Abstract: Objective To investigate the clinical and pathological features, diagnosis, and differential diagnosis of myxopapillary ependymoma (MPE) with extensive sacral destruction.Methods Retrospective analysis of the clinical and radiological data, histopathological morphology, and immunophenotype was conducted for one case of MPE with extensive sacral destruction.Results The patient, female, 73 years of age, with a history of low backache for one month, was admitted to hospital with lumbosacral injury.MRI image demonstrated lesions involving vertebral bodies of S2-3.Microscopically, the lesion was composed of cuboidal to elongated tumour cells radially arranged in a papillary manner around vascularied stromal cores.In areas without nipples, myxoid matrix material accumulated between tumour cells and hyaline blood vessels.The tumour cells showed no pleomorphism, with low mitotic activity.Immunohistochemically, tumour cells were positive for GFAP, S100, and Vimentin, and negative for EMA and cytokeratin.Ki67 labeling index was <1% positive.Conclusion MPE with extensive sacral destruction is a rare tumor with indolent behaviour.Late recurrence may occur with incomplete resection.Differential diagnosis include chordoma and metastatic carcinoma.

Key words: Myxopapillary ependymoma, Sacrum, Immunohistochemistry, Diagnosis, Differential diagnosis