Ependymoma - MRS

Case contributed by Dr Ahmed Abd Rabou

Presentation

Patient with intraventricular tumor detected by CT and underwent MRI for further assessment. The patient had renal failure and no contrast was given.

Patient Data

Age: 19 years old
Gender: Male
MRI

An ill defined soft tissue mass is seen centered on the 4th ventricle obliterating its cavity and extends through foramen of Magendi posterior to the pons and medulla oblongata. It squeezes into the aqueduct of sylvius and extends to the 3rd then through foramina of Monro to frontal horns of both lateral ventricles as well as the suprasellar and prepontine cisterns. MRS reveals striking elevation of Cho peak with Cho/Cr ratio of 6.5 with marked reduction of NAA peak and small traces of lipid and lactate.

Case Discussion

Such squeezable mass is suggestive of ependymoma which was confirmed by biopsy that revealed WHO grade II ependymoma. Ependymoma is a plastic tumor that has the capability to squeeze through foramina and reaches other CSF spaces.

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Case information

rID: 37199
Case created: 28th May 2015
Last edited: 15th Dec 2015
Inclusion in quiz mode: Included

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