Ependymoma

Case contributed by A.Prof Frank Gaillard

Presentation

Headache.

Patient Data

Age: 60 years
MRI

A lobulated heterogeneously enhancing tumour centred along the floor of the fourth ventricle demonstrates mild FLAIR hyperintensity with internal areas of FLAIR hypointensity/T2 hyperintensity, regions of mild T1 hyperintensity, and patchy susceptibility. Ao diffusion restriction. No surrounding oedema. It traverses foramen Magendie into the cisterna magna. No extension through either of the foramina of Luschka. There is some mass effect on the tegmentum of the medulla, but is no distortion of the fourth ventricle and no hydrocephalus. No enhancing abnormality elsewhere.

Conclusion: Solitary heterogeneous posterior fossa tumour with cystic components and hemorrhage/calcifcation, protruding through the foramen of Magendie, most likely an ependymoma.

Case Discussion

The patient went on to have a resection. 

Histology

MICROSCOPIC DESCRIPTION: Sections show a hypercellular tumour with prominent perivascular pseudorosettes. The tumour focally forms papillae and well formed ependymal canals. Tumour cells contain abundant pale eosinophilic to clear cytoplasm, oval nuclei with coarse granular chromatin and inconspicuous nucleoli. Focally tumour cells demonstrate mild to moderate nuclear atypia. There are up to 4 mitoses per 10 HPF identified. No necrosis or microvascular proliferation are seen.

Immunohistochemistry results show tumour cells stain:

  • GFAP positive
  • EMA positive (perinuclear dot staining)
  • S100 negative
  • Synaptophysin negative
  • The Ki67 proliferation index is approximately 5%.

FINAL DIAGNOSIS: Ependymoma (WHO grade II).

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Case information

rID: 50686
Case created: 17th Jan 2017
Last edited: 21st Jan 2017
Inclusion in quiz mode: Included

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