Pineal Anaplastic Ependymoma With Multifocal Intradural Extramedullary Metastases on MRI and 18FDG-PET

A 49-year-old woman presented to the emergency room with subacute paraparesis associated with bilateral cervicobrachial neuralgia. Brain and spine MRI revealed a heterogeneous hypervascular pineal tumor and a multifocal thoracolumbar intradural-extramedullary infiltrate with signs of medullary compression. C7-T2 laminectomy was performed on the same day for medullary decompression, allowing for partial lesion excision. Histological examination was in favor of a poorly differentiated anaplastic ependymoma. Two weeks later, FDG-PET showed markedly increased uptake in the pineal mass and significant hypermetabolism of the spinal metastases.