Preoperative Intracranial Dissemination of Spinal Myxopapillary Ependymoma Attributed to Tumor Hemorrhage
Preoperative Intracranial Dissemination of Spinal Myxopapillary Ependymoma Attributed to Tumor Hemorrhage
复制标题
肿瘤出血所致脊髓粘液乳头状室管膜瘤术前颅内播散
DOI：
10.1016/j.wneu.2020.08.169
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发表时间：
2021
影响因子：
2
通讯作者：
Natsume Atsushi
中科院分区：
文献类型：
--
作者：
Awaya Takayuki;Nishimura Yusuke;Eguchi Kaoru;Nagashima Yoshitaka;Ando Ryo;Akahori Sho;Yoshikawa Satoshi;Haimoto Shoichi;Hara Masahito;Natsume Atsushi
背景脊柱粘液乳头状室管膜瘤（SME）通常被认为是一种良性肿瘤，可出现脑部和全脊柱转移以及手术后局部复发。然而，存在术前逆行颅内传播时diagnosis.Case DescriptionWe报告的情况下，中小企业在一个22岁的男子谁提出了急性加重慢性背痛拍摄下来的两个大腿和双腿无力。脑和整个脊柱的磁共振成像显示，在诊断时，L1-L2水平的大部分椎管内有一个增强的肿块，多个病灶扩散，包括右侧脑桥、外侧中脑和枕叶，以及椎管的C7、Th 6、L4和S2水平。在大体上完全切除位于L1-L2节段的优势肿瘤时，注意到严重的硬膜内蛛网膜炎和充满黄色素脑脊液的空洞，表明存在既往肿瘤出血。肿瘤的组织学分析支持SME诊断，<1%的细胞显示Ki-67表达。我们推测远端逆行性播散可能是由于肿瘤出血引起的脑脊液转移所致，这可能解释了尽管Ki-67表达较低但仍存在远端播散的原因。结论当肿瘤发生在神经轴的任何水平时，在诊断时进行全脑和脊柱的筛查是必要的。本例SME术前颅内病变是医学文献中记录的第5例。
BackgroundSpinal myxopapillary ependymoma (SME), generally considered a benign entity, can exhibit brain and whole-spine metastases as well as local recurrence after surgery. However, the presence of preoperative retrograde intracranial dissemination at the time of diagnosis is very rare.Case DescriptionWe report a case of SME in a 22-year-old man who presented with acute exacerbation of chronic back pain shooting down both thighs and weakness in both legs. Magnetic resonance imaging of the brain and whole spine showed an enhancing mass occupying the majority of the spinal canal at the L1-L2 level and multiple foci dissemination, including in the right pons, lateral midbrain, and occipital lobe, and at the C7, Th6, L4, and S2 levels of the spinal canal at the time of diagnosis. On gross total removal of the dominant tumor located at the L1-L2 level, severe intradural arachnoiditis and syrinx filled with xanthochromic cerebrospinal fluid was noted, indicating the presence of previous tumor hemorrhage. Histopathologic analysis of the tumor supported SME diagnosis, and <1% of cells showed Ki-67 expression. We speculated that distant retrograde dissemination could have been attributed to metastatic spread through cerebrospinal fluid caused by tumor hemorrhage, which may explain distant dissemination despite low expression of Ki-67.ConclusionsScreening of the whole brain and spine at the time of diagnosis is imperative when tumor is detected at any level of the neuraxis. The present case of SME with a preoperative intracranial lesion is the fifth case documented in the medical literature.