Presentation
Severe headache with vomiting.
Patient Data
Large size heterogeneous intraventricular mass within the fourth ventricle unilaterally extending into the left foramen of Luschka with areas of internal hemorrhage and areas of restriction.
The mass shows heterogeneous enhancement in the post-contrast study.
Supratentorial hydrocephalus with periventricular interstitial edema is noted.
Compression of mass on the posterior aspect of the medulla is evident.
The posterior fossa tumor was resected and the final pathology was attached.
Epithelial membrane antigen (EMA) was positive in the luminal surface of the ependymal rosettes
Perivascular pseudorosettes were also seen.
No malignant cell was detected in CSF analysis.
Based on pathology findings, posterior fossa ependymoma was the final diagnosis.
Case Discussion
Medulloblastoma and ependymoma are two important differential considerations in the pediatric fourth ventricular masses.
Tumoral heterogeneity, origin from the floor of the fourth ventricle, heterogeneous enhancement, and extension through ventricular foramina into the adjacent cisterns, all are features in favor of ependymoma.
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