Primary Subcutaneous Sacrococcygeal Ependymoma with Lung Metastasis: A Case Report

Ependymomas arising outside the central nervous system are rare. We here report a case of a 37 years old male not known to have any chronic medical illnesses apart from the history of recurrent pilonidal sinus that was treated surgically 5 years before his presentation. The patient presented with a painful enlarging sacrococcygeal area mass for 1 year. Imaging studies and tissue biopsy of the mass revealed sacrococcygeal maxilopapillary ependymoma with lung metastasis. Local excision of the primary mass was carried and 2 months after the primary procedure, thoracotomy for the possibility of metastasectomy was aborted due to disseminated. Local recurrence was evident 6 months after the primary procedure. The patient has received adjuvant chemotherapy for a total of 9 cycles and was on regular surveillance for a total of 11 months from starting the chemotherapy which showed stable disease.
Myxopapillary ependymoma despite its low grade-can metastasize and recur early. Wide local excision of the primary lesion is recommended even in metastatic disease. Role of adjuvant chemotherapy still questionable despite evidence of disease stabilization. Adjuvant radiotherapy to decrease local recurrence is an option that needs further research.