Thoracic neural crest tumors in Beckwith-Wiedemann syndrome.

diagnosis, degree of surgical resection or prior treatment and subsequent development of extraneural metastases was found [4]. The exact route of extraneural metastases is not known, but in the vast majority metastases occurred in the wake of craniotomy, suggesting iatrogenic vascular seeding [3]. Typically, extraneural metastases of ependymoma occur in the lungs, pleura, and lymph nodes while metastases to the mediastinum, liver, bone, and diaphragmatic muscle are even less common [4]. In most cases, the existence of pleuropulmonary metastases was disclosed only at autopsy usually coexisting with CNS recurrence and systemic metastases [5]. Extraneural metastases or relapses of ependymoma are extremely rare but physicians caring for ependymoma patients must remain aware of this possible complication.