PMC3326940_01
Preoperative MR. (a-c) Dorsal lesion. (a) T1-weighted image showing an isointense extraxial mass. (b) T2-weighted image. Isointense mass with a hyperintense ring surrounded by a better well-defined hypointense area, representing different stages of bleeding. (c) T1-weighted image with contrast administration, where the lesion enhances homogenously. (d-f) Lumbar lesion. (d) Sagittal T1-weighted image. Isointense mass viewed between cauda equina roots with a hyperintense caudal part, as a sign of acute hemorrhage. (e) Sagittal and (f) axial T2-weighted images, where the lesion is heterogeneous suggesting different stages of bleeding
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F1
Magnetic resonance (MR) showed two lesions on the spinal canal [Figure 1].
Intraoperative photographs: (a) Dorsal and (b) lumbar lesions were both seen as well-defined extramedullary masses after opening the dura mater, with blood products and clots in both levels. There are signs of acute and chronic hemorrhage surrounding the tumor, as can be seen in a macroscopic image after the resection of the caudal lesion (c)
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F2
The patient was operated on an emergency basis and a lumbar L1-L3 and dorsal D8-D11 laminectomy was performed [Figure 2].
Microscopy (a, HE 4x; b, HE 10x). Both tumors are formed by papillary structures surrounded by a single layer of columnar cells with round nuclei and delicate chromatin. The cores of the papillae have a central blood vessel surrounded by a mucinous/myxoid matrix. There is extensive thickening and hyalinization of vessel walls. Mitotic activity is absent. Well-defined margins are present. (c, HE 10x) Dorsal and (d, HE 2.5x) lumbar lesions. Histological signs of acute and chronic bleeding can be seen within the tumor, with fresh red blood cells (white arrow) and hemosiderin-laden macrophages (black arrows)
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F3
Pathology revealed both tumors to be myxopapillary ependymomas [Figure 3].