Case contributed by A.Prof Frank Gaillard



Patient Data

Age: 25 years

FLAIR/T2 hyperintense and enhancing extra-axial mass centred 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 haemosiderin 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. 


MR features and location of the tumour are most in keeping with an ependymoma.

Case Discussion

The patient went on to have surgery confirming the diagnosis. 



Sections show a moderately cellular tumour with a fibrillary background forming scattered nests, perivascular pseudorosettes and occasional true rosettes. Tumour cells demonstrate mildly enlarged elongated nuclei and small nucleoli. No mitoses are seen. No microvascular proliferation or necrosis are seen. Immunohistochemically tumour 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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Case information

rID: 48747
Published: 22nd Oct 2016
Last edited: 22nd Oct 2016
Inclusion in quiz mode: Included

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