Subependymoma: lateral ventricle

Case contributed by Dr Yune Kwong

Presentation

Incidentally detected lesion on sinus CT

Patient Data

Age: 45 years old
Gender: Female
Race: Caucasian
Modality: MRI

Large left lateral ventricle lesion, with internal cystic degeneration. Susceptibility images suggest calcification. A few foci of enhancement are seen, but the bulk of the lesion does not enhance. Obstruction of the foramen of Monro, with dilatation of the left lateral ventricle.

Histology:

MACROSCOPIC DESCRIPTION:
Eight fragments of white to pale tan,  rubbery  tissueranging in size from 6 x 5 x 2mm to 40 x 25 x 10mm.
MICROSCOPIC DESCRIPTION:
Highly  fibrillary  glial  lesion  featuring  clustered  cell  bodies accompanied by microcysts, with areas of prominent Rosenthal fibre formation, thromboed  and  scleroses   blood  vessels  and  old  haemorrhage.   Perivascular pseudorosettes are present focally. Mitotic figures are not seen.  The lesion is separated from ventricular lining by a layer of white matter.  Features  qualify for subependymoma.
DIAGNOSIS: Subependymoma.

Case Discussion

At the time of imaging, the differential included meningioma, but this would be expected to show more intense and homogeneous enhancement. Central neurocytoma was also considered, as it is commonly found in the lateral ventricles near the foramen of Monro, with 'bubbly' cystic areas. However moderate to strong heterogenous enhancement would be expected.

Although subependymomas are typically described in the inferior fourth ventricle, they also occur in the lateral, third ventricles and spinal cord. They are most commonly small, although can become large as in this case. Variable enhancement is seen (typically none to mild), but marked enhancement is also a feature (more commonly in the fourth ventricle than lateral ventricles). The most common demographics is in middle-aged to elderly males. In general, the diagnosis should be considered in a hyperintense ventricular tumour with poor enhancement (other ventricular tumours enhance more prominently).

They are WHO grade I tumours.

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Case Information

rID: 29582
Case created: 6th Jun 2014
Last edited: 8th Feb 2017
Inclusion in quiz mode: Included

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