Subependymoma

Case contributed by A.Prof Frank Gaillard

Presentation

Headache.

Patient Data

Age: 80 years
Modality: MRI

There is a heterogeneously enhancing mass that occupies the inferior fourth ventricle and extends through the foramen Magendie to lie posterior to the cervicomedullary junction. The medulla and cervico-medullary junction are mildly anteriorly displaced with partial effacement of the premedullary cistern. There is no upstream obstructive hydrocephalus. The mass is mildly hyperintense to cortex on T2, with multiple small T2 hyperintense foci that suppress on FLAIR, as well as containing multiple rounded foci of signal loss on 2D MERGE sequence which may represent calcifications or blood product or both. The ADC values within the enhancing component of the mass are approximately 1560mm2/s, although given the amount of T2* signal loss, these values should be interpreted with caution. No increased CBV (not shown; same caution due to T2* effects should be exercised) identified and MR spectroscopy is non-contributory (not shown).

Conclusion: The appearance is most consistent with an ependymoma although in this age group a subependymoma is more likely, although they are usually smaller and non-enhancing. Other entities (e.g. metastases, choroid plexus papilloma and haemangioblastoma) are all thought to be far less likely.

Case Discussion

The patient went on to have surgery.

Histology

MICROSCOPIC DESCRIPTION: Sections show a variably cellular glioma composed of monotonous tumour cells set within a dense fibrillary stroma. Tumour cells demonstrate round nuclei with granular chromatin and inconspicuous nucleoli. There are scattered foci of dystrophic calcification present. No perivascular pseudorosettes, nuclear atypia or mitoses are seen. No necrosis or microvascular proliferation are seen. There is no evidence of malignancy.

FINAL DIAGNOSIS: Subependymoma (WHO grade I).

Discussion

When it comes to ependymomas/subependymomas, age is a good guide as the two can look very similar. 

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Case Information

rID: 45850
Case created: 10th Jun 2016
Last edited: 16th Jun 2016
Inclusion in quiz mode: Included

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