Virtual Microscope
A 41 year-old man with low back pain
Elizabeth Rushing, M.D., Col.
Department of Neuropathology and Ophthalmic Pathology, Armed Forces Institute of Pathology, Washington, D.C.
Last updated: March 31, 2007
Clinical Information: The patient was a 41year-old male who was admitted to the hospital with a 6-month history of worsening low back pain. Further evaluation included an MRI of the thoracolumbar spine that revealed an intramedullary, heterogeneously enhancing mass filling the canal from T11-L1. The virtual images are obtained from this mass.
Diagnosis: Myxopapillary ependymoma, WHO grade I.
Pathology: On scaning magnification, the lesion is rather myxoid in nature. The cellular component has a tendency to arrange in a perivascular fashion. On higher magnification, a substantial of thick walled blood vessels are present. The tumor cells have fine cytoplasmic processes that point towards the blood vessels. There is no significant pleomorphism, mitotic activity, or necrosis.
The tumor cells are strongly positive for vimentin, and S100 protein. There is also focal positivity for glial fibrillary acidic protein (GFAP).
Comment: The clinical and pathologic features of this case is classic for myxopapillary ependymoma of WHO grade I. One of the differential diagnosis for consideration is well differentiated metastatic carcinoma. Separation of these two entities is rather straight forward. The immunohistochemical positivity for S100 and GFAP is quite helpful.