Mixed Subependymoma/Ependymoma

Case contributed by Shanyar Qadir Hama Karim
Diagnosis certain

Presentation

Worsening occipital headache for the past 3 weeks. No nausea or vomiting. No increased sensitivity to light. No fever or trauma. No previous history of migraines. Unremarkable neurological examination.

Patient Data

Age: 60 years
Gender: Male

Non-contrast Brain CT

ct

Normal intracranial appearances. No mass lesion, infarction, hemorrhage, hydrocephalus or extra-axial collection.

Preoperative Brain MRI

mri

7x10x15mm (APxMLxCC) fourth-ventricle-mass, which is isointense to cortex and shows homogenous contrast enhancement. No calcifications or blood products seen. No hydrocephalus.

 

Postoperative Brain MRI

mri

Postoperative MRI within 24 hours of the procedure:

Status post suboccipital craniotomy with related soft tissue changes.
Small amount of postoperative pneumocephalus is seen.
Minimal blood products in the fourth ventricle.
No acute ischemia. No enhancing tumor rest. No hydrocephalus.

Case Discussion

The patient was given the option between surgical removal vs. reimaging in a few months, as the tumor was not thought of as the cause of the patient's symptoms. The patient chose the surgical removal of the tumor.

Immunohistochemistry expression profile:

  • No IDH1 (R132H) expression
  • Nuclear ATRX expression

Molecular-pathology expression profile:

  • MGMT-promoter methylation
  • Wildtype sequence of IDH1-Gene (R132) and IDH2-Gene (R172)
  • Wildtype sequence of TERT-promoter (C228 and C250)
  • No evidence of KIAA1549:BRAF fusion transcript Type A, B, C

Final Histological Diagnosis:

How to use cases

You can use Radiopaedia cases in a variety of ways to help you learn and teach.

Creating your own cases is easy.