Primary intracranial ependymomas originate from ependymal cells. They\nmay migrate mainly in the spinal cord but rarely metastasize outside the central\nnervous system. Metastases outside the central nervous system are rare.\nMetastatic diffusion from the central nervous system is low due to the unique\ninteraction of the brain and the tumor with the blood-brain barrier. Nevertheless,\nthree main hypotheses have been mentioned in the literature, the tumor\ngrowth, the surgical manipulation (which may be considered to be the\ncase in our patient), and the aggressiveness of the tumor according to the\nKi67 index. We report the case of a 16-year-old female, who underwent complete\nsurgical removal of a left occipital 2007 WHO grade II ependymoma. 3\nyears later, the patient presented multiple cervical and occipital indurated\nmasses. MRI showed a left hemispheric meningeal infiltration, with multiple\nnodules located on the neck, occiput and mastoid. Histopathological study of\na left temporal surgical biopsy and resection of an occipital subcutaneous\nnodule turned to be metastases of an anaplastic ependymoma. The ependymoma\nconsidered as a benign tumor could very quickly turn into malignancy\nby its metastatic potential. Early diagnosis and longer follow-up of patients\nwould be recommended for a rapid management.
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