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Disseminated adult spinal extramedullary myxopapillary ependymoma
Accepted Manuscript Title: Disseminated adult spinal extramedullary myxopapillary ependymoma Author: Zafer Orkun Toktaş, Mustafa Kemal Demir, Özlem Yapıcıer, Akın Akakın, Baran Yılmaz, Deniz Konya PII: DOI: Reference:
S1529-9430(15)01217-6 http://dx.doi.org/doi:10.1016/j.spinee.2015.08.007 SPINEE 56513
To appear in:
The Spine Journal
Please cite this article as: Zafer Orkun Toktaş, Mustafa Kemal Demir, Özlem Yapıcıer, Akın Akakın, Baran Yılmaz, Deniz Konya, Disseminated adult spinal extramedullary myxopapillary ependymoma, The Spine Journal (2015), http://dx.doi.org/doi:10.1016/j.spinee.2015.08.007. This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
1
Disseminated adult spinal extramedullary myxopapillary ependymoma
1 2 3 4
Zafer Orkun Toktaş, MD1
5
Mustafa Kemal Demir, MD2
6
Özlem Yapıcıer, MD3
7
Akın Akakın MD1
8
Baran Yılmaz, MD1
9
Deniz Konya, MD1
10 11 12 13 14 15 16 17 18 19 20 21 22
Department of Neurosurgery, Bahçeşehir University School of Medicine, Goztepe Medical Park Hospital, Istanbul/ Turkey 2 Department of Radiology, Bahçeşehir University School of Medicine, Goztepe Medical Park Hospital, Istanbul/ Turkey 3 Department of Pathology, Acıbadem University School of Medicine, Istanbul/ Turkey 1
Corresponding author: Mustafa Kemal Demir, M.D, Prof. E-mail: [email protected] 11. kisim, Yasemin Apt, D blok. Daire 35 Ataköy, Istanbul/ Turkey. 34158 Phone: +90 533 553 12 46
23 24
Authors e-mails:
25 26
[email protected], [email protected], [email protected], [email protected], [email protected]
27 28 29
Conflict of Interest: The authors declare that they have no conflict of interest.
30 31
Page 1 of 3
2 32
A 26-year-old male patient presented with a three month history of progressive low-back
33
pain and bilateral lower limb radiculopathy for three months prior to presentation. Magnetic
34
resonance (MR) imaging of the lumbar spine revealed a large intradural mass with T1 and T2
35
heterogeneous hyperintense signals and intense enhancement on postcontrast images. There was
36
also diffuse and irregular leptomeningeal enhancement (Fig. 1) associated with multiple
37
intradural extramedullary solid nodules along the dorsal surface of the spinal cord causing
38
superficial
39
unremarkable. Partial tumor resections were performed (Fig. 3). The final histopathologic
40
diagnosis was myxopapillary ependymoma WHO grade 1 with low Ki-67 proliferative index.
41
Although usually benign, in some cases myxopapillary ependymoma can spread through the CSF,
42
resulting in multiple lesions.
invasion
and
compression
(Fig.
2).
MR
imaging
of
the
brain
was
43 44 45 46 47 48 49 50 51
Figure Legends
Page 2 of 3
3 52
Figure 1. Sagittal T2-weighted (a), unenhanced T1-weighted (b), and contrast-enhanced T1-
53
weighted (c) MR images of the lumbar spine showed a large intradural mass with heterogeneous
54
high signals on T2-weighted image (black stars), heterogeneous low signals on unenhanced T1-
55
weighted image (white stars), and showed intense enhancement on contrast-enhanced T1-
56
weighted image (c). There was also diffuse and irregular leptomeningeal enhancement through
57
the cauda equina nerve roots up to the level of the conus medullaris (arrows).
58
Figure 2. Sagittal contrast-enhanced T1-weighted MR images of the dorsal (a,b) and cervical (c)
59
spine showed intradural extramedullary solid nodules along the dorsal surface of the spinal cord
60
(arrowheads), and cord compressions (arrows). Axial contrast-enhanced T1-weighted dorsal
61
spine MR image (d) showed cord compression with superficial invasion (arrow).
62
Figure 3. Postoperative sagittal contrast-enhanced T1-weighted MR images of the cervical (a)
63
and dorsal spine (b) showed the resection of the tumors and resolution of the cord compressions.
64
Optimal debulking surgery was performed at lumbar spine (c).
Page 3 of 3
S1529-9430(15)01217-6 http://dx.doi.org/doi:10.1016/j.spinee.2015.08.007 SPINEE 56513
To appear in:
The Spine Journal
Please cite this article as: Zafer Orkun Toktaş, Mustafa Kemal Demir, Özlem Yapıcıer, Akın Akakın, Baran Yılmaz, Deniz Konya, Disseminated adult spinal extramedullary myxopapillary ependymoma, The Spine Journal (2015), http://dx.doi.org/doi:10.1016/j.spinee.2015.08.007. This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
1
Disseminated adult spinal extramedullary myxopapillary ependymoma
1 2 3 4
Zafer Orkun Toktaş, MD1
5
Mustafa Kemal Demir, MD2
6
Özlem Yapıcıer, MD3
7
Akın Akakın MD1
8
Baran Yılmaz, MD1
9
Deniz Konya, MD1
10 11 12 13 14 15 16 17 18 19 20 21 22
Department of Neurosurgery, Bahçeşehir University School of Medicine, Goztepe Medical Park Hospital, Istanbul/ Turkey 2 Department of Radiology, Bahçeşehir University School of Medicine, Goztepe Medical Park Hospital, Istanbul/ Turkey 3 Department of Pathology, Acıbadem University School of Medicine, Istanbul/ Turkey 1
Corresponding author: Mustafa Kemal Demir, M.D, Prof. E-mail: [email protected] 11. kisim, Yasemin Apt, D blok. Daire 35 Ataköy, Istanbul/ Turkey. 34158 Phone: +90 533 553 12 46
23 24
Authors e-mails:
25 26
[email protected], [email protected], [email protected], [email protected], [email protected]
27 28 29
Conflict of Interest: The authors declare that they have no conflict of interest.
30 31
Page 1 of 3
2 32
A 26-year-old male patient presented with a three month history of progressive low-back
33
pain and bilateral lower limb radiculopathy for three months prior to presentation. Magnetic
34
resonance (MR) imaging of the lumbar spine revealed a large intradural mass with T1 and T2
35
heterogeneous hyperintense signals and intense enhancement on postcontrast images. There was
36
also diffuse and irregular leptomeningeal enhancement (Fig. 1) associated with multiple
37
intradural extramedullary solid nodules along the dorsal surface of the spinal cord causing
38
superficial
39
unremarkable. Partial tumor resections were performed (Fig. 3). The final histopathologic
40
diagnosis was myxopapillary ependymoma WHO grade 1 with low Ki-67 proliferative index.
41
Although usually benign, in some cases myxopapillary ependymoma can spread through the CSF,
42
resulting in multiple lesions.
invasion
and
compression
(Fig.
2).
MR
imaging
of
the
brain
was
43 44 45 46 47 48 49 50 51
Figure Legends
Page 2 of 3
3 52
Figure 1. Sagittal T2-weighted (a), unenhanced T1-weighted (b), and contrast-enhanced T1-
53
weighted (c) MR images of the lumbar spine showed a large intradural mass with heterogeneous
54
high signals on T2-weighted image (black stars), heterogeneous low signals on unenhanced T1-
55
weighted image (white stars), and showed intense enhancement on contrast-enhanced T1-
56
weighted image (c). There was also diffuse and irregular leptomeningeal enhancement through
57
the cauda equina nerve roots up to the level of the conus medullaris (arrows).
58
Figure 2. Sagittal contrast-enhanced T1-weighted MR images of the dorsal (a,b) and cervical (c)
59
spine showed intradural extramedullary solid nodules along the dorsal surface of the spinal cord
60
(arrowheads), and cord compressions (arrows). Axial contrast-enhanced T1-weighted dorsal
61
spine MR image (d) showed cord compression with superficial invasion (arrow).
62
Figure 3. Postoperative sagittal contrast-enhanced T1-weighted MR images of the cervical (a)
63
and dorsal spine (b) showed the resection of the tumors and resolution of the cord compressions.
64
Optimal debulking surgery was performed at lumbar spine (c).
Page 3 of 3