Ependymoma (hemorrhagic)

Case contributed by Assoc Prof Frank Gaillard


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

Patient Data

Age: 30 years
Gender: Male

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 hemorrhage. 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 hemorrhagic mass is mainly between a hemangioblastoma and an ependymoma, although hemorrhage in both is quite uncommon. Pilocytic astrocytomas can rarely hemorrhage as can medulloblastomas, however in both cases the age group is a little atypical. Metastases would be unusual in a patient of this age. 


The sections  show  multiple  fragments of  variably  but up to  moderately cellular tumor.  Part of the tumor has an ependymal lining but the tumor 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 tumor 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 tumor - ependymoma, WHO grade 2.

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Case information

rID: 14394
Published: 21st Jul 2011
Last edited: 13th Aug 2019
Inclusion in quiz mode: Included

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