Uterine Cervix Metastasis of Myxopapillary Ependymoma Originated from the Spinal Cord

Abstract

Background: Myxopapillary ependymomas are well differentiated low-grade tumors which have been documented to local or distant metastasis. In the literature, this is a unique case of myxopapillary ependymoma with metastasis to the uterine cervix. Here, we present a rare case of extra neural metastasis of spinal ependymoma that developed over a long period. Case Report: A 34-year-old woman was referred to our hospital for pelvic mass. A mass (110x100 mm) localized between the sacrococcygeal region and the uterus was detected by magnetic resonance imaging. In 2004, she had been operated upon for myxopapillary ependymoma seated in the sacrococcygeal region for the first time. She underwent tumor resection eight times due to the recurrence of spinal tumor in the same region in nine years. Under the diagnosis of uterine neoplasm, we carried out radical hysterectomy, omentectomy and pelvic lymphadenectomy as the surgical procedure. The pathological findings were reported as myxopapillary ependymoma. Immunohistochemically, the myxopapillary ependymal cells showed strong positivity for glial fibrillary acidic protein, whereas they were negative for low molecular weight cytokeratin. The Ki-67 labeling index was about 2-3%. The patient had an uneventful postoperative period. She has remained free of symptoms in the year since surgery. Conclusion: Extra-spinal myxopapillary ependymoma is very rare, but it must be considered in the differential diagnosis of pelvic mass lesions.

Keywords

• Ependymoma, spinal cord tumor, uterine cervix

References

1. 1. Kaner T, Sasani M, Oktenoglu T, Solmaz B, Sarloglu AC, Ozer AF. Clinical analysis of 21 cases of spinal cord ependymoma: positive clinical results of gross total resection. J Korean Neurosurg Soc 2010;47:102-6. [CrossRef]
2. 2. Wang H, Zhang S, Rehman SK, Zhang Z, Li W, Makki MS, et al. Clinicopathological features of myxopapillary ependymoma. J Clin Neurosci 2014;21:569-73. [CrossRef]
3. 3. Duggan MA, Hugh J, Nation JG, Robertson DI, Stuart GC. Ependymoma of the uterosacral ligament. Cancer 1989;64:2565-71. [CrossRef]
4. 4. Fujimori T, Iwasaki M, Nagamoto Y, Kashii M, Sakaura H, Yoshikawa H. Extraneural metastasis of ependymoma in the cauda equina. Global Spine J 2013;3:33-40.
5. 5. Mavroudis C, Townsend JJ, Wilson CB. A metastasizing ependymoma of the cauda equina. Case report. J Neurosurg 1977;47:771-5. [CrossRef]
6. 6. Louis DN, Ohgaki H, Wiestler OD, Cavenee WK, Burger PC, Jouvet A, et al. The 2007 WHO classification of tumours of the central nervous system. Acta Neuropathol 2007;114:97-109. [CrossRef]
7. 7. Rickert CH, Kedziora O, Gullotta F. Ependymoma of the cauda equina. Acta Neurochir (Wien) 1999;141:781-2. [CrossRef]
8. 8. Suri VS, Tatke M, Singh D, Sharma A. Histological spectrum of ependymomas and correlation of p53 and Ki-67 expression with ependymoma grade and subtype. Indian J Cancer 2004;41:66-71.

9. 9. Ruda R, Gilbert M, Soffietti R. Ependymomas of the adult: molecular biology and treatment. Curr Opin Neurol 2008;21:754-61. [CrossRef]
10. 10. Hirahara F, Yamanaka M, Miyagia E, Nakazawa T, Gorai I, Minaguchi H, et al. Pure ovarian ependymoma: report of a case treated with surgery, chemotherapy, irradiation and hyperthermotherapy. Eur J Obstet Gynecol Reprod Biol 1997;75:221-3. [CrossRef