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Yaltırık CK, Yamaner EO, Suakar Ö, Gürkan S, Sav A, Türe U. Whorling Sclerosing Ependymoma of the Cervical Spinal Cord Presenting Tanycytic Histopathologic Features: A Rare Case Report. Int J Surg Pathol 2023; 31:239-246. [PMID: 35611479 DOI: 10.1177/10668969221099629] [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: 11/16/2022]
Abstract
Tanycytic ependymoma is a neuroectodermal tumor that arises from ependymoglial cells or tanycytes. It is highly uncommon. We reported a 34-year-old man who was diagnosed with intradural-intramedullary tanycytic ependymoma, located at the level of C4-5 who had a 9-months history of neck pain and left arm pain, and numbness on fingers. One month prior to presentation, his left arm numbness and paresthesia deteriorated. The lesion was removed totally by C4, C5 hemilaminoplasty. The histologic pattern of this lesion was consisted of fascicles forming nebula-like whorling structures. Because of these structures, tanycytic ependymoma should be taken into consideration in the differential diagnosis of a whorling-sclerosing variant of meningiomas.
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Affiliation(s)
- Cumhur Kaan Yaltırık
- Department of Neurosurgery, Ümraniye Training And Research Hospital, Istanbul, Turkey
| | - Emin Oğuzcan Yamaner
- Department of Neurosurgery, 64172Yeditepe University School of Medicine, Istanbul, Turkey
| | - Öznur Suakar
- Department of Medical Genetics, School of Medicine, Yeditepe University, Istanbul, Turkey
| | - Sezin Gürkan
- Department of Medical Genetics, School of Medicine, Yeditepe University, Istanbul, Turkey
| | - Aydın Sav
- Department of Pathology, 64172Yeditepe University School of Medicine, Istanbul, Turkey
| | - Uğur Türe
- Department of Neurosurgery, 64172Yeditepe University School of Medicine, Istanbul, Turkey
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Molecular characterization of histopathological ependymoma variants. Acta Neuropathol 2020; 139:305-318. [PMID: 31679042 DOI: 10.1007/s00401-019-02090-0] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Revised: 10/15/2019] [Accepted: 10/27/2019] [Indexed: 01/27/2023]
Abstract
According to the WHO classification, ependymal tumors are classified as subependymomas, myxopapillary ependymomas, classic ependymomas, anaplastic ependymomas, and RELA-fusion-positive ependymomas (RELA-EPN). Among classic ependymomas, the WHO defines rare histological variants, i.e., the clear cell, papillary, and tanycytic ependymoma. In parallel, global DNA methylation patterns distinguish nine molecular groups, some of which tightly overlap with histopathological subgroups. However, the match of the aforementioned histological variants to DNA methylation classes remains unclear. We analyzed histomorphology, clinical parameters, and global DNA methylation of tumors with the initial histological diagnoses of tanycytic (n = 12), clear cell (n = 14), or papillary ependymoma (n = 19). Forty percent of these tumors did not match to the epigenetic profile of ependymomas, using a previously published DNA methylation-based classifier for brain tumors. Instead, they were classified as low-grade glioma (n = 3), plexus tumor (n = 2), CNS high-grade neuroepithelial tumor with MN1 alteration (n = 2), papillary tumor of the pineal region (n = 2), neurocytoma (n = 1), or did not match to any known brain tumor methylation class (n = 8). Overall, integrated diagnosis had to be changed in 35.6% of cases as compared to the initial diagnosis. Among the tumors molecularly classified as ependymoma (27/45 cases), tanycytic ependymomas were mostly located in the spine (5/7 cases) and matched to spinal or myxopapillary ependymoma. 6/8 clear cell ependymomas were found supratentorially and fell into the methylation class of RELA-EPN. Papillary ependymomas with a positive ependymoma match (12/19 cases) showed either a "papillary" (n = 5), a "trabecular" (n = 1), or a "pseudo-papillary" (n = 6) growth pattern. The papillary growth pattern was strongly associated with the methylation class B of posterior fossa ependymoma (PFB, 5/5 cases) and tumors displayed DNA methylation sites that were significantly different when compared to PFB ependymomas without papillary growth. Tumors with pseudo-papillary histology matched to the methylation class of myxopapillary ependymoma (4/6 cases), whereas the trabecular case was anatomically and molecularly a spinal ependymoma. Our results show that the diagnosis of histological ependymoma variants is challenging and epigenetic profiles may improve diagnostic accuracy of these cases. Whereas clear cell and papillary ependymomas display correlations between localization, histology, and methylation, tanycytic ependymoma does not represent a molecularly distinct subgroup.
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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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Das DK. Commentary. J Neurosci Rural Pract 2019; 10:383-385. [PMID: 31001045 PMCID: PMC6454948 DOI: 10.4103/jnrp.jnrp_431_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Dilip Kumar Das
- Department of Pathology, Faculty of Medicine, Kuwait University, Safat and Cytology Unit, Jabriya, Kuwait
- Department of Laboratory Medicine, Mubarak Al-Kabeer Hospital, Jabriya, Kuwait
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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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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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The clinical features and surgical outcomes of intracranial tanycytic ependymomas: a single-institutional experience. J Neurooncol 2017; 134:339-347. [DOI: 10.1007/s11060-017-2531-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Accepted: 06/22/2017] [Indexed: 10/19/2022]
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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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Divito A, Keller JT, Hagen M, Zuccarello M. Vestibular schwannoma or tanycytic ependymoma: Immunohistologic staining reveals. Surg Neurol Int 2014; 5:158. [PMID: 25506503 PMCID: PMC4253034 DOI: 10.4103/2152-7806.144595] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2014] [Accepted: 09/05/2014] [Indexed: 11/04/2022] Open
Abstract
Background: The cerebellopontine angle (CPA) is a common location for primary tumors, most often vestibular schwannomas, and also meningiomas, dermoids, and a host of other neoplasms. Our case report illustrates how radiologic and histopathologic presentations of an unusual variant of ependymal neoplasm can be diagnostically challenging and how accurate diagnosis can affect treatment protocols. Case History: Our patient had a CPA mass that was a variant of ependymoma known as tanycytic ependymoma that mimicked vestibular schwannoma radiologically and during intraoperative pathologic examination. Diagnosis as a World Health Organization (WHO) grade II tanycytic ependymoma was supported by its appearance on evaluation of the permanent sections, its diffuse immunoreactivity for glial fibrillary acidic protein (GFAP), and the perinuclear dot-and-ring-like staining for epithelial membrane antigen (EMA). Conclusions: Our patient's CPA mass initially believed to be a vestibular schwannoma on preoperative evaluation, surgical appearance, and intraoperative pathologic consultation was then correctly diagnosed as a WHO grade II tanycytic ependymoma on permanent histologic sections with the assistance of immunohistochemical stains, including EMA. After this definitive diagnosis, our patient's adjuvant treatment was adjusted. Earlier diagnosis could have provided guidance for goals of resection and prompt initiation of adjuvant treatment.
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Affiliation(s)
- Anthony Divito
- Department of Neurosurgery, University of Cincinnati (UC) College of Medicine, Cincinnati, OH, USA
| | - Jeffrey T Keller
- Department of Neurosurgery, University of Cincinnati (UC) College of Medicine, Cincinnati, OH, USA ; Comprehensive Stroke Center at UC Neuroscience Institute, OH, USA ; Mayfield Clinic, Cincinnati, OH, USA
| | - Matthew Hagen
- Department of Pathology and Laboratory Medicine, University of Cincinnati (UC) College of Medicine, Cincinnati, OH, USA
| | - Mario Zuccarello
- Department of Neurosurgery, University of Cincinnati (UC) College of Medicine, Cincinnati, OH, USA ; Comprehensive Stroke Center at UC Neuroscience Institute, OH, USA ; Mayfield Clinic, Cincinnati, OH, USA
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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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Prognostic role of the number of involved extraspinal organs in patients with metastatic spinal cord compression. Clin Neurol Neurosurg 2014; 118:12-5. [DOI: 10.1016/j.clineuro.2013.12.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2013] [Accepted: 12/14/2013] [Indexed: 12/17/2022]
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