ABSTRACT

Myxopapillary ependymomas (MPE) are distinctive variant of spinal cord ependymomas, typically arise in the filum terminale and conus medullaris, accounting 40-60% of spinal cord tumors. We report a case of MPE with two discrete foci on the both ends of the filum terminale and discuss solitary and multifocal MPEs with data of other four patients with double MPEs of filum terminale founded in the literature. A 24-year-old previously healthy male presented with a two-month history of back pain radiating to his right leg. He reported no motor, sensory, bowel, or bladder dysfunction. A MRI examination of lumbosacral region which was performed with a prediagnosis of discal pathology, revealed two mass lesions. The patient underwent surgery. Histopathological sectioning of both tumors revealed that tumor tissues showed mucinous stromal changes. There were cuboidal uniform tumor cells which spread papillary structures usually as single-row on the hyalinized stroma. There was no mitosis. The patient was followed for 15 months. Postoperative spinal MRI was performed 6 and 12months after surgery showed no recurrence of the tumors. Double independent MPEs of filum terminale are rarely reported. Right interpretation and diagnosis are open to discussion with diagnosis of drop metastasis and two different foci of an ependymoma. Cranial and whole spinal MRI with Gadolinium included sacrococcygeal region should be done in patient with MPEs. En bloc total removal of multifocal MPEs gives a good prognosis.