Subependymoma - large and enhancing

Case contributed by Frank Gaillard

Patient Data

Age: Elderly

Heterogeneous mass with multiple specks of calcification in the region of the fourth ventricle. No convincing enhancement. 

Heterogeneously enhancing mass with several foci of blooming in seen in the fourth ventricle. It is associated with edema in the medulla and appears to protrude out through the left foramen of Luschka. Features would favor an ependymoma, although the older age of the patient is a little unusual. A subependymoma is another possibility, although usually smaller and non-enhancing. 

Case Discussion

The patient went on to have a craniotomy and resection of the mass. 


Sections show a low-grade glial tumor with areas of calcification and microcyst formation. The cysts contain colloid-like material. The tumor cells are relatively small in size, with round to oval nuclei, and are arranged in small linear clusters and around vessels, rendering a perivascular pseudorosette pattern. A few areas display a modest increase in cellularity. For the most part, cellularity is relatively low. Mitotic activity is not conspicuous.

Final Diagnosis: subependymoma

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