Spinal dissemination of intracranial ependymomas through cerebrospinal pathway is not rare and has been reported in approximately 10% of the cases. However, the reverse is an uncommon phenomenon. We report one case that was initially treated for spinal ependymoma but later presented with intracranial metastasis. Introduction Ependymomas are an uncommon group of glial tumors that typically arise within or adjacent to the ependymal lining of the ventricular system (1). Ependymomas occasionally occur within the brain parenchyma or outside the central nervous system (CNS). The spread of ependymoma from brain to spinal canal occurs in approximately 10% of all cases (2). Dissemination of the neoplastic cells within the ventricular cavity is thought to be facilitated by the active circulation of the cerebrospinal fluid (CSF) throughout the neuraxis, coupled with the effect of gravity (3). However, the reverse is an uncommon phenomenon (4). We report a young man with intracranially disseminated spinal ependymoma. Case report A 32-year-old male presented with sudden decrease in his level of consciousness and seizures. Admitting GCS was 6/15. anisocoric (R=2, L=4mm) mild right hemiparesis 3/5 and bilateral upward plantar reflexes was present. He had a medical history of spinal malignant ependymoma at the T12-L1-L2 level that surgically total removed 2 years ago and then radiotherapy was done. One year later treated with conventional radiotherapy 5600 cGY for seeding in L2-L3 level without recurrence in tumor bed (Fig. 1). Brain CT scan showed a cerebellopontine angle mass with IVH mild hydrocephalus (Fig. 2). The patient underwent an emergency EVD and then VP-shunt after the surgery pupils was isocoria and GCS=7/15 and one day after shunt the mass was operated and near total excision of cerebellopontine angle lesion was done. After surgery hemiparesis was recovered but otherwise no change in patient’s GCS was seen. He received a course of chemotherapy. In the follow up a tracheostomy was done and with physiotherapy and GCS of 9/15 the patient was discharged. A grossly yellowish brown tumor had been found during the operation and microscopically cluster of atypical cells with hyperchromatic nucleus and foci of papillary like structures with fibrovascular core that lined by epithelial like cells with few necrosis and mitotic activity compatible with malignant ependymoma was found.(fig.3)
展开▼
