Case 4

This is a lumbosacral MRI study showing an oval, oblong lesion in the spinal canal, which is intradural and extra-medullary; it lies at the level of L2/3, demonstrates high T2 and intermediate T1 SI. It displaces the filum terminale peripherally. It shows avid, slightly heterogeneous post-gadolinium enhancement.  

This is a tumour arising from the filum terminale, with features most suggestive of a myxopapillary ependymoma.

The differential diagnosis includes nerve sheath tumour (schwannoma / neurofibroma) and meningioma.

I would notify the referring physician and suggest discussion at neurosurgery MDT.