC: 3475949. DOI: 10.4081/rt.2012.e42. View

18.

Zawrocki A, Izycka-Swieszewska E, Papierz W, Liberski P, Zakrzewski K, Biernat W . Analysis of the prognostic significance of selected morphological and immunohistochemical markers in ependymomas, with literature review. Folia Neuropathol. 2011; 49(2):94-102. View

19.

Kukreja S, Ambekar S, Sin A, Nanda A . Cumulative survival analysis of patients with spinal myxopapillary ependymomas in the first 2 decades of life. J Neurosurg Pediatr. 2014; 13(4):400-7. DOI: 10.3171/2014.1.PEDS13532. View

20.

Feldman W, Clark A, Safaee M, Ames C, Parsa A . Tumor control after surgery for spinal myxopapillary ependymomas: distinct outcomes in adults versus children: a systematic review. J Neurosurg Spine. 2013; 19(4):471-6. DOI: 10.3171/2013.6.SPINE12927. View