Ependymoma - 4th ventricle

Case contributed by Bahman Rasuli
Diagnosis certain


Intermittent vomiting, ataxia, and irritability.

Patient Data

Age: 2 years
Gender: Male

There is a 35 x 50 x 60 mm intermediate signal intensity (T1/T2 weighted) mass in the fourth ventricle, with extension through the foramina of Luschka and Magendie foramina into the left cerebellopontine (CP) angle and cervicomedullary junction, respectively.

Obstruction of the quadrigeminal cistern and mild mass effect on the posterior midbrain represents the upward extension of the mass.

The mass effect also causes right-sided displacement of the medulla. There is no hydrocephalus.

On post-contrast images, the mass shows heterogeneous enhancement.


Posterior fossa ependymoma, NOS, compatible with anaplastic ependymoma, corresponding to WHO grade III.

Case Discussion

Tumoral heterogeneity, origin from the floor of the fourth ventricle, heterogeneous enhancement, and extension through ventricular foramina into the adjacent cisterns are features in favor of ependymoma. Patient underwent resection and was confirmed as ependymoma on histopathology.

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