Anaplastic myxopapillary ependymoma: A case report and review of literature

Figure 1 Gadolinium-enhanced T1 weighted magnetic resonance imaging at ultra-late recurrence of a myxopapillary ependymoma. A: Sagittal magnetic resonance imaging (MRI) demonstrated an enhanced mass localized at L3-S1 in the intraspinal canal. A part of the mass extended into the spine axis and dorsal extraspinal tissues; B-D: Axial MRI demonstrated a slightly enhanced mass from intracanal to extraspinal regions.

Figure 2 Computed tomography at ultra-late recurrence of a myxopapillary ependymoma. A: A plain sagittal image demonstrated the previous laminectomy area (L1-S1); B: Three-dimensional image demonstrated a recurrent tumor (dark red) in the previous laminectomy area (L1-S1).

Figure 3 Intraoperative photograph showing an encapsulated tumor (arrow) surrounded by granulated tissues. Right side: Caudal; Left side: Rostral.

Figure 4 Microscopic appearance of the tumor. Magnification: 200 ×; scale bar: 50 μm. A: Microphotography with hematoxylin and eosin (HE) stain showed the appearance of a typical myxopapillary ependymoma including much mucoid; B: Immunohistochemical microphotography with anti-glial fibrillary acidic protein (GFAP) antibody showed distinct expression of GFAP; C: Microphotography with Alcian blue stain showed much Alcian blue positive mucoid; D and E: Microphotography with HE stain showed anaplastic features such as hypercellularity, rapid mitotic rate, vascular proliferation, and connective tissue proliferation; F: Immunohistochemical microphotography showed a high MIB-1 labeling index (12.3%) in the area with anaplastic features.