title: Late spinal cord metastasis of fourth ventricle ependymoma appeared nineteen years after the initial treatment.
abstract: Spinal cord dissemination (metastasis) of a fourth ventricle ependymoma more than ten years after surgical resection is extremely rare. In this report, we present an unusual case of a fourth ventricle ependymoma with metastasis to the thoracic spinal cord 19 years after the initial therapy, but without local recurrence. A 37 year-old patient underwent gross total resection of a fourth ventricle ependymoma and postoperative radiation therapy to the posterior fossa. Computed tomography (CT) scanning and/or magnetic resonance (MR) imaging performed during follow up examinations, conducted annually for ten years after the therapy, revealed no evidence of local tumor recurrence. However, 19 years after the initial treatment, the patient complained of back pain and gait disturbances. MR imaging revealed an intradural extramedullary tumor at the Th2-5 levels. MR imaging of the brain revealed no local tumor recurrence or intracranial tumor dissemination. Cerebrospinal fluid cytology revealed no presence of tumor cells. Total resection of the spinal cord tumor was performed, and the tumor was diagnosed as an ependymoma. We describe the clinical features of this rare lesion and particularly emphasize the need for long-term follow up, for more than ten years after the initial treatment, in patients with fourth ventricle ependymoma.
authors.affiliation: Department of Neurosurgery, Miyazaki Prefectural Hospital, 5-30, Kita-takamatsu-cho, Miyazaki, Miyazaki 880-8510, Japan. hochiai@fc.miyazaki-u.ac.jp
authors.forename: Hidenobu
authors.initials: H
authors.lastname: Ochiai
authors.forename: Yuzo
authors.initials: Y
authors.lastname: Yamakawa
authors.forename: Hirokazu
authors.initials: H
authors.lastname: Kawano
authors.forename: Yoshiya
authors.initials: Y
authors.lastname: Shimao
authors.forename: Tohru
authors.initials: T
authors.lastname: Hayashi
mesh_terms: D002551:Cerebral Ventricle Neoplasms / Q000473:pathology*; D003131:Combined Modality Therapy / Q000379:methods; D004806:Ependymoma / Q000473:pathology*; D005260:Female; D020546:Fourth Ventricle / Q000473:pathology*; D006801:Humans; D019394:Ki-67 Antigen / Q000378:metabolism; D008137:Longitudinal Studies; D008279:Magnetic Resonance Imaging / Q000379:methods; D008875:Middle Aged; D013120:Spinal Cord Neoplasms / Q000532:radiotherapy / Q000556:secondary*; D014057:Tomography, X-Ray Computed / Q000379:methods
chemical_list: D019394:Ki-67 Antigen