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Lo Piccolo R, Cianci MC, Sardi I, Di Nicola M, Buccoliero AM, Caporalini C, Morabito A. Paediatric extra-axial myxopapillary ependymoma: what to expect? Case report and literature review. Front Oncol 2025; 15:1519842. [PMID: 39949744 PMCID: PMC11821608 DOI: 10.3389/fonc.2025.1519842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2024] [Accepted: 01/03/2025] [Indexed: 02/16/2025] Open
Abstract
Extra-axial ependymomas are rare tumours, and myxopapillary ependymoma (MPE) is the most common subtype in children, often misdiagnosed as other sacral lesions. MPEs are considered low-grade tumours, but relapse with distant metastasis is frequent. Therefore, therefore a proper diagnosis and subsequent follow-up are warranted. The current report presents a case of extra-axial MPE in a paediatric patient who presented with an indolent sacral mass and underwent surgical resection, along with a review of the literature. The aim was to highlight the importance of diagnostic suspicion in differential diagnosis of sacral soft-tissue masses.
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Affiliation(s)
- Roberto Lo Piccolo
- Azienda Ospedaliera Universitaria Meyer Istituto di Ricerca e Cura a carattere Scientifico (IRCCS) - Firenze, Florence, Italy
- Department of Pediatric Surgery, Istituto di Ricerca e Cura a carattere Scientifico (IRCCS) Meyer Children’s Hospital, Florence, Italy
| | - Maria Chiara Cianci
- Department of Pediatric Surgery, Istituto di Ricerca e Cura a carattere Scientifico (IRCCS) Meyer Children’s Hospital, Florence, Italy
| | - Iacopo Sardi
- Neuro-Oncology Unit, Meyer Children’s Hospital, Florence, Italy
| | - Marco Di Nicola
- Neuro-Oncology Unit, Meyer Children’s Hospital, Florence, Italy
| | | | | | - Antonino Morabito
- Department of Pediatric Surgery, Istituto di Ricerca e Cura a carattere Scientifico (IRCCS) Meyer Children’s Hospital, Florence, Italy
- Department of Neuroscience, Psychology, Drugs and Child Health Area, School of Psychology, University of Florence, Florence, Italy
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Chatzopoulos K, Hytiroglou P, Charville GW, Toland AMS, Martinez-Lage M, Cimino PJ, Rosenblum MK, Linos K. When a dermatopathologist encounters the ultra-rare: A case series of superficial soft tissue/cutaneous myxopapillary ependymomas. J Cutan Pathol 2024; 51:20-29. [PMID: 37317818 PMCID: PMC10721733 DOI: 10.1111/cup.14475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 05/17/2023] [Accepted: 05/22/2023] [Indexed: 06/16/2023]
Abstract
Myxopapillary ependymoma (MPE) is an uncommon variant of ependymoma, almost exclusively seen in conus medullaris or filum terminale. MPE can be diagnostically challenging, especially when arising extra-axially. Here we report 5 cases of superficial soft tissue/cutaneous MPE, identified across three tertiary institutions. All patients were female and three of them (3/5, 60%) were children (median age 11 years, range 6-58 years). The tumors presented as slow-growing masses of the sacrococcygeal subcutaneous soft tissues, occasionally identified after minor trauma and clinically favored to be pilonidal sinuses. Imaging showed no neuraxis connection. Macroscopically, tumors were well-circumscribed, lobulated, and solid and microscopically they exhibited typical histopathology of MPE, at least focally. Two of the tumors (2/5, 40%) showed predominantly solid or trabecular architecture with greater cellular pleomorphism, scattered giant cells, and increased mitotic activity. All tumors (5/5, 100%) showed strong diffuse immunohistochemical expression of GFAP. One tumor clustered at the category "ependymoma, myxopapillary" by methylome analysis. Two patients (2/5, 40%) had local recurrence at 8 and 30 months after the initial surgery. No patients developed metastases during the follow-up period (median 60 months, range 6-116 months). Since a subset of extra-axial MPEs behaves more aggressively, timely and accurate diagnosis is of paramount importance.
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Affiliation(s)
| | | | - Gregory W. Charville
- Department of Pathology, Stanford University School of Medicine, Stanford, CA, USA
| | - Angus M. S. Toland
- Department of Pathology, Stanford University School of Medicine, Stanford, CA, USA
| | | | - Patrick J. Cimino
- Surgical Neurology Branch, National Institute of Neurological Disorders and Stroke, National Institute of Health, Bethesda, MD, USA
| | - Marc K. Rosenblum
- Department of Pathology & Laboratory Medicine, Memorial Sloan Kettering Cancer Center, NY, NY, USA
| | - Konstantinos Linos
- Department of Pathology & Laboratory Medicine, Memorial Sloan Kettering Cancer Center, NY, NY, USA
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Pediatric Extraspinal Sacrococcygeal Ependymoma: Report of Two Cases and Literature Review. Diagnostics (Basel) 2021; 11:diagnostics11091680. [PMID: 34574021 PMCID: PMC8471863 DOI: 10.3390/diagnostics11091680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 09/11/2021] [Accepted: 09/12/2021] [Indexed: 11/24/2022] Open
Abstract
Primary central nervous system (CNS) tumors represent the most common solid tumors in childhood. Ependymomas arise from ependymal cells lining the wall of ventricles or central canal of spinal cord and their occurrence outside the CNS is extremely rare, published in the literature as case reports or small case series. We present two cases of extra-CNS myxopapillary ependymomas treated at our institution in the past three years; both cases originate in the sacrococcygeal region and were initially misdiagnosed as epidermoid cyst and germ cell tumor, respectively. The first case, which arose in a 9-year-old girl, was treated with a surgical excision in two stages, due to the non-radical manner of the first operation; no recurrence was observed after two years of follow-up. The other case was a 12-year-old boy who was treated with a complete resection and showed no evidence of recurrence at one-year follow-up. In this paper, we report our experience in treating an extremely rare disease that lacks a standardized approach to diagnosis, treatment and follow-up; in addition, we perform a literature review of the past 35 years.
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Lien BV, Brown NJ, Himstead AS, Ball BZ, Guillen A, Acharya N, Yi Yang C, Sahyouni R, Perez-Rosendahl M, Stitzlein RN, Hsu FPK. Surgical management of a rare myxopapillary ependymoma of the gluteal region: A case report. Surg Neurol Int 2021; 12:130. [PMID: 33880235 PMCID: PMC8053468 DOI: 10.25259/sni_768_2020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Accepted: 02/25/2021] [Indexed: 11/21/2022] Open
Abstract
Background: Ependymomas are rare tumors originating from neuroepithelial cells lining the wall of the ventricles or central canal of the spinal cord. While these tumors mainly occur within the central nervous system (CNS), there are occasional reports in children and young adult patients with a primary tumor occurrence outside of the CNS. Ependymomas of the sacrococcygeal region have been infrequently described in the literature with no standard of care established. We present a case report and review of the literature regarding this rare entity. Case Description: A 24-year-old woman presented with right gluteal pain worsened by sitting and a palpable soft tissue mass of the sacrococcygeal region. Magnetic resonance imaging revealed a 3.7 cm cystic mass centered in the right gluteal region. She underwent a biopsy at an outside institution, with histology revealing myxopapillary ependymoma. The patient was referred to our hospital and underwent an interdisciplinary neurosurgical and orthopedic oncology en bloc resection of the ependymoma, which intraoperatively appeared to originate from the coccygeal nerve. Conclusion: In the present report, the authors demonstrate that a myxopapillary ependymoma may present as an isolated gluteal mass attached to the coccygeal nerve, without frank CNS involvement. Furthermore, an interdisciplinary approach to surgical resection of this lesion appears to represent an effective treatment modality.
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Affiliation(s)
- Brian V Lien
- Department of Neurological Surgery, University of California, UCI Medical Center, Orange, United States
| | - Nolan J Brown
- Department of Neurological Surgery, University of California, UCI Medical Center, Orange, United States
| | - Alexander S Himstead
- Department of Neurological Surgery, University of California, UCI Medical Center, Orange, United States
| | - Benjamin Z Ball
- Department of Neurological Surgery, University of California, UCI Medical Center, Orange, United States
| | - Aileen Guillen
- Department of Neurological Surgery, University of California, UCI Medical Center, Orange, United States
| | - Nischal Acharya
- Department of Neurological Surgery, University of California, UCI Medical Center, Orange, United States
| | - Chen Yi Yang
- Department of Neurological Surgery, University of California, UCI Medical Center, Orange, United States
| | - Ronald Sahyouni
- Department of Neurosurgery, UC San Diego School of Medicine, La Jolla, United States
| | - Mari Perez-Rosendahl
- Department of Pathology, University of California, UCI Medical Center, Orange, California, United States
| | - Russell N Stitzlein
- Department of Orthopedic Surgery, University of California, UCI Medical Center, Orange, California, United States
| | - Frank P K Hsu
- Department of Neurological Surgery, University of California, UCI Medical Center, Orange, United States
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Planas S, Cruz O, Bejarano M, Albert A, Rovira C, Bombi JA. Extra-axial sacral soft tissue giant cell ependymoma affecting a child: Case report and review of the literature. Neuropathology 2021; 41:139-145. [PMID: 33569822 DOI: 10.1111/neup.12713] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Revised: 10/04/2020] [Accepted: 10/09/2020] [Indexed: 11/30/2022]
Abstract
An otherwise healthy eight-year-old girl presented with a mass in the soft tissue of the sacral region. The lesion was diagnosed as a vascular malformation on imaging studies, for which percutaneous sclerotherapy was attempted. The mass continued to grow and a complete resection was performed after four years. The pathological diagnosis was giant cell ependymoma (GCE). GCE is a term used to describe a rare histologic variant of ependymoma characterized by malignancy-like morphologic phenotype and indolent behavior. To the best of our knowledge, this is the first case of extra-axial soft tissue sacral GCE reported in a child.
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Affiliation(s)
- Silvia Planas
- Department of Pathology, Hospital Sant Joan de Déu, Barcelona, Spain
| | - Ofelia Cruz
- Department of Pediatric Oncology, Hospital Sant Joan de Déu, Barcelona, Spain
| | - Miguel Bejarano
- Department of Pediatric Surgery, Hospital Sant Joan de Déu, Barcelona, Spain
| | - Asteria Albert
- Department of Pediatric Surgery, Hospital Sant Joan de Déu, Barcelona, Spain
| | - Carlota Rovira
- Department of Pathology, Hospital Sant Joan de Déu, Barcelona, Spain
| | - Josep A Bombi
- Department of Pathology, University of Barcelona, Hospital Clinic, Barcelona, Spain
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