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DOI: 10.1148/rg.26si065020
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Myxopapillary Ependymoma of the Sacrum

Stephanie M. Shors, MD, Tera A. Jones, MD, Miral D. Jhaveri, MD and Michael S. Huckman, MD

1 From the Department of Diagnostic Radiology and Nuclear Medicine (S.M.S., M.D.J., M.S.H.) and the Department of Pathology (T.A.J.), Rush University Medical Center, 1653 W Congress Pkwy, Chicago, IL 60612. Received March 6, 2006; revision requested April 12 and received May 10; accepted May 23. All authors have no financial relationships to disclose.

Figure 1
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  		Figure 1.  Contrast-enhanced CT scan shows an expansile soft-tissue mass located in the sacral canal (solid arrow) and extending into the presacral space (open arrow). The right common iliac vein (arrowhead) is poorly enhanced, a finding that suggests the presence of thrombus.

 

Figure 2
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  		Figure 2a.  Sagittal T1-weighted (a) and T2-weighted (b) MR images show a lobulated expansile mass that has destroyed the sacrum and extended anteriorly into the presacral space and superiorly into the spinal canal. The mass is isointense relative to the spinal cord on the T1-weighted image and heterogeneous but predominantly hyperintense on the T2-weighted image.

 

Figure 2
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  		Figure 2b.  Sagittal T1-weighted (a) and T2-weighted (b) MR images show a lobulated expansile mass that has destroyed the sacrum and extended anteriorly into the presacral space and superiorly into the spinal canal. The mass is isointense relative to the spinal cord on the T1-weighted image and heterogeneous but predominantly hyperintense on the T2-weighted image.

 

Figure 3
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  		Figure 3a.  Sagittal (a) and axial (b) contrast-enhanced fat-saturated T1-weighted MR images show the mass with heterogeneous enhancement and central necrosis.

 

Figure 3
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  		Figure 3b.  Sagittal (a) and axial (b) contrast-enhanced fat-saturated T1-weighted MR images show the mass with heterogeneous enhancement and central necrosis.

 

Figure 4
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  		Figure 4a.  Sagittal unenhanced (a) and contrast-enhanced (b) T1-weighted MR images of the pelvis show enhancing soft-tissue-intensity material in the distal IVC (solid arrow) and in both proximal common iliac veins (open arrows), findings that are compatible with thrombus.

 

Figure 4
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  		Figure 4b.  Sagittal unenhanced (a) and contrast-enhanced (b) T1-weighted MR images of the pelvis show enhancing soft-tissue-intensity material in the distal IVC (solid arrow) and in both proximal common iliac veins (open arrows), findings that are compatible with thrombus.

 

Figure 5
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  		Figure 5.  Photograph of the sagittally sectioned gross specimen from en bloc resection of the sacrum shows a large, lobulated mass occupying the sacral canal (solid arrow) and extending anteriorly into the sacral hollow (open arrow). Areas of hemorrhage and necrosis are present within the mass. S1 = sacral vertebra.

 

Figure 6
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  		Figure 6.  Photomicrograph (original magnification, x 100; hematoxylineosin [H-E] stain) demonstrates a blood vessel (black arrows) containing tumor cells that distend the lumen and are focally attached to the endothelium. Fibrovascular cores can be appreciated within the tumor plug (white arrow). Arrowhead indicates a normal blood vessel.

 

Figure 7
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  		Figure 7.  Photomicrograph (original magnification, x200; H-E stain) shows cuboidal cells (arrows) arranged in a microcystic pattern with abundant basophilic mucinous material within the cystic spaces. There is minimal variation among the cells and no mitotic activity.

 

Figure 8
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  		Figure 8.  Photomicrograph (original magnification, x 200; H-E stain) shows the cells, which range from cuboidal to more elongate, arranged around fibrovascular cores containing blood vessels (black arrows). Mucoid matrix material (arrowhead) is present between the cells and the fibrovascular cores. The photomicrograph in the inset, which was obtained at a higher magnification (x 400) with H-E stain, shows the eosinophilic cytoplasmic processes of the tumor cells oriented toward the blood vessel (white arrow).

 

Figure 9
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  		Figure 9.  Photomicrographs (original magnification, x200) show the tumor cells to be diffusely reactive with GFAP (left), an immunohistochemical stain, and completely nonreactive with cytokeratins 8/18 (right), findings that support the diagnosis of myxopapillary ependymoma.

 




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