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Nair JN, Bathala RT, Krishnaswamy V, Mahadevan S. Synchronous presentation of prolactinoma and supratentorial tanycytic ependymoma. J Neurosci Rural Pract 2024; 15:140-142. [PMID: 38476418 PMCID: PMC10927033 DOI: 10.25259/jnrp_217_2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Accepted: 09/23/2023] [Indexed: 03/14/2024] Open
Abstract
Tanycytic ependymomas mostly occur in the spinal cord and it is the rarest histological subtype of ependymoma. A 29-year-old male was referred from the infertility clinic after serum prolactin levels were found to be elevated. Magnetic resonance imaging (MRI) brain showed an irregular necrotic lesion in the periventricular region of the left parietal lobe which had an intraventricular component and associated perilesional edema. In addition, a sellar mass with suprasellar extension was also found on the MRI. He was started on cabergoline therapy for macroprolactinoma and underwent a left parietal craniotomy, and microsurgical excision of the tumor using intraoperative neurosonographic guidance. Histologically, the tumor showed spindle cytologic features and poorly developed inconspicuous pseudorosettes, with areas of rounded nuclear profiles and perinuclear cytoplasmic clearing. Tumor cells were positive for vimentin, glial fibrillary acidic protein and S100, and negative for epithelial membrane antigen. Ki67 was <7%. He was diagnosed with tanycytic ependymoma and a coexistent prolactinoma. He received 10 cycles of image-guided radiotherapy. Post-operative imaging showed minimal residual tumor the size of which remained stable at 1-year follow-up scan. The pituitary macroadenoma regressed with cabergoline therapy and he clinically improved. This presentation of synchronous macroprolactinoma and tanycytic ependymoma has not been reported in the literature previously. An exhaustive literature review showed only 18 previously reported cases of supratentorial tanycytic ependymoma.
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Affiliation(s)
- Jishnu Narayanan Nair
- Department of Neurosurgery, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India
| | - Rav Tej Bathala
- Department of Neurosurgery, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India
| | - Visvanathan Krishnaswamy
- Department of Neurosurgery, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India
| | - Shriraam Mahadevan
- Department of Endocrinology, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India
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de Paiva JLR, Sabino JV, Pereira FV, Okuda PA, Villarinho LDL, Queiroz LDS, França MC, Reis F. The Role of MRI in the Diagnosis of Spinal Cord Tumors. Semin Ultrasound CT MR 2023; 44:436-451. [PMID: 37555685 DOI: 10.1053/j.sult.2023.03.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/10/2023]
Abstract
Spinal cord tumors are uncommon, and its multiple representatives not always have pathognomonic characteristics, which poses a challenge for both patients and caring physicians. The radiologist performs an important role in recognizing these tumors, as well as in differentiating between neoplastic and non-neoplastic processes, supporting clinical and surgical decision-making in patients with spinal cord injury. Magnetic Resonance Imaging (MRI) assessment, paired with a deep understanding of the various patterns of cord involvement allied to detailed clinical data can provide a diagnosis or significantly limit the differential diagnosis in most cases. In this article, we aim to review the most common and noteworthy intramedullary and extramedullary spinal tumors, as well as some other tumoral mimics, with an emphasis on their MRI morphologic characteristics.
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Affiliation(s)
- Jean L R de Paiva
- Department of Anesthesiology, Oncology and Radiology, University of Campinas (UNICAMP), Campinas, Brazil
| | - João V Sabino
- Department of Anesthesiology, Oncology and Radiology, University of Campinas (UNICAMP), Campinas, Brazil
| | - Fernanda V Pereira
- Department of Anesthesiology, Oncology and Radiology, University of Campinas (UNICAMP), Campinas, Brazil
| | - Paulo A Okuda
- Department of Anesthesiology, Oncology and Radiology, University of Campinas (UNICAMP), Campinas, Brazil
| | | | | | - Marcondes C França
- Department of Neurology, University of Campinas (UNICAMP), Campinas, Brazil
| | - Fabiano Reis
- Department of Anesthesiology, Oncology and Radiology, University of Campinas (UNICAMP), Campinas, Brazil.
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3
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Farooqi S, Tebha SS, Qamar MA, Singh S, Alfawares Y, Ramanathan V, Haider AS, Ferini G, Sharma M, Umana GE, Aoun SG, Palmisciano P. Clinical Characteristics, Management, and Outcomes of Intramedullary Spinal Cord Ependymomas in Adults: A Systematic Review. World Neurosurg 2023; 173:237-250.e8. [PMID: 36858296 DOI: 10.1016/j.wneu.2023.02.098] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 02/18/2023] [Accepted: 02/20/2023] [Indexed: 03/02/2023]
Abstract
BACKGROUND Intramedullary spinal cord ependymomas (IMSCEs) are rare tumors that mostly occur in adults. Management strategies and related outcomes are heterogeneously reported across the literature, demanding a comprehensive analysis to standardize guidelines. We performed a systematic review of the literature on IMSCEs. METHODS A literature search was conducted using 6 databases from inception up to July 28, 2022. Studies with data on clinical characteristics, management strategies, and related outcomes in adult patients with histopathologically confirmed IMSCEs were pooled and analyzed. RESULTS The analysis included 69 studies comprising 457 patients (52.7% males). Mean age was 42.4 ± 7.4 years. Sensory deficit (58.0%) was the most prevalent symptom, followed by radicular pain (50.5%). Tumors mostly involved the cervical (64.4%) or thoracic (18.8%) spinal cord and were mostly World Health Organization grade II (80.5%) and classic subtype (72.4%). Gross total resection was performed in most cases (83.4%), with adjuvant radiotherapy delivered in 10.5% of cases. Progression-free survival ≥2 years was reported in 61.1% of cases, and tumor recurrence or progression was reported in only 7.0% of the patients. At last follow-up, 97.4% of patients were alive. CONCLUSIONS IMSCEs are uncommon tumors that frequently manifest with debilitating symptoms that require surgical treatment. When feasible, gross total resection may be pursued to improve the patient's functional status and prevent tumor progression, with adjuvant radiotherapy required only in some more aggressive grade III lesions. Future studies should investigate different growth patterns and prognoses based on different IMSCE subtypes.
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Affiliation(s)
| | - Sameer Saleem Tebha
- Department of Neurosurgery and Neurology, Jinnah Medical and Dental College, Karachi, Pakistan
| | | | - Spencer Singh
- Department of Neurosurgery, University of Cincinnati, Cincinnati, Ohio, USA
| | - Yara Alfawares
- Department of Neurosurgery, University of Cincinnati, Cincinnati, Ohio, USA
| | - Vishan Ramanathan
- Department of Neurosurgery, University of Cincinnati, Cincinnati, Ohio, USA
| | - Ali S Haider
- Department of Neurosurgery, The University of Texas M.D. Anderson Cancer Center, Houston, Texas, USA
| | - Gianluca Ferini
- Department of Radiation Oncology, REM Radioterapia srl, Viagrande, Italy
| | - Mayur Sharma
- Department of Neurosurgery, University of Minnesota, Minneapolis, Minnesota, USA
| | - Giuseppe E Umana
- Department of Neurosurgery, Trauma Center, Gamma Knife Center, Cannizzaro Hospital, Catania, Italy
| | - Salah G Aoun
- Department of Neurosurgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Paolo Palmisciano
- Department of Neurosurgery, University of Cincinnati, Cincinnati, Ohio, USA.
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Sankhla SK, Khan GM. Holocord Tanycytic Ependymoma: An Interesting Case with Unusual Presentation, Challenging Histological Diagnosis, and Single-staged Complete Tumor Resection. J Pediatr Neurosci 2020; 15:183-189. [PMID: 33531930 PMCID: PMC7847113 DOI: 10.4103/jpn.jpn_100_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2019] [Revised: 11/04/2019] [Accepted: 03/29/2020] [Indexed: 11/12/2022] Open
Abstract
An interesting case of intramedullary holocord cystic tumor in an 11-year old boy is reported, who presented with unusual clinical manifestations and radiological features. Gross total resection of the tumor was performed in a single-staged surgery. A rare combination of unusual presentation, uncommon histopathological findings, and challenges in the selection of surgical options were discussed with a detailed review of the literature.
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Affiliation(s)
| | - Ghulam M Khan
- Department of Neurosurgery, Global Hospital, Mumbai, India
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Parkhi M, Gupta K, Singh A, Salunke P. Giant Cell-rich Tanycytic Ependymoma as Intramedullary Spinal Mass. Neurol India 2019; 67:1327-1330. [PMID: 31744969 DOI: 10.4103/0028-3886.271272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Intramedullary spinal cord tumors are rare neoplasms and harbour full spectrum of primary neoplasms as seen within the intracranial compartment. They include tumors with diverse pathologies, arising in both adults and children and pose considerable diagnostic challenge. The differentials at this site include wide ranging pathologies from benign, circumscribed pilocytic to diffuse astrocytoma, myxopapillary or tanycytic ependymoma and malignant diffuse midline glioma. Rare instances of glioneuronal tumors, pleomorphic xanthoastrocytoma have also been described at this location. H3K27M mutant diffuse midline high grade glioma is the new entry to this list in 2016 updated WHO classification. We describe the morphologic features of a diagnostically challenging intramedullary spinal cord tumor masquerading as a high grade lesion due its cellular composition and discuss its differentials. The report also emphasizes the role of already established and recently introduced immunohistochemical markers and other ancillary techniques as useful adjuncts in the diagnosis.
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Affiliation(s)
- Mayur Parkhi
- Department of Histopathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Kirti Gupta
- Department of Histopathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Apinderpreet Singh
- Department of Neurosurgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Pravin Salunke
- Department of Neurosurgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Kim DJ, Han MH, Lee S. Extramedullary tanycytic ependymoma of the lumbar spinal cord. Yeungnam Univ J Med 2019; 37:128-132. [PMID: 31707775 PMCID: PMC7142023 DOI: 10.12701/yujm.2019.00367] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Accepted: 11/04/2019] [Indexed: 11/06/2022] Open
Abstract
Tanycytic ependymoma is a rare variant of ependymoma that commonly affects the cervical and thoracic spinal cord. It usually arises as intramedullary lesions, and extramedullary cases are extremely rare. We report a case of a 44-year-old woman who was diagnosed with tanycytic ependymoma in her lumbar spine at level 2-3. The tumor mass developed in an intradural extramedullary location. Histopathologically, tanycytic ependymoma can be misdiagnosed as schwannoma or pilocytic astrocytoma. Immunohistochemical findings such as strong positivity for glial fibrillary acidic protein, perinuclear dot-like positive patterns for epithelial membrane antigen, and focal positivity for S100 protein are helpful in diagnosing tanycytic ependymoma. It is important to be aware of this rare tumor to ensure appropriate patient management and accurate prognosis.
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Affiliation(s)
- Dong Ja Kim
- Department of Forensic Medicine, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Man-Hoon Han
- Department of Pathology, Kyungpook National University Hospital, Daegu, Korea
| | - SangHan Lee
- Department of Forensic Medicine, School of Medicine, Kyungpook National University, Daegu, Korea
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7
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Sun XY, Wang W, Zhang TT, Kong C, Sun SY, Guo MC, Ding JZ, Lu SB. Factors associated with postoperative outcomes in patients with intramedullary Grade II ependymomas: A Systematic review and meta-analysis. Medicine (Baltimore) 2019; 98:e16185. [PMID: 31232977 PMCID: PMC6637017 DOI: 10.1097/md.0000000000016185] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Most of the previous studies combined all types of intramedullary ependymomas without providing accurate pathological subtypes. In addition, it was very difficult to evaluate the factors associated with postoperative outcomes of patients with different pathological subtypes of intramedullary Grade II ependymomas by traditional meta-analysis. This study evaluated the factors related with postoperative outcomes of patients with intramedullary Grade II ependymomas. METHODS Individual patient data analysis was performed using PubMed, Embase, and the Cochrane Central Register of Controlled Trials. The search included articles published up to April 2018 with no lower date limit on the search results. The topics were intramedullary Grade II ependymomas. Progression-free survival (PFS) and overall survival (OS) were analyzed by Kaplan-Meier survival analysis (log-rank test). The level of significance was set at P < .05. RESULTS A total of 21 studies with 70 patients were included in this article. PFS of patients who underwent total resection was much longer than the PFS of those who received subtotal resection (P < .001). Patients who received adjuvant therapy (P = .005) or radiotherapy and chemotherapy (P < .001) seemed to have shorter PFS than others; PFS of patients who had cerebrospinal fluid disease dissemination (P = .022) or scoliosis (P = .001) were significantly shorter than others. OS of cellular ependymoma patients was less than giant cell ependymoma patients (P < .001). CONCLUSIONS PFS of patients who received total resection was much longer than those who received subtotal resection. Patients treated with adjuvant therapy or radiotherapy and chemotherapy appeared to have shorter PFS than others; PFS of patients with cerebrospinal fluid disease dissemination or scoliosis were significantly shorter than others. Cellular ependymomas would have better OS than giant cell ependymoma. However, giant cell ependymoma patients might have the worst OS.
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Affiliation(s)
- Xiang-Yao Sun
- Department of Orthopedics, Xuanwu Hospital Capital Medical University
- National Clinical Research Center for Geriatric Diseases
- Capital Medical University
| | - Wei Wang
- Department of Orthopedics, Xuanwu Hospital Capital Medical University
- National Clinical Research Center for Geriatric Diseases
- Capital Medical University
| | - Tong-Tong Zhang
- Department of Orthopedics, Xuanwu Hospital Capital Medical University
- Capital Medical University
- Department of Orthopaedics, ChuiYangLiu Hospital Affiliated to Tsinghua University, Beijing, China
| | - Chao Kong
- Department of Orthopedics, Xuanwu Hospital Capital Medical University
- National Clinical Research Center for Geriatric Diseases
| | - Si-Yuan Sun
- Department of Orthopedics, Xuanwu Hospital Capital Medical University
- National Clinical Research Center for Geriatric Diseases
- Capital Medical University
| | - Ma-Chao Guo
- Department of Orthopedics, Xuanwu Hospital Capital Medical University
- National Clinical Research Center for Geriatric Diseases
- Capital Medical University
| | - Jun-Zhe Ding
- Department of Orthopedics, Xuanwu Hospital Capital Medical University
- National Clinical Research Center for Geriatric Diseases
- Capital Medical University
| | - Shi-Bao Lu
- Department of Orthopedics, Xuanwu Hospital Capital Medical University
- National Clinical Research Center for Geriatric Diseases
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8
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Hou Z, Tao X, Zhang J, Wu Z, Liu B. Tanycytic ependymoma of filum terminale: Clinical characteristics and surgical outcomes. Oncol Lett 2018; 16:6910-6917. [PMID: 30546423 PMCID: PMC6256739 DOI: 10.3892/ol.2018.9531] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2016] [Accepted: 11/29/2017] [Indexed: 11/05/2022] Open
Abstract
Tanycytic ependymoma (TE), a rare subtype of ependymoma, was classified as grade II ependymoma by the World Health Organization in 2000 and 2007. Preoperative diagnosis of TE is challenging due to its similarities to schwannoma and astrocytoma; therefore, differentiation is required. The present study investigated the clinical, imaging and pathological characteristics of TE in the filum terminale. A retrospective analysis was conducted on the clinical, imaging, pathological and immunohistochemical characteristics of 8 patients with TE in the filum terminale and the relevant literature was reviewed. Of the 8 patients 7 were female and 1 was male, with an age range of 24–62 years old. The primary clinical symptom observed was lumbago, accompanied by lower limb pain and numbness. Magnetic resonance imaging predominantly identified isointensity on thoracic (T) 1-weighted images and iso- or hyperintense signal intensity on T2-weighted images, with homogeneous or inhomogeneous enhancement. All patients underwent resection of the tumor through a posterior median approach, and total resection was acighieved in 7 patients. During postoperative follow-up, all patients experienced improvement compared with their preoperative status, and were without tumor recurrence. The present study comprised the largest group of cases with TE in the filum terminale reported so far, to the best of our knowledge, which could foster a better understanding of this disease. Complete surgical resection of the tumor has the greatest effectiveness of any treatment for TE in the filum terminale. Postoperative histological examination, immunohistochemistry and electron microscopy for tumor specimens may assist in its diagnosis and differential diagnosis.
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Affiliation(s)
- Zonggang Hou
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing 100050, P.R. China
| | - Xiaogang Tao
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing 100050, P.R. China
| | - Junting Zhang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing 100050, P.R. China
| | - Zhen Wu
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing 100050, P.R. China
| | - Baiyun Liu
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing 100050, P.R. China
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9
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Petrovic M, Miletic-Kovacevic M, Jovanovic N, Nikolic R, Raicevic S, Kovacevic V. Tanycytic Ependymoma of the Filum Terminale Region; a Case Report. SERBIAN JOURNAL OF EXPERIMENTAL AND CLINICAL RESEARCH 2018. [DOI: 10.1515/sjecr-2017-0007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Tanycytic ependymoma is a very rare spindle-cell variant of ependymoma derived from tanycytes, which are part of the primitive nervous system. This paper is presenting 48-year old woman who presented with low back and right-sided leg pain of moderate intensity. MRI showed spinal intradural tumor at the level of the L1 vertebral body. Right-sided L1 hemilaminectomy and en bloc tumor resection were performed. Neuroradiological and intraoperative diagnosis of schwannoma was revised to tanycytic ependymoma after careful immunohistochemical analysis. Six months post-operativly, MRI did not show tumor recurrence. Tanycytic ependymoma at the region of filum terminale is extremely uncommon and only three cases have been described in the literature. The low incidence of this tumor and atypical histological image, which is distinct from the typical features of commonly encountered ependymomas, can present a challenge in terms of making an accurate diagnosis. Awareness of this transitional form of ependymoma among neurosurgeons and pathologists may avoid incorrect surgical approaches and postoperative treatment course.
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Affiliation(s)
- Marko Petrovic
- Center for neurosurgery, Clinical Center Kragujevac , Kragujevac , Serbia
- Faculty of Medical Sciences , University of Kragujevac , Kragujevac , Serbia
| | | | - Nemanja Jovanovic
- Center for neurosurgery, Clinical Center Kragujevac , Kragujevac , Serbia
- Faculty of Medical Sciences , University of Kragujevac , Kragujevac , Serbia
| | - Radivoje Nikolic
- Center for neurosurgery, Clinical Center Kragujevac , Kragujevac , Serbia
- Faculty of Medical Sciences , University of Kragujevac , Kragujevac , Serbia
| | - Savo Raicevic
- Department of pathology, Clinical Center of Serbia , Belgrade , Serbia
| | - Vojin Kovacevic
- Center for neurosurgery, Clinical Center Kragujevac , Kragujevac , Serbia
- Faculty of Medical Sciences , University of Kragujevac , Kragujevac , Serbia
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10
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Sun XY, Kong C, Lu SB, Sun SY, Guo MC, Ding JZ. Survival outcomes and prognostic factors of patients with intramedullary Grade II ependymomas after surgical treatments. J Clin Neurosci 2018; 57:136-142. [PMID: 30146401 DOI: 10.1016/j.jocn.2018.08.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2017] [Revised: 05/23/2018] [Accepted: 08/08/2018] [Indexed: 12/12/2022]
Abstract
This study evaluated survival outcomes of patients with intramedullary Grade II ependymomas and identify prognostic factors. Electronic searches of PubMed, EMBASE, OVID, the Cochrane Central Register of Controlled Trials were performed to identify trials according to the Cochrane Collaboration guidelines. The objects were intramedullary Grade II ependymoma according to 2007 WHO classification. Kaplan-Meier survival analysis with log-rank test was used to analyze progressive free survival (PFS) and overall survival (OS). Cox proportional hazard model was utilized for multivariate analysis with hazard ratio (HR) and 95% confidence interval (CI) calculated. P values <0.05 were considered statistically significant. A total of 28 studies including 138 cases of intramedullary Grade II ependymomas were retrieved. Patients who were classified as cellular ependymomas or papillary ependymomas had higher risks of progression than those who possessed typical Grade II ependymomas. Patients who were treated with adjuvant therapy had a higher risk of progression than those without adjuvant therapy. OS of patients with giant cell ependymoma was significantly shorter than those with typical Grade II ependymoma. Patients who had cellular or papillary subtype, adjuvant therapy would have a shorter estimated value of progression-free time and a higher risk of progression than typical Grade II ependymomas. Giant cell ependymoma patients would have a higher risk of fatality than those with typical Grade II ependymomas. Definite pathology type and appropriate treatments were foundations of intramedullary Grade II ependymomas' managements.
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Affiliation(s)
- Xiang-Yao Sun
- Department of Orthopedics, Xuanwu Hospital Capital Medical University, China; National Clinical Research Center for Geriatric Diseases, China; Capital Medical University, China.
| | - Chao Kong
- Department of Orthopedics, Xuanwu Hospital Capital Medical University, China; National Clinical Research Center for Geriatric Diseases, China
| | - Shi-Bao Lu
- Department of Orthopedics, Xuanwu Hospital Capital Medical University, China; National Clinical Research Center for Geriatric Diseases, China.
| | - Si-Yuan Sun
- Department of Orthopedics, Xuanwu Hospital Capital Medical University, China; National Clinical Research Center for Geriatric Diseases, China; Capital Medical University, China
| | - Ma-Chao Guo
- Department of Orthopedics, Xuanwu Hospital Capital Medical University, China; National Clinical Research Center for Geriatric Diseases, China; Capital Medical University, China
| | - Jun-Zhe Ding
- Department of Orthopedics, Xuanwu Hospital Capital Medical University, China; National Clinical Research Center for Geriatric Diseases, China; Capital Medical University, China
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Wang Y, Cai R, Wang R, Wang C, Chen C. Outcome predictors in the management of intramedullary classic ependymoma: An integrative survival analysis. Medicine (Baltimore) 2018; 97:e10870. [PMID: 29879023 PMCID: PMC5999504 DOI: 10.1097/md.0000000000010870] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
UNLABELLED This is a retrospective study.The aim of this study was to illustrate the survival outcomes of patients with classic ependymoma (CE) and identify potential prognostic factors.CE is the most common category of spinal ependymomas, but few published studies have discussed predictors of the survival outcome.A Boolean search of the PubMed, Embase, and OVID databases was conducted by 2 investigators independently. The objects were intramedullary grade II ependymoma according to 2007 WHO classification. Univariate Kaplan-Meier analysis and Log-Rank tests were performed to identify variables associated with progression-free survival (PFS) or overall survival (OS). Multivariate Cox regression was performed to assess hazard ratios (HRs) with 95% confidence intervals (95% CIs). Statistical analysis was performed by SPSS version 23.0 (IBM Corp.) with statistical significance defined as P < .05.A total of 35 studies were identified, including 169 cases of CE. The mean follow-up time across cases was 64.2 ± 51.5 months. Univariate analysis showed that patients who had undergone total resection (TR) had better PFS and OS than those with subtotal resection (STR) and biopsy (P = .002, P = .004, respectively). Within either univariate or multivariate analysis (P = .000, P = .07, respectively), histological type was an independent prognostic factor for PFS of CE [papillary type: HR 0.002, 95% CI (0.000-0.073), P = .001, tanycytic type: HR 0.010, 95% CI (0.000-0.218), P = .003].It was the first integrative analysis of CE to elucidate the correlation between kinds of factors and prognostic outcomes. Definite histological type and safely TR were foundation of CE's management. LEVEL OF EVIDENCE 4.
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12
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Tao X, Hou Z, Hao S, Zhang Q, Wu Z, Zhang J, Liu B. The Clinical Features and Surgical Outcomes of Spinal Cord Tanycytic Ependymomas: A Report of 40 Cases. World Neurosurg 2017. [PMID: 28647654 DOI: 10.1016/j.wneu.2017.06.111] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Spinal cord tanycytic ependymomas (TEs) rarely are reported because of extremely low incidence. Understanding of this disease is therefore poor. The aim of this study was to analyze the incidence and clinical, radiologic, pathologic, and prognostic features of spinal cord TEs. METHODS Approximately 4000 spinal cord tumors were resected surgically in Beijing Tiantan Hospital between April 2009 and May 2016. We identified all cases of pathologically proved TEs among these patients. RESULTS TEs accounted for approximately 1% of spinal cord tumors (40 of an estimated 4000). Patients with TE were a mean age of 40.0 years and had no significant sex preference (21 male and 19 female). The median diameter of the maximal tumor was 54.2 mm (range, 16-153 mm). The mean preoperative Japanese Orthopedic Association (JOA) score was 13.0. Radiologically, 47.5% (19/40) cases showed poorly defined tumor border, and 40% (16/40) of them showed preoperative syringomyelia. Gross total resection was achieved in 30 cases, subtotal resection in 8, and partial resection in 2. At the time of discharge, JOA score and neurologic function showed improvement in 26 cases (65%), no change in 12 cases (30%), and worsening in 2 cases (5%). At a median follow-up of 43 months (range, 7-101 months), 1- and 5-year progression-free survival rates were 100.0% and 97.5%, respectively. Only one patient had tumor recurrence which was found 30 months after surgery. No patient died of tumor recurrence. At the latest follow-up, JOA score showed improvement in 30 cases (75%), no change in 8 cases (20%), and worsening in 2 cases (5%). Univariate analysis revealed that tumor size and preoperative JOA score were significantly associated with the short-term outcomes. Meanwhile, age ≥40 years, tumor size ≥50 mm, non-gross total resection, and preoperative JOA score <14 were significantly associated with an increased risk of worsened long-term outcomes. Poorly defined tumor border and preoperative JOA score <14 significantly limited the extent of tumor resection. CONCLUSIONS Spinal cord TE is a rare subtype of ependymomas with low recurrence. Long-term survival can be expected, although poorly defined tumor border is an independent predictor of long-term outcomes. Microsurgical treatment of spinal cord TEs remains a formidable challenge due to the poorly defined border and critical neurovascular structures encasement. It is unnecessary for radical tumor resection at the cost of severe neurologic deficits.
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Affiliation(s)
- Xiaogang Tao
- Department of Neurosurgery, Beijing Tian Tan Hospital, Capital Medical University, Beijing, China
| | - Zonggang Hou
- Department of Neurosurgery, Beijing Tian Tan Hospital, Capital Medical University, Beijing, China
| | - Shuyu Hao
- Department of Neurosurgery, Beijing Tian Tan Hospital, Capital Medical University, Beijing, China
| | - Qi Zhang
- Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Zhen Wu
- Department of Neurosurgery, Beijing Tian Tan Hospital, Capital Medical University, Beijing, China
| | - Junting Zhang
- Department of Neurosurgery, Beijing Tian Tan Hospital, Capital Medical University, Beijing, China
| | - Baiyun Liu
- Department of Neurosurgery, Beijing Tian Tan Hospital, Capital Medical University, Beijing, China; Department of Neurotrauma, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China; Nerve Injury and Repair Center of Beijing Institute for Brain Disorders, Beijing, China; China National Clinical Research Center for Neurological Diseases, Beijing, China; Beijing Key Laboratory of Central Nervous System Injury, Beijing, China.
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Tomek M, Jayajothi A, Brandner S, Jaunmuktane Z, Lee CH, Davagnanam I. Imaging features of spinal tanycytic ependymoma. Neuroradiol J 2016; 29:61-5. [PMID: 26755489 DOI: 10.1177/1971400915621322] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Tanycytic ependymoma is an unusual morphological variant of WHO grade II ependymoma, typically arising from the cervical or thoracic spinal cord. Although the literature deals extensively with pathological features of this tumour entity, imaging features have not been well characterised. The purpose of this study was to review magnetic resonance imaging (MRI) features of spinal tanycytic ependymomas reported in the literature to date, exemplified by a case of a patient with tanycytic ependymoma of the conus medullaris presenting to our hospital. A Medline search of the English literature for all previously published cases of spinal tanycytic ependymoma was carried out and the reported MRI features reviewed. The tumours were found to be typically well-demarcated masses, predominantly showing isointensity on T1-weighted signal, and T2-weighted hyperintensity, with variable patterns of contrast enhancement. A cystic component was seen in half of the cases, and in a minority a mural nodule was present within the cyst wall. Associated syrinx formation was observed in one-third of the cases and haemorrhage was rare, which may be helpful pointers in differentiating the lesion from other ependymoma subtypes. In conclusion, MRI characteristics of spinal tanycytic ependymoma are variable and non-specific, and radiological diagnosis thus remains challenging, although certain predominant features are identified in this report. Knowledge of these is important in the diagnostic differentiation from other intramedullary and extramedullary spinal tumours in order to guide appropriate surgical management.
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Affiliation(s)
- Michal Tomek
- Lysholm Department of Neuroradiology, National Hospital for Neurology and Neurosurgery, UK
| | | | - Sebastian Brandner
- Department of Pathology, National Hospital for Neurology and Neurosurgery, UK
| | - Zane Jaunmuktane
- Department of Pathology, National Hospital for Neurology and Neurosurgery, UK
| | - Cheong Hung Lee
- Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, UK
| | - Indran Davagnanam
- Lysholm Department of Neuroradiology, National Hospital for Neurology and Neurosurgery, UK
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14
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Crowley RW, Burke RM, Lopes MBS, Hamilton DK, Jane JA. Long-term cure of high-grade spinal cord glioma in a pediatric patient who underwent cordectomy. J Neurosurg Spine 2015; 23:635-641. [PMID: 26252785 DOI: 10.3171/2015.7.spine15656] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
High-grade spinal cord gliomas are rare and carry a poor prognosis. A number of treatment modalities exist for spinal cord gliomas, but no consensus exists regarding their management. Cordectomy represents a possible option for treating these lesions; however, few cases have been reported in adults, and none have been reported in the pediatric population. The authors describe the use of cordectomy for the treatment of a high-grade spinal glioma in a 9-year-old boy who remains cancer free 14 years following his initial presentation.
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Affiliation(s)
| | | | - M Beatriz S Lopes
- Pathology, University of Virginia Health System, Charlottesville, Virginia; and
| | - D Kojo Hamilton
- Department of Neurosurgery, University of Pittsburgh, Pennsylvania
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15
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Kuga Y, Ohnishi H, Kodama Y, Takakura S, Hayashi M, Yagi R, Fukutome K, Matsushima K, Okamoto K, Taomoto K, Takahashi H. Cerebral and spinal cord tanycytic ependymomas in a young adult with a mutation in theNF2gene. Neuropathology 2014; 34:406-13. [DOI: 10.1111/neup.12109] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2013] [Revised: 01/21/2014] [Accepted: 01/22/2014] [Indexed: 11/29/2022]
Affiliation(s)
- Yoshihiro Kuga
- Department of Neurosurgery, Ohnishi Neurological Center, Akashi, Japan
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16
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Rigante L, Novello M, Massimi L, Caldarelli M. A cortical cystic epileptogenic lesion: tanycytic ependymoma. Acta Neurol Belg 2013; 113:523-5. [PMID: 23160807 DOI: 10.1007/s13760-012-0157-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2012] [Accepted: 10/31/2012] [Indexed: 10/27/2022]
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17
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Arvanitis LD, Gattuso P, Nag S. A 40-year-old male with an intraventricular tumor. Combined tanycytic ependymoma and subependymoma. Brain Pathol 2013; 23:359-60. [PMID: 23587142 DOI: 10.1111/bpa.12054] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Combined tumors showing histologic features of both ependymoma and subependymoma have been described. In this report we present a case of combined tanycytic ependymoma with foci of subependymoma (WHO grade II), occurring in a 40 year-old male, which arose in the wall of the lateral ventricle. The tanycytic ependymoma component showed elongated fibrillary cells with a fascicular pattern of growth, while the subependymoma component showed clustered cell bodies surrounded by a fibrillary stroma with a microcystic appearance.We consider the present case to be an unusual example of tanycytic ependymoma; which to the best of our knowledge has not been associated with a subependymoma.
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Funayama T, Sakane M, Yoshizawa T, Takeuchi Y, Ochiai N. Tanycytic ependymoma of the filum terminale associated with multiple endocrine neoplasia type 1: first reported case. Spine J 2013; 13:e49-54. [PMID: 23562332 DOI: 10.1016/j.spinee.2013.02.066] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2012] [Revised: 02/25/2013] [Accepted: 02/25/2013] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Ependymoma associated with multiple endocrine neoplasia type 1 (MEN-1) is an extremely rare clinical entity. To the best of our knowledge, only five cases of ependymoma associated with MEN-1 have been previously described. Furthermore, there has been no case of tanycytic ependymoma of the filum terminale associated with MEN-1. PURPOSE The present case report illustrates a 53-year-old man with tanycytic ependymoma of the filum terminale associated with MEN-1. We review the literature on ependymoma with MEN-1 and tanycytic ependymoma of the cauda equina region and also discuss the risk of recurrence. STUDY DESIGN A case report. METHODS The patient presented with complaints of nocturnal pain in the lower back, accompanied by numbness around the anus and intermittent claudication for approximately 1 year. Magnetic resonance imaging (MRI) identified an intradural-enhancing, large mass lesion at the level from Th12 to L2 vertebrae, with a cranial cystic lesion. RESULTS Open-door laminoplasty of the Th12, L1, and L2 and en bloc tumor resection with thickened filum terminale were performed. Histopathologic examination of the tumor specimens showed tanycytic ependymoma (World Health Organization Classification Grade II). At the time of the 2-year and 8-month follow-up examination, MRI did not show tumor recurrence. CONCLUSIONS This is the first reported case of this clinical entity. A careful follow-up of patients with this unusual tumor is strongly recommended.
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Affiliation(s)
- Toru Funayama
- Department of Orthopaedic Surgery, Graduate School of Comprehensive Human Sciences, University of Tsukuba, 1-1-1 Tennoudai, Tsukuba, Ibaraki 305-8575, Japan.
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Oh MC, Tarapore PE, Kim JM, Sun MZ, Safaee M, Kaur G, Aranda DM, Parsa AT. Spinal ependymomas: benefits of extent of resection for different histological grades. J Clin Neurosci 2013; 20:1390-7. [PMID: 23768966 DOI: 10.1016/j.jocn.2012.12.010] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2012] [Accepted: 12/08/2012] [Indexed: 11/26/2022]
Abstract
Although the World Health Organization (WHO) categorizes spinal ependymomas into three histological grades, difference in surgical outcomes between WHO grades I and II tumors are unclear. For these benign tumors, prognosis may be best determined by factors other than tumor grade alone, such as extent of resection. To analyze the effects of the extent of resection on different grades of spinal ependymomas, we performed a comprehensive literature review to identify adult spinal ependymoma patients who received surgical resection with a clearly identifiable WHO grade. A total of 175 patients were identified. While grade III tumors carried the worst prognosis as expected (p<0.001), grade I and II tumors did not differ significantly in outcomes following surgery. Overall, gross total resection (GTR, 68.7%, 114/166) provided significantly improved progression-free survival (PFS, p<0.001) and overall survival (OS, p=0.022) compared to the subtotal resection group. Surprisingly, the highest GTR rate was achieved for grade II tumors (78.8%, 78/99; p<0.001) followed by grade I (58.9%, 33/56) and grade III tumors (27.3%, 3/11). Interestingly, PFS was significantly improved by GTR for grade II tumors (p<0.001), but not for grade I (p=0.705). Similar trends, although not statistically significant, were found for OS. Our results show that while GTR provides the best overall outcomes, GTR is most effective for classic grade II ependymomas, but not for grade I ependymomas. Despite having a lower WHO grade, myxopapillary ependymomas have a lower GTR rate, and benefit less from GTR.
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Affiliation(s)
- Michael C Oh
- Department of Neurological Surgery, University of California San Fransisco, 505 Parnassus Avenue, San Francisco, CA 94117, USA
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20
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Tanycytic ependymoma: a challenging histological diagnosis. Case Rep Neurol Med 2013; 2013:170791. [PMID: 23476839 PMCID: PMC3586445 DOI: 10.1155/2013/170791] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2012] [Accepted: 01/09/2013] [Indexed: 11/18/2022] Open
Abstract
Tanycytic ependymoma is a rare form of ependymoma that usually arises in the intramedullary spine. It has a unique histology emphasized by the inconspicuous ependymal pattern of cells and close resemblance to schwannoma and astrocytoma. The authors report a 50-year-old man with a cervical tanycytic ependymoma that was initially thought to be a schwannoma. The frozen histology section showed spindle cells with oval and elongated nuclei with occasional hemosiderin deposits present suggesting a preliminary diagnosis of schwannoma. Immunohistochemical staining of the permanent section revealed strong immunoreactivity for glial fibrillary acidic protein with intermittent S-100 positivity, confirming that the tumor was a tanycytic ependymoma. This underlines the challenges involved in making an accurate diagnosis and demonstrates that careful and detailed histological inspection with immunohistochemical stains and ultrastructural microscopy may be necessary to distinguish tanycytic ependymoma from other neoplasms.
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Oh MC, Kim JM, Kaur G, Safaee M, Sun MZ, Singh A, Aranda D, Molinaro AM, Parsa AT. Prognosis by tumor location in adults with spinal ependymomas. J Neurosurg Spine 2013; 18:226-35. [PMID: 23311515 DOI: 10.3171/2012.12.spine12591] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
OBJECT Ependymomas are primary central nervous system tumors that occur more frequently in the spines of adults than they do there in children. Previous studies consist mainly of retrospective single-institutional experiences or case studies. In this study, a comprehensive literature review was performed on reported cases of spinal ependymoma treated with resection to determine whether tumor location along the spinal axis conveys important prognostic information. METHODS A PubMed search was performed to identify all papers that included data on patients with spinal ependymoma. Only cases involving adult patients who underwent ependymoma resection with a clearly reported tumor location were included for analysis. Tumor locations were separated into 6 groups: cervicomedullary, cervical, cervicothoracic, thoracic, thoracolumbar, and conus + cauda equina. Kaplan-Meier survival and Cox regression analyses were performed to determine the effect of tumor location on progression-free survival (PFS) and overall survival (OS). RESULTS A total of 447 patients who underwent resection of spinal ependymomas with clearly indicated location of tumor were identified. The most common locations of spinal ependymomas were the cervical (32.0%) and conus + cauda equina (26.8%) regions. The thoracolumbar and cervicomedullary regions had the fewest tumors (accounting for, respectively, 5.1% and 3.4% of the total number of cases). The conus + cauda equina and thoracolumbar regions had the highest percentage of WHO Grade I tumors, while tumors located above these regions consisted of mostly WHO Grade II tumors. Despite the tendency for benign grades in the lower spinal regions, PFS for patients with spinal ependymomas in the lower 3 regions (thoracic, thoracolumbar, conus + cauda equina) was significantly shorter (p < 0.001) than for those with tumors in the upper regions (cervicomedullary, cervical, cervicothoracic), but the difference in OS did not achieve statistical significance (p = 0.131). CONCLUSIONS Spinal ependymomas along different regions of spinal axis have different characteristics and clinical behaviors. Tumor grade, extent of resection, and PFS varied by tumor location (upper vs lower spinal regions), while OS did not. Recurrence rates were higher for the lower spinal cord tumors, despite a greater prevalence of lower WHO grade lesions, compared with upper spinal cord tumors, suggesting that tumor location along the spinal axis is an important prognostic factor.
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Affiliation(s)
- Michael C Oh
- Departments of Neurological Surgery, University of California, SanFrancisco, CA 94117 USA
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22
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Oh MC, Ivan ME, Sun MZ, Kaur G, Safaee M, Kim JM, Sayegh ET, Aranda D, Parsa AT. Adjuvant radiotherapy delays recurrence following subtotal resection of spinal cord ependymomas. Neuro Oncol 2012; 15:208-15. [PMID: 23229996 DOI: 10.1093/neuonc/nos286] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Ependymoma is the most common glial tumor of the adult spinal cord. Current consensus recommends surgical resection with gross total resection (GTR) whenever possible. We performed a comprehensive review of the literature to evaluate whether adjuvant radiotherapy after subtotal resection (STR) has any benefit. METHODS A PubMed search was performed to identify adult patients with spinal cord ependymoma who underwent surgical resection. Only patients who had clearly defined extent of resection with or without adjuvant radiotherapy were included for analysis. Kaplan-Meier and multivariate Cox regression survival analyses were performed to determine the effects of adjuvant radiotherapy on progression-free survival (PFS) and overall survival (OS). RESULTS A total of 348 patients underwent surgical resection of spinal cord ependymomas, where GTR was obtained in 77.0% (268/348) of patients. Among those who received STR, 58.8% (47/80) received adjuvant radiotherapy. PFS was significantly prolonged among those who received adjuvant radiotherapy after STR (log rank; P < .001). This prolonged PFS with adjuvant radiotherapy remained significant in multivariate Cox regression analysis (STR versus STR + RT group; hazard ratio (HR) = 2.26, P = .047). By contrast, improved OS was only associated with GTR (GTR versus STR + RT group; HR = 0.07, P = .001) and benign ependymomas (HR = 0.16, P = .001). CONCLUSIONS Surgery remains the mainstay treatment for spinal cord ependymomas, where GTR provides optimal outcomes with longest PFS and OS. Adjuvant radiotherapy prolongs PFS after STR significantly, and OS is improved by GTR and benign tumor grade only.
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Affiliation(s)
- Michael C Oh
- Department of Neurological Surgery, University of California at San Francisco, 505 Parnassus Ave, San Francisco, CA 94117, USA
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Shintaku M, Yoshida M, Ikarashi T, Arakawa Y, Nagashima T. Ependymoma with "granular cell" features: report of two cases. Neuropathology 2012; 32:654-61. [PMID: 22369487 DOI: 10.1111/j.1440-1789.2012.01298.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
We report two cases of ependymoma which showed prominent "granular cell" changes of the cytoplasm. The patients were a 7-year-old boy with a tumor in the cerebellum (case 1) and a 70-year-old man with a tumor in the frontal lobe (case 2). The tumor of case 1 showed a histopathological appearance of ependymoma containing many focal aggregates of large polygonal cells in which the cytoplasm was stuffed with numerous eosinophilic granules. The tumor of case 2 predominantly showed the features of papillary ependymoma, and some tumor cells were swollen and contained similar eosinophilic granules. Intracytoplasmic granules in both tumors were immunoreactive for GFAP and ubiquitin, but not for epithelial membrane antigen, CD68 or mitochondria. Ultrastructurally, they were found as aggregates of membrane-bound, electron-dense, globular structures. Karyotypic analysis of the tumor in case 1 demonstrated 2, 11 and 12 trisomies. Intracytoplasmic eosinophilic granules occasionally occur in astrocytic and oligodendroglial neoplasms, but an appearance of similar granules is very rare in ependymoma. The two cases presented here may represent a new histopathological variant of ependymoma, and the term "granular cell ependymoma" is appropriate for them.
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Affiliation(s)
- Masayuki Shintaku
- Department of Pathology, Osaka Red Cross Hospital, Tennoji, Osaka, Japan.
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Rapid spontaneous malignant progression of supratentorial tanycytic ependymoma with sarcomatous features – “Ependymosarcoma”. Pathol Res Pract 2010; 206:493-8. [DOI: 10.1016/j.prp.2009.07.013] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2009] [Revised: 06/28/2009] [Accepted: 07/15/2009] [Indexed: 11/17/2022]
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Spinal cord tanycytic ependymoma associated with neurofibromatosis type 2. J Clin Neurosci 2010; 17:922-4. [PMID: 20403699 DOI: 10.1016/j.jocn.2009.09.045] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2009] [Revised: 09/14/2009] [Accepted: 09/15/2009] [Indexed: 11/23/2022]
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Shintaku M, Sakamoto T. Tanycytic ependymoma of the filum terminale with pleomorphic giant cells. Brain Tumor Pathol 2009; 26:79-82. [DOI: 10.1007/s10014-009-0252-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2009] [Accepted: 04/13/2009] [Indexed: 10/20/2022]
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A case of cervicomedullary junction tanycytic ependymoma associated with marked cyst formation. Brain Tumor Pathol 2009; 22:29-33. [PMID: 18095101 DOI: 10.1007/s10014-005-0174-5] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2005] [Accepted: 02/16/2005] [Indexed: 10/25/2022]
Abstract
Tanycytic ependymomas are a subtype of ependymomas that were formally recognized as a new pathological entity in the latest World Health Organization (WHO) classification of 2000. They occur mostly in the spinal cord. Only a few reports have analyzed the proliferative potentials of these tumors; however, it has been reported that the MIB-1 labeling index of tanycytic ependymoma is lower than that of other subtypes of WHO grade II ependymomas. We report a rare case of cervicomedullary junction tanycytic ependymoma associated with marked cyst formation. A 62-year-old man had a history of progressive gait disturbance, diplopia, and swallowing disturbance over a one-month period prior to admission. Magnetic resonance imaging (MRI) showed a cystic mass with a mural nodule at the cervicomedullary junction with Gd-DTPA enhancement. Cyst-subarachnoid shunt was performed using a far lateral approach. After 6 years, however, the man was readmitted to the hospital because of reaccumulation of the cyst. Partial removal of a mural nodule and a cyst-subarachnoid shunt were performed simultaneously by a midline suboccipital approach. The pathological diagnosis was tanycytic ependymoma. Postoperatively, the patient recovered well and was discharged from the hospital without further treatment. Most of the tumor cells had small, round nuclei; pleomorphism was minimal. The cytoplasm was dilated. The tumor cells were positive for EMA and s-100, and negative for CD-34. GFAP was not determined due to difficulty caused by background glial processes. The MIB-1 labeling index was less than 1%. Ultrastructurally, the tumor cells had ependymal cell features, such as desmosomes and microvilli. Based on these findings, the pathological diagnosis was tanycytic ependymoma.
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Abstract
Ependymomas represent a heterogeneous group of glial tumors whose biological behavior depends on various histological, molecular, and clinical variables. The scope of this chapter is to review the clinical and histo-logical features as well as the molecular genetics of ependymomas with special emphasis on their influence on tumor recurrence and prognosis. Furthermore, potential molecular targets for therapy are outlined.
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Affiliation(s)
- Martin Hasselblatt
- Institute of Neuropathology, University of Münster, Domagkstr. 19, Münster, 48129, Germany.
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29
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Tanycytic ependymoma of the spinal cord with anaplastic cytological features. Brain Tumor Pathol 2009; 26:7-10. [PMID: 19408091 DOI: 10.1007/s10014-008-0239-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2008] [Accepted: 09/18/2008] [Indexed: 10/20/2022]
Abstract
In a 43-year-old man, an intramedullary spinal cord tumor spreading from the level of the T2 to T5 vertebrae was subtotally resected. The tumor predominantly consisted of a fascicular proliferation of spindle cells having bland nuclei and bipolar, long cytoplasmic processes, and a few perivascular pseudo-rosettes were found. Although there were no true ependymal rosettes, intracytoplasmic dot-like immunoreactivity for epithelial membrane antigen (EMA) was found in a few cells. In some areas, a dense and diffuse proliferation of anaplastic, short-spindled cells having hyperchromatic nuclei and scant cytoplasm was noted, and the Ki-67 labeling index was remarkably higher (18.2%) in these areas. Neither microvascular proliferation nor necrosis was observed. In the boundary region, these two areas showed gradual transition from one to the other. The patient has remained free from recurrence for 10 months postoperatively. This is the first documentation of tanycytic ependymoma in which tumor cells showed anaplastic cytological features.
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Du J, Zhou XJ, Tang QQ, Ma HH, Zhou HB, Wang JD, Lu ZF, Yin HL. Tanycytic ependymoma: two case reports and review of the literature. ACTA ACUST UNITED AC 2009. [DOI: 10.1007/s00580-008-0780-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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31
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Mohindra S, Bal A, Singla N. Pediatric tanycytic ependymoma of the cauda equina: case report and review of the literature. J Child Neurol 2008; 23:451-4. [PMID: 18401036 DOI: 10.1177/0883073807309234] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Tanycytic tumors of the cauda equina region are being increasingly reported. Such tumors can occur among pediatric patients and adults. An unusual case of tanycytic ependymoma located at the region of the cauda equina is reported in a girl. The clinical presentation, radiological features, intraoperative findings, and histopathologic features are described. The prognostic significance of differentiating such a neoplasm from other intramedullary tumors is noted. A heightened awareness of this pathologic entity among neurosurgeons and pathologists will help in diagnosing this neoplasm and in enabling better patient management.
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Affiliation(s)
- Sandeep Mohindra
- Department of Neurosurgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
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Chordoid glioma: report of two rare examples with unusual features. Acta Neurochir (Wien) 2008; 150:295-300; discussion 300. [PMID: 18246456 DOI: 10.1007/s00701-008-1420-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2007] [Accepted: 10/12/2007] [Indexed: 10/22/2022]
Abstract
BACKGROUND Chordoid glioma, a rare tumour of the third ventricle, represents a distinct clinico-pathologic entity. Thirty nine examples have been described in the literature, mostly in females and in the third ventricle. The clinical presentation is variable but they tend to occur mostly in adults. There is only one report of a chordoid glioma in a 12 year old child. FINDING This paper describes two examples of chordoid glioma in a seven year old female child and a 70 year old male respectively. Radiologically, the paediatric chordoid glioma was located in the juxtaventricular region in the occipital horn of the lateral ventricle and was of mixed density whereas the adult patient had a typical third ventricle location with homogenous contrast enhancement. Gross total surgical removal was achieved in both but the adult patient died post-operatively due to intra ventricular bleeding and bacterial meningitis. The younger patient is doing well at the last follow up two years post-operatively. Microscopically, both showed the classic morphology of chordoid glioma. Ultrastructural examination was suggestive of ependymal differentiation. CONCLUSION The younger age and unusual location are some of the rare features which need documentation and have not been described earlier. We propose that chordoid glioma is a variant of an ependymoma (WHO grade II) which arises from tanycytes and should be included in the WHO classification of brain tumors.
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Central Nervous System Tumors With Ependymal Features: A Broadened Spectrum of Primarily Ependymal Differentiation? J Neuropathol Exp Neurol 2008; 67:177-88. [DOI: 10.1097/nen.0b013e31816543a6] [Citation(s) in RCA: 67] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
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Zhang S, Wang X, Zhang Z, Chen Y. Tanycytic ependymoma arising from the right lateral ventricle: a case report and review of the literature. Neuropathology 2008; 28:427-32. [PMID: 18312548 DOI: 10.1111/j.1440-1789.2007.00857.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
A 38-year-old man presented with a year-long history of worsening headache. Neuroradiological findings showed that a solid cystic mass occupied the right lateral ventricle. Histologically, the tumor composed of nuclear dense zones consisting of a cluster of spindle cells and fibrillary zones consisting of streaming of cell processes. The tumor cells showed the characteristics of monopolar or bipolar processes. Some tumor cell processes extended to the vessel wall and formed ill-defined perivascular rosettes. No mitoses or necrosis were found. The cells presented positive for GFAP, S-100 protein, vimentin, Nestin and neurofilament, and dotlike positive for epithelial membrane antigen, but negative for Syn and NeuN. Four cases of tanycytic ependymoma arising from the lateral ventricle have been reported in literature. Histological differential diagnosis includes spindle-shaped neuroepithelial tumors, such as pilocytic astrocytoma, fibrillary astrocytoma and schwannoma. Tanycytic ependymoma has slightly better prognosis than other ependymoma subtypes.
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Affiliation(s)
- Sheng Zhang
- Department of Pathology, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China.
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Ito T, Ozaki Y, Nakamura H, Tanaka S, Nagashima K. A case of tanycytic ependymoma arising from the cerebral hemisphere. Brain Tumor Pathol 2006; 23:91-5. [DOI: 10.1007/s10014-006-0208-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2006] [Accepted: 06/22/2006] [Indexed: 10/24/2022]
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Kubota T, Sato K, Arishima H, Takeuchi H, Kitai R, Nakagawa T. Astroblastoma: immunohistochemical and ultrastructural study of distinctive epithelial and probable tanycytic differentiation. Neuropathology 2006; 26:72-81. [PMID: 16521483 DOI: 10.1111/j.1440-1789.2006.00636.x] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
We report the clinicopathological findings of astroblastoma found in an 8-year-old girl who was subsequently treated for 11 years. The primary superficially circumscribed tumor was located in the frontoparietal lobe, while the recurrent and the second recurrent tumor were restricted to the same region 11 years later. The tumors obtained on these three occasions showed fundamentally the same histological, immunohistochemical and fine structural features. They exhibited astrocytic as well as ependymal tanycytic features with apparent epithelial cell lineage. The tumor cells showed typical features of astroblastoma comprising prominent perivascular pseudorosettes with remarkable vascular sclerosis. The immunohistochemical study revealed intensive positivity of GFAP, vimentin, epithelial membrane antigen (EMA), cytokeratin, connexin 26 and 32, desmocollin 1 and neuronal cadherin. The fine structure revealed divergent types of junctional complexes, some of which were connected with tonofilament bundles. Numerous microvilli protruded and basal lamina abutted on the tumor cell surface. We report these unique histological features, and stress that astroblastoma should be categorized as a specific type of neuroepithelial tumor.
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Affiliation(s)
- Toshihiko Kubota
- Department of Neurosurgery, Faculty of Medical Sciences, University of Fukui, Matsuoka-Cho, Yoshida-Gun, Fukui, Japan.
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Sato K, Kubota T, Ishida M, Handa Y. Spinal tanycytic ependymoma with hematomyelia--case report--. Neurol Med Chir (Tokyo) 2005; 45:168-71. [PMID: 15782011 DOI: 10.2176/nmc.45.168] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
A 58-year-old man presented with an extremely rare case of "pure type" spinal tanycytic ependymoma associated with hematomyelia manifesting as sensory disturbance of the bilateral hands and weakness of the right arm. Magnetic resonance imaging demonstrated a tumor in the spinal cord from C-2 to C-4 levels. The soft gelatinous tumor was subtotally resected and the adjacent chronic liquid hematoma was aspirated. The immunohistochemical and ultrastructural findings indicated a diagnosis of tanycytic ependymoma.
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Affiliation(s)
- Kazufumi Sato
- Division of Neurosurgery, Department of Sensory & Locomotor Medicine, Faculty of Medical Science, University of Fukui.
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Richards AL, Rosenfeld JV, Gonzales MF, Ashley D, Mc Lean C. Supratentorial tanycytic ependymoma. J Clin Neurosci 2004; 11:928-30. [PMID: 15519882 DOI: 10.1016/j.jocn.2004.03.022] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2004] [Accepted: 03/22/2004] [Indexed: 10/26/2022]
Abstract
Tanycytic ependymoma is a rare fibrillary variant of ependymoma with a predilection for the spinal cord. We present an unusual supratentorial subcortical tanycytic ependymoma in a 17-year old male presenting with seizures. Only two other cases of subcortical tanycytic ependymoma have been reported.
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Affiliation(s)
- Amanda L Richards
- Department of Neurosurgery and Surgery, The Alfred Hospital, Commercial Road, Prahran, Vic. 3181, Australia
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Moritani S, Kushima R, Bamba M, Kobayashi TK, Oka H, Fujimoto M, Hattori T, Okabe H. Highly anaplastic extraventricular ependymoma arising in an adult, mimicking metastatic adenocarcinoma with heavy stromal inflammation and emperiporesis. Pathol Int 2003; 53:539-46. [PMID: 12895233 DOI: 10.1046/j.1440-1827.2003.01517.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
We report a case of extraventricular ependymoma arising in a 50-year-old woman that took an aggressive clinical course with recurrence three times. The initial tumor was a well-circumscribed nodule in the right temporal white matter measuring 2 cm in diameter. It showed variegated histological findings mimicking metastatic adenocarcinoma: an epithelioid arrangement of highly pleomorphic cells with pseudopapillary structures and perivascular pseudorosettes, and bizarre multinucleated giant cells with occasional emperiporesis surrounded by abundant mononuclear inflammatory cells, as well as a focal small area of conventional ependymoma. Emperiporesis and abundant mononuclear cell infiltration were not previously described in an ependymoma. The recurrent tumors predominantly showed an epithelioid pattern with frequent formation of astroblastoma-like pseudopapillary structures. Neoplastic cells were markedly atypical and had characteristic intracytoplasmic eosinophilic inclusion bodies. Much of the cells in both the initial and recurrent tumors showed a positive immunostaining for glial fibrillary acidic protein (GFAP) with accentuation to the cytoplasmic processes of the pseudorosettes and pseudopapillary structures. Epithelial membrane antigen (EMA) highlighted the epithelial differentiation of the tumor cells, while cytokeratin was completely negative. Although this tumor might be classified to at least WHO grade III from the histology and aggressive behavior, the exact grading is still controversial because of the rarity of such cases.
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Affiliation(s)
- Suzuko Moritani
- Department of Pathology, Saiseikai Shiga Hospital Imperial Gift Foundation Inc., Ohtsu, Japan.
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Mrak RE. The Big Eye in the 21st century: the role of electron microscopy in modern diagnostic neuropathology. J Neuropathol Exp Neurol 2002; 61:1027-39. [PMID: 12484565 DOI: 10.1093/jnen/61.12.1027] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Electron microscopy (EM) remains a powerful and even essential tool in modern diagnostic neuropathology. tumors are still encountered that defy histological or immunohistochemical classification, and EM can often provide answers in these cases. Tumors of the CNS for which EM is useful include unusual or atypical variants of meningioma, ependymoma, and schwannoma; oligodendroglioma-like tumors composed of small "clear" cells; and small "blue cell" tumors of childhood. EM is of great value in identifying site of origin for metastatic adenocarcinomas of unknown origin-an under-recognized and under-utilized potential for this technique. EM is useful in the diagnosis of peripheral nerve sheath tumors and gastrointestinal autonomic nerve tumors. EM is also important in the evaluation of certain congenital, inherited and metabolic diseases-including ceroid lipofuscinoses, CADASIL syndrome, certain myopathies, and mitochondrial encephalomyopathies--and of certain toxic and drug-induced peripheral neuropathies. An important application of EM is its utility in initiating a workup of an atypical tumor or metabolic condition, for which clinical and histological clues point in no obvious direction. In these situations, EM may provide either an answer outright (including answers to questions not asked) or important clues that guide further workup and narrow the range of diagnostic possibilities.
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Affiliation(s)
- Robert E Mrak
- Department of Pathology, University of Arkansas for Medical Sciences, 4301 West Markham Street, Little Rock, AR 72205, USA
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