Ependymoma

Case contributed by A.Prof Frank Gaillard

Presentation

Headache, recently much worse.

Patient Data

Age: 30 years
CT

A sizable mass is seen within the fourth ventricle, isodense to adjacent brain and demonstrating prominent, but not vivid, enhancement. Hydrocephalus is present. 

MRI

Within the fourth ventricle has an enhancing tumour extending inferiorly posterior to the upper cervical cord. It moulds to the contours of the surrounding brainstem and cerebellum. On some of the lower images there appears to be a component arising from the dorsal aspect of the the medulla. The mass demonstrates only intermediate diffusion restriction, prominent susceptibility induced signal loss suggesting blood product, without frank haemorrhage.

On the right side of the lesion a more focal region demonstrates signal loss and increased density on CT and may represent calcification or more acute blood. The PICAs are embedded with thin the mass without obvious large additional flow voids. The outlet to the fourth ventricle is occluded with resultant obstructive hydrocephalous and minor transependymal oedema. The remainder of the brain is unremarkable in appearance,

Conclusion: Fourth ventricular mass almost certainly represents an ependymoma. Choroid plexus papilloma and haemangioblastoma are much less likely differentials.

Case Discussion

The patient went on to have surgery.

Histology

MICROSCOPIC DESCRIPTION: Sections show a moderately cellular tumour with a fibrillary background forming prominent perivascular pseudorosettes. True rosettes are absent. Tumour cells demonstrate mildly enlarged elongated nuclei and inconspicuous nucleoli. No mitoses are seen. No microvascular proliferation or necrosis are seen.

Immunohistochemically tumour cells stain:GFAP+ and EMA+ (perinuclear dot positivity). The Topoisomerase proliferation index is approximately: 1-2%. .

FINAL DIAGNOSIS: Ependymoma (WHO Grade II).

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Case information

rID: 45783
Case created: 8th Jun 2016
Last edited: 20th Apr 2017
Inclusion in quiz mode: Included

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