Ependymoma (lateral ventricle)

Case contributed by A.Prof Frank Gaillard

Presentation

No history provided.

Patient Data

Age: 55 years
Gender: Male
CT

CT brain

Digitized images from printed film. A large, heterogeneous mass is present within the left frontal lobe. It is strikingly hyperdense, without definite calcification. The solid component enhances. Hydrocephalus is present, best seen on the right, due to outflow obstruction.

MRI

MRI brain

There is a large left frontal mixed cystic/solid lesion, measuring approximately 4x4x5cm in perpendicular dimensions, with intralesional haemorrhage and fluid level which may indicate areas of necrosis. Large surrounding vasogenic edema involving the contralateral hemisphere, and significant mass effect causing almost 2cm midline shift, obstructing the monro foramina resulting moderate non-communicating hydrocephalus.  

The epicenter of the mass demonstrates diffusion restriction. There is no evidence of an increased rCBV. MRS demonstrates significantly increased choline and lactate/lipid peak with substantial decrease in NAA (not shown). 

The patient went on to have a craniotomy and excision of this lesion. 

Pathology

Histology

Paraffin sections show a moderately hypercellular glial tumour. Tumour cells have uniform round and ovoid nuclei with a granular arrangement of chromatin and a variable amount of pale to clear cytoplasm.  These are arranged in prominent perivascular pseudorosettes as well as diffuse sheets.  No mitotic figures are identified. A single small focus of vascular endothelial cell hyperpklasia is noted in one fragment. There is no necrosis. Large calibre intensely congested vascular channels are present in separate fragments. The majority of tumour cells show prominent perinuclear dot immunostaining for epithelial membrane antigen (EMA) typical of ependymal cells.  There is also patchy immunostaining for GFAP.  The features are of ependymoma.  The topoisomerase labelling index is <1%.

DIAGNOSIS: Left frontal and lateral ventricle tumour: Ependymoma (WHO Grade II).

Case Discussion

This case highlights the difficulty in establishing a firm imaging diagnosis in atypical cases. 

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Case information

rID: 14372
Case created: 19th Jul 2011
Last edited: 19th Dec 2016
Inclusion in quiz mode: Included

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