Ependymoma - haemorrhagic

Case contributed by A.Prof Frank Gaillard

Presentation

Acute deterioration in level of consciousness. Scanned on arrival in the emergency department.

Patient Data

Age: 30 years
Gender: Male
CT

CT brain

A large rounded mass is present in the posterior fossa, centered on the fourth ventricle. Centrally it is of high attenuation, consistent with haemorrhage. Following administration of contrast, moderate enhancement of the solid component is seen. 

There is marked obstructive hydrocephalus and a little blood is also seen pooling in the occipital horns. 

Case Discussion

In a 30 year old the differential for a posterior fossa haemorrhagic mass is mainly between a haemangioblastoma and an ependymoma, although haemorrhage in both is quite uncommon. Pilocytic astrocytomas can rarely haemorrhage as can medulloblastomas, however in both cases the age group is a little atypical. Metastases would be unusual in a patient of this age. 

Pathology

The sections  show  multiple  fragments of  variably  but up to  moderately cellular tumour.  Part of the tumour has an ependymal lining but the tumour has a  distinctive  pattern  of moderately   pleomorphic  oval  nuclei with speckled   chromatin  in a   neurofibrillary   background.     Perivascular pseudorosetting  is a  prominent  feature.   In areas,  true  rosettes with lumens are also noted.  Areas of tumour necrosis are not seen but there are focal collections  of hemosiderin-laden  macrophages and  focal fibrosis is noted.  An occasional  mitotic figure is noted.   The features are those of  a classical  ependymoma.

DIAGNOSIS :  Posterior fossa tumour - ependymoma, WHO grade 2.

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Case information

rID: 14394
Case created: 21st Jul 2011
Last edited: 13th Nov 2015
Inclusion in quiz mode: Included

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