A 75 year old female presented to her local hospital with pains in the chest and was admitted under a Respiratory Physician with (incidental) rib fractures, that in retrospect were old. Clinical suspicion lead to further investigation and the diagnosis of an intradural mass at the level of T6 and T7 vertebrae.
An MRI suggested showed the mass with significant spinal cord compression, but despite these rather dramatic findings on scan, the patient maintained good strength in her lower limbs and normal sensation and function of the bladder and bowel.
Commenced on dexamethasone, she was taken to theatre after transfer to St Andrew’s Hospital 3 days after her diagnosis was made.
Intraoperative findings were that of a mass arising from within the substance of the spinal cord. Resection required careful dissection out of the cord itself.
Post-operatively function has returned quite quickly to normal. The only deficit was some loss of joint position sense (proprioception) – as one may expect from this area of the spinal cord itself (the dorsal columns).
2 weeks after her operation she is off to rehab to regain her confidence, but currently she is walking without any assistance and has normal bladder and bowel function.
Histology revealed Anaplastic Ependymoma (WHO Grade III). The rest of the brain and spine were clear of any obvious tumour.
A Brief Discussion
Ependymomas are rare tumours and make up about 3% of the primary tumours that we as neurosurgeons encounter. The more aggressive anaplastic tumour is even rarer and possibly accounts for 5-10% of ependymal tumours.
Because the numbers of this particular tumour as so low, the exact history of the disease is not entirely clear. Almost all anaplastic ependymomas will recur and current treatment recommendations are for excision followed by radiation therapy and possible chemotherapy.
Whilst quite a “pretty” tumour histologically, their more aggressive behaviour can see them behave in a “not-so-pretty” clinical way.
This patient will be followed closely post radiation for any signs of recurrence.
– Dr Michael Bryant, Neurosurgeon and Spinal Surgeon