Presentation
Headache.
Patient Data
FLAIR/T2 hyperintense and enhancing extra-axial mass centered at the floor of the fourth ventricle and extending caudally through the left foramen of Luschka and foramen of Magendie and toward the right foramen of Luschka. No appreciable intra-axial component. No flow voids are demonstrated, however there is a small volume of intrinsic T1 signal at its margins with corresponding moderate hemosiderin staining which extends to the adjacent sulci of the cerebellar vermis and hemispheres. No abnormal diffusion restriction nor hydrocephalus. No other abnormal focus of enhancement elsewhere identified within the brain.
MRI whole spine (not shown): normal.
Conclusion:
MR features and location of the tumor are most in keeping with an ependymoma.
Case Discussion
The patient went on to have surgery confirming the diagnosis.
Histology
MICROSCOPIC DESCRIPTION:
Sections show a moderately cellular tumor with a fibrillary background forming scattered nests, perivascular pseudorosettes and occasional true rosettes. Tumor cells demonstrate mildly enlarged elongated nuclei and small nucleoli. No mitoses are seen. No microvascular proliferation or necrosis are seen. Immunohistochemically tumor cells stain: GFAP+, EMA+ (occasional cells demonstrate perinuclear dot positivity), NeuN-, Synaptophysin- The Topoisomerase proliferation index is approximately: 1-2%
FINAL DIAGNOSIS: Ependymoma (WHO Grade II).
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