Presentation
Refractory and persistent headaches.
Patient Data
Image quality is suboptimal due to marked susceptibility artifact associated with orthodontic braces.
There is an enhancing mass in the fourth ventricle which extends laterally through the left foramen of Luschka into the left perimedullary cistern and left CPA cistern. There is also questionable extension in the midline inferiorly through the foramen of Magendie.
There is obstructive hydrocephalus with enlargement of the third and lateral ventricle with dilatation of the rostral portion of the fourth ventricle and cerebral aqueduct.
Case Discussion
This is an ependymoma.
Overall, the patient underwent gross total resection, induction chemotherapy, proton beam therapy, and 4 cycles of maintenance chemotherapy. Histopathologic examination showed perivascular pseudorosettes and ependymal tubules, with no anaplastic features. The tumor was positive for GFAP and vimentin, with focal dot-like stain for EMA and a low Ki-67 (<4%). It was negative for IDH-1 and there was no evidence of neuropil infiltration by tumor (neurofilament, synaptophysin).
No recurrence has been noted. He continues serial imaging with the most recent study absent of signs of recurrence.
Co-authors:
Rushali Kohari
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