An unusual presentation of myxopapillary ependymoma with faecal incontinence and literature review

Abstract

Myxopapillary ependymomas are slow-growing and highly vascular tumours that occur almost exclusively in the cauda equina [Gerber S, Ollivier L, Leclère J, et al. Imaging of sacral tumours. Skeletal Radiol 2008;37:277–89; Shors SM, Jones TA, Jhaveri MD, Huckman MS. Best cases from the AFIP: myxopapillary ependymoma of the sacrum. Radiographics 2006;26:111–6]. Their clinical manifestations are frequently nonspecific, such as low back pain, leg or sacral pain. Lower motor neuron symptoms such as weakness of lower limbs, loss of sensation, and erectile and sphincter dysfunction can be caused by disruption of the cauda equina by a spinal tumour, which is termed cauda equine syndrome [Shors SM, Jones TA, Jhaveri MD, Huckman MS. Best cases from the AFIP: myxopapillary ependymoma of the sacrum. Radiographics 2006;26:111–6]. Faecal incontinence as the first symptom of a primary spinal tumour is rare, although it has been reported with lumbar schwannoma of the cauda equina, metastatic spinal deposits, and lumbosacral intraspinal lipomas. Ependymomas are not frequently associated with this symptom, however. Here we report a case of a myxopapillary ependymoma presenting with faecal incontinence and discuss the radiological appearance of myxopapillary ependymomas.