EXTRANEURAL METASTASIS OF AN EPENDYMOMA: A CASE REPORT

Case Report: A 36 - year old man, previously healthy. presented with intracranial hypertension syndrome: intense headache that started 2 months ago associated with convergent squint and diplopia. Brain MRI with contrast showed a right temporal parietal expansive lesion with a 12 mm deviation of the longitudinal fissure, subfalcine and transtentorial herniation, suggestive of high grade neoplasic lesion. The histopathological/ immunohistochemical diagnostic indicated a high grade glioma compatible with anaplastic ependymoma. Patient received adjuvant radiotherapy. 11 months after surgery, presented with intense pain in lumbar region with left leg irradiation and concomitant force reduction in the same member. Lumbar MRI showed diffuse infiltration of vertebras and tumoral extension to muscle. Abdominal CT scan also showed lesions in the pelvic bone. Finally, a biopsy of a lesion in the left iliac bone confirmed metastasis of the ependymoma. Discussion: Ependymomas are ependymal cells tumors, specific types of glial cells, originated from the neuroectoderm, that arise within or adjacent to the ependymal lining of the ventricular system . Ependymomas most commonly occur in the posterior fossa, in contact with the fourth ventricle, or in the intramedullary spinal cord, they ocasionally occur in the brain parenchya outside the posterior fossa, and very rarely outside the central nervous system (CNS). Ependymomas account for less 10 percent of tumors arising in the CNS. The metastatic occurrence is rare, nevertheless metastasis cases were described in adults in the following areas: lungs, cervical and hilar lymph nodes, skin, pleura, mediastinum, liver, diaphragm and bones. Final comments: Anaplastic ependymoma case was related, in which the chosen treatment was resection of the tumor associated with adjuvant therapy. The tumor evolved with metastasis to various locations with bone tissue, liver and muscle. The situation is a rare evolution to this type of tumor.

Publication History

Article published online:
23 October 2019