What Does This MRI Report Indicate?

Posted on Wed, 23 Aug 2017

Question: Hello, my uncle had been suffering from back pain, leg pain and gluteal pain since last 2 months. Approx 7-8 kg weight loss.

MRI spine was done and reports suggest possibility of ependymoma (Reports attached). He has been advised tumor excision by neurosurgeon.

He is known case of thalassemia minor, DM and a known smoker.

On pre-surgical fitness evaluations, high blood sugar was reported along with Kohl's lesion in right upper lung on X ray. Hence, he underwent CT thorax ( Reports attached). MT test report awaited. ESR is 56. Except weight loss he doesn't show any other symptoms of TB.....attached file contains all the reports

Now, CT guided biopsy is suggested. So I have few queries-

1 . How long spine surgery can be differed?

2. What should be priority?? TB or ependymoma??

3. Is CT guided biopsy must prior to surgery or it can be done post spine surgery??

4. Prognosis

Answered by Dr. Ishu Bishnoi (30 minutes later)

Brief Answer:
Ependymoma and pulmonary TB prognosis/management

Detailed Answer:
Hi, thanks for asking from HCM.

I can understand your concern. Your uncle is suffering from multiple diseases like DM, pulmonary TB, Thalassemia minor and ependymoma. All these diseases can cause deterioration in patient's general condition. Thus worsen the prognosis of TB and ependymoma.

Now coming to your questions,

1 Spine surgery can be deferred for few weeks till 1-2 months. It is because your uncle is having ependymoma at terminal spinal cord. it is usually "Myxopapillary ependymoma". This ependymoma is grade I and carries a good prognosis. It is very slow growing tumor. Waiting for few weeks will not going to increase the size of tumor.

2 Both are priorities. Pulmonary TB can be completely treated by anti-tubercular treatment. During TB therapy, patient can undergo surgery of ependymoma. Also you have to wait for decision of neurosurgeon who is going to operate him. If he thinks, patient is not fit for surgery, then wait.

3 CT guided biopsy can be done after surgery. If his sputum was positive for TB, then there is no need of CT guided biopsy.

4 Prognosis of both diseases are good. Pulmonary TB is 100% curable if complete ATT is received. Ependymoma can be completely resected. Myxopapillary ependymoma carries best prognosis among ependymoma.

Hope above answers will clear your doubts.
Hope it will help you. If still in doubt, do let me know.
Thanks. Take care.
Dr Ishu Bishnoi

Above answer was peer-reviewed by : Dr. Prasad