Secondary ependymoma presenting as a presacral mass

Ependymomas are common types of tumors occurring within the brain and usually derive from the ependymal lining, especially of the ventricles. Ependymomas also occur, usually within the spinal canal, as primary intramedullary lesions or as late “drop” metastases from intracranial ependymomas. Extradural ependymomas are rare. They could occur as intraspinal or extraspinal lesions. We hereby report a case of an extradural (intraspinal) lesion with extraspinal extension, the extraspinal lesion being presacral in position, which presented with urinary and colonic symptoms. The lesions were secondary ependymoma subsequent to an intracranial ependymoma previously treated by combined surgery, radiotherapy, and chemotherapy 4 years earlier. The extradural and extraspinal site of the secondary lesion as well as its mode of presentation are noteworthy.