Signet-ring cell ependymoma with intratumoral hemorrhage in the medulla oblongata

We report a case of signet-ring cell ependymoma of the medulla oblongata. The patient presented with acute paralysis of the soft palate and absent gag reflex resulting in respiratory distress after accidental inhalation of water. MRI revealed a large intra-axial mass with foci of intratumoral hemorrhage in the medulla oblongata. A subtotal resection was performed as histopathological findings on the frozen section were consistent with metastatic carcinoma. However, the final paraffin section showed an ependymoma with signet-ring cells. A total removal was then performed with preservation of the lower cranial nerves. Postoperatively, the patient made a slow but steady recovery, and was able to swallow both water and food within 3 months. Signet-ring cell ependymoma must be included in the differential diagnosis of metastatic carcinoma to the central nervous system.