Spinal drop metastasis in myxopapillary ependymoma: A case report and a review of treatment options

Abstract

Myxopapillary ependymoma (MPE) is a World Health Organization grade I ependymoma that is quite rare and generally thought to be benign. Possible drop metastasis from MPE has been reported three times in the literature; in each case there were cotemporaneous additional MPE lesions. We report the case of a man who had a piecemeal gross total resection of a MPE at L1-L3 followed by adjuvant external beam radiotherapy (EBRT) who presented sixteen months later with a lesion in the thecal sac consistent with drop metastasis. A subtotal resection and adjuvant EBRT were performed. The patient has been disease-free in follow-up 27 months from the second surgery. A review of the literature regarding the treatment for MPE showed that gross total resection is optimal initial management. Several retrospective studies supported the role of adjuvant radiotherapy in enhancing local control and progression- free survival. Chemotherapy has a minimal role in the management of MPE. Published reports of drop metastases in patients with MPE are scarce; what is reported describes cases in which drop metastases were discovered simultaneously with the primary tumor.4,5 In this case report, we discuss an adult patient who presented with secondary MPE drop metastases following an initial piecemeal resection and post-operative radiotherapy of the tumor bed of a primary MPE. © J.E. Bates et al., 2014. Licensee PAGEPress, Italy.