A rare case of cauda equina paraganglioma histologically simulating ependymoma.

BACKGROUND

Paragangliomas of the cauda equina are rare neuroendocrine tumors that can mimic ependymomas on imaging and histology, creating diagnostic challenges and influencing surgical planning.

CASE DESCRIPTION: A 41-year-old man presented with progressive low back pain and bilateral leg numbness. MRI showed a well-circumscribed, enhancing intradural extramedullary mass at L3. He underwent L3-L4 laminectomy with gross-total microsurgical excision. Histopathology revealed pseudorosettes and uniform tumor cells, initially suggesting ependymoma; however, immunohistochemistry demonstrated strong synaptophysin and S100 positivity with negative GFAP and EMA, confirming a cauda equina paraganglioma. Postoperatively, the patient recovered fully and remained asymptomatic at 1-year follow-up.

CONCLUSION

Paragangliomas can closely resemble ependymomas, and accurate diagnosis requires immunohistochemistry. Complete surgical excision yields excellent outcomes, and individualized long-term imaging follow-up is recommended because recurrence, although uncommon, can occur.