Myxopapillary Ependymoma-a Case Report of Rare Multicentric Subtype and Literature Review.

Background: Myxopapillary ependymoma is a rare type of primary spinal tumor, it is distinctly a slow-growing tumor that originates in the conus medullaris, cauda equina, or film terminals and is rarely identified as a multicentric type. Myxopapillary ependymoma has a unique histological characteristic and is associated with a generally better prognosis. Objective: We present a case of a rare multicentric myxopapillary ependymoma. Case presentation: A 28-year-old male with 1-year history of low back pain and 3 months of radiating pain to left lower limb with perianal anesthesia. Magnetic resonance imaging (MRI) exhibited a large intradural intramedullary lesion from the level of the conus medullaris extending to the filum terminals at the level of T12 to L3 with smaller multiple enhancing lesions seen opposite to L4 and L5 level as well as within the exiting nerve roots, at the left side of L1/L2 and L2/L3 and right side of L3/L4 and L5/S1 level. The patient underwent surgical resection with significant improvement in symptoms and no tumor progression on follow up MRI scan. Conclusion: We hereby present a case of multicentric myxopapillary ependymoma with a literature review of the previous reported cases. We believe that our study will make a significant contribution to the literature and will be of interest to the readership regarding of the rarity of multicentric Myxopapillary ependymoma and it will help in decision making for the proper surgical Intervention on these kinds of cases.

Can apparent diffusion coefficient values help distinguish between different types of pediatric brain tumors?

RATIONALE AND OBJECTIVES: Classifying brain tumors is challenging, but recently developed imaging techniques offer the opportunity for neuroradiologists and neurosurgeons to diagnose, differentiate, and manage different types of brain tumors. Such advances will be reflected in improvements in patients' life expectancy and quality of life. Among the newest techniques, the apparent diffusion coefficient (ADC), which tracks the rate of microscopic water diffusion within tissues, has become a focus of investigation. Recently, ADC has been used as a preoperative diffusion-weighted magnetic resonance imaging (MRI) parameter that facilitates tumor diagnosis and grading. Here, we aimed to determine the ADC cutoff values for pediatric brain tumors (PBTs) categorized according to the World Health Organization (WHO) classification of brain tumors. MATERIALS AND METHODS: We retrospectively reviewed 80 cases, and assessed them based on their MRI-derived ADC. These results were compared with those of WHO classification-based histopathology. RESULTS: Whole-lesion ADC values ranged 0.225-1.240 × 10-3 mm2/s for ependymal tumors, 0.107-1.571 × 10-3 mm2/s for embryonal tumors, 0.1065-2.37801 × 10-3 mm2/s for diffuse astrocytic and oligodendroglial tumors, 0.5220-0.7840 × 10-3 mm2/s for other astrocytic tumors, and 0.1530-0.8160 × 10-3 mm2/s for meningiomas. These findings revealed the usefulness of ADC in the differential diagnosis of PBT, as it was able to discriminate between five types of PBTs. CONCLUSION: The application of an ADC diagnostic criterion would reduce the need for spectroscopic analysis. However, further research is needed to implement ADC in the differential diagnosis of PBT.

Neuroschistosomiasis mimicking lower back pain: case report of a rare differential diagnosis in a pediatric patient.

BACKGROUND: Spinal myelitis is an infrequent manifestation of spinal cord infection. It is caused by the Schistosoma species, which are endemic in South America, part of the Middle East, and Africa. CASE PRESENTATION: We report the case of a 13-year-old male adolescent complaining of progressive lower back pain and weakness of the lower extremities for 3 days. Initial magnetic resonance imaging revealed typical transverse myelitis. Subsequently, parasite serology showed a markedly elevated level of Schistosoma antibody titers, and cerebrospinal fluid analysis yielded normal results. Because of our presumptive diagnosis of neuroschistosomiasis, the patient was prescribed an empirical regimen of an anti-parasitic agent, after which his neurological deficit promptly subsided. The patient was followed for 1 year and showed a complete long-term resolution of symptoms. CONCLUSIONS: This case highlights the increasing prevalence of neuroschistosomiasis in recent years, particularly in patients with a history of travel to endemic regions. Moreover, the study reports the clinicoradiological features of this enigmatic disorder. This rare occurrence potentiates further studies to address unanswered questions about neuroschistosomiasis.