Ependymoma Workup

  • Author: Jeffrey N Bruce, MD; Chief Editor: Jules E Harris, MD   more...
 
Updated: Jan 13, 2012
 

Laboratory Studies

  • No laboratory studies are helpful in making the diagnosis of ependymoma.
Next

Imaging Studies

  • Ependymomas have some characteristic features on CT scan and MRI that help narrow the differential diagnosis. Whenever possible, patients in whom an ependymoma is suspected should undergo MRI with and without administration of intravenous contrast.[22]
    • Intracranial ependymoma: Intracranial ependymomas are typically isodense on unenhanced CT scans with minimal to moderate enhancement upon contrast administration. Calcification can be noted on unenhanced CT scans in approximately one half of cases. Cyst formation is common in these tumors, and foraminal spread can be observed in posterior fossa lesions through the foramina of Luschka and Magendie. On precontrast and postcontrast MRI, tumors often appear heterogeneous secondary to necrosis, hemorrhage, and calcification. Variable signal intensity is noted on T1- and T2-weighted images, although intracranial ependymomas are usually hypointense to isointense on T1-weighted images and hyperintense compared with gray matter, on T2-weighted images. See the images below. CT scan without contrast. Fourth ventricle ependymCT scan without contrast. Fourth ventricle ependymoma. CT scan without contrast. Fourth ventricle ependymCT scan without contrast. Fourth ventricle ependymoma. Note blood in the fourth ventricle. CT scan without contrast in the patient with fourtCT scan without contrast in the patient with fourth ventricle ependymoma. Blood has refluxed into the third and lateral ventricles. CT scan without contrast in the patient with fourtCT scan without contrast in the patient with fourth ventricle ependymoma. Note blood traversing foramina. T1-weighted MRI. Rare case of a fourth ventricle eT1-weighted MRI. Rare case of a fourth ventricle ependymoma presenting as an intraventricular bleed. T1-weighted MRI without contrast demonstrating epeT1-weighted MRI without contrast demonstrating ependymoma located in the fourth ventricle. T2-weighted MRI demonstrating ependymoma in the foT2-weighted MRI demonstrating ependymoma in the fourth ventricle. Coronal T1-weighted MRI with contrast demonstratinCoronal T1-weighted MRI with contrast demonstrating ependymoma of the fourth ventricle.
    • Spinal ependymoma:
      • In general, most intramedullary tumors are isointense or slightly hypointense to the surrounding spinal cord on T1-weighted images. Often, only subtle spinal cord enlargement is evident. T2-weighted images are more sensitive because most tumors are hyperintense to the spinal cord on these pulse sequences. T2 studies are not particularly specific and may not distinguish the solid tumor from polar cysts. Nearly all intramedullary neoplasms enhance on T1-weighted contrast examinations. Ependymomas usually demonstrate uniform contrast enhancement and are located symmetrically within the spinal cord. Polar cysts are identified in the majority of cases, particularly in the setting of cervical or cervicothoracic tumors. Heterogeneous enhancement from intratumoral cysts or necrosis can also be observed.
      • In some cases, contrast enhancement of a cystic ependymoma may be minimal. In these cases, distinguishing these tumors from intramedullary astrocytomas is difficult.
Previous
Next

Other Tests

  • Electroencephalography (EEG) performed on a patient with a supratentorial ependymoma may show generalized, diffuse slowing and/or epileptogenic spikes over the area of the tumor. However, no findings on EEG are specific for ependymoma.
Previous
Next

Procedures

  • Lumbar puncture (LP) is generally contraindicated in the setting of a brain tumor because of the risk of transtentorial herniation secondary to increased intracranial pressure. CSF studies do not aid significantly in the diagnosis of ependymomas, with the possible exception of determining leptomeningeal spread in children with posterior fossa tumors. Yet even in this case, spinal MRI performed with and without contrast enhancement is a more optimal study for such a determination. In the case of spinal ependymoma, CSF obtained from LP may show elevated protein levels.
Previous
Next

Histologic Findings

Ependymoma (WHO grade II) pathology includes cellular, papillary, and clear cell variants, as well as anaplastic ependymomas (WHO grade III), myxopapillary ependymomas (WHO grade I), and subependymomas (WHO grade I) (see the images below). Histologically, ependymomas are characterized by ependymal pseudorosettes with glial fibrillary acidic protein (GFAP)–positive processes tapering toward blood vessels. Myxopapillary ependymomas are located at the cauda equina and conus, while subependymoma and anaplastic ependymomas are described at intramedullary locations. See the images below.

Gross surgical specimen of a fourth ventricle epenGross surgical specimen of a fourth ventricle ependymoma. Histologic study of a classic ependymoma. Note theHistologic study of a classic ependymoma. Note the characteristic perivascular pseudorosettes. Cellular ependymoma. Cells with a high nuclear-cytCellular ependymoma. Cells with a high nuclear-cytoplasmic ratio. Few pseudorosettes or paucicellular areas are present. Myxopapillary ependymoma. Clusters of loosely arraMyxopapillary ependymoma. Clusters of loosely arranged cuboidal cells separated by pools of mucin. Clear cell ependymoma. Round cells with cytoplasmiClear cell ependymoma. Round cells with cytoplasmic clearing. This may mimic an oligodendroglioma.

A variety of histologic ependymoma subtypes may be encountered. The cellular ependymoma is the most common, but epithelial, tanycytic (fibrillar), subependymoma, myxopapillary, or mixed examples also occur. Histologic differentiation from astrocytoma may be difficult, but the presence of perivascular pseudorosettes or true rosettes establishes the diagnosis. Most spinal ependymomas are histologically benign, although necrosis and intratumoral hemorrhage are frequent. Although unencapsulated, these glial-derived tumors are usually well circumscribed and do not infiltrate adjacent spinal cord tissue. Recent attempts to correlate the expression of MIB-1 antigen with malignancy of ependymomas have been confounded by tumor heterogeneity. Myxopapillary ependymoma histology consists of a papillary arrangement of cuboidal or columnar tumor cells surrounding a vascularized core of hyalinized and poorly cellular connective tissue.

Previous
Next

Staging

No conventional staging criteria exist for intracranial or spinal ependymomas. Postoperative MRI is recommended within 48 hours of tumor resection to assess presence of residual tumor and to facilitate adjuvant treatment planning. In the case of children with ependymomas of the fourth ventricle, a surveillance spinal MRI is often recommended to rule out seeding.

Previous
Proceed to Treatment & Management
 
 
Contributor Information and Disclosures
Author

Jeffrey N Bruce, MD  Edgar M Housepian Professor of Neurological Surgery Research, Vice-Chairman and Professor of Neurological Surgery, Director of Brain Tumor Tissue Bank, Director of Bartoli Brain Tumor Laboratory, Department of Neurosurgery, Columbia University College of Physicians and Surgeons

Jeffrey N Bruce, MD is a member of the following medical societies: Alpha Omega Alpha, American Association for the Advancement of Science, American Association of Neurological Surgeons, American Society of Clinical Oncology, Congress of Neurological Surgeons, New York Academy of Sciences, North American Skull Base Society, Pituitary Society, Society for Neuro-Oncology, and Society of Neurological Surgeons

Disclosure: NIH Grant/research funds Other

Coauthor(s)

David J Fusco, MD  Resident Physician in Neurological Surgery, Barrow Neurosurgical Institute, St Joseph's Hospital and Medical Center

David J Fusco, MD is a member of the following medical societies: American Association of Neurological Surgeons, American Medical Association, Congress of Neurological Surgeons, and North American Spine Society

Disclosure: Nothing to disclose.

Neil A Feldstein, MD  Director of Pediatric Neurosurgery, Department of Neurosurgery, Babies and Children's Hospital of New York, Assistant Professor, Departments of Clinical Neurosurgery and Pediatrics, Columbia-Presbyterian Medical Center, Columbia University

Neil A Feldstein, MD is a member of the following medical societies: American Association of Neurological Surgeons, American Cleft Palate/Craniofacial Association, American College of Surgeons, American Medical Association, and Medical Society of the State of New York

Disclosure: Nothing to disclose.

Benjamin Kennedy  Columbia University College of Physicians and Surgeons

Disclosure: Nothing to disclose.

Specialty Editor Board

Robert C Shepard, MD, FACP  Associate Professor of Medicine in Hematology and Oncology at University of North Carolina at Chapel Hill; Vice President of Scientific Affairs, Therapeutic Expertise, Oncology, at PRA International

Robert C Shepard, MD, FACP is a member of the following medical societies: American Association for Cancer Research, American College of Physician Executives, American College of Physicians, American Federation for Clinical Research, American Federation for Medical Research, American Medical Association, American Medical Informatics Association, American Society of Hematology, Association of Clinical Research Professionals, Eastern Cooperative Oncology Group, European Society for Medical Oncology, Massachusetts Medical Society, and Society for Biological Therapy

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Rajalaxmi McKenna, MD, FACP  Southwest Medical Consultants, SC, Department of Medicine, Good Samaritan Hospital, Advocate Health Systems

Rajalaxmi McKenna, MD, FACP is a member of the following medical societies: American Society of Clinical Oncology, American Society of Hematology, and International Society on Thrombosis and Haemostasis

Disclosure: Nothing to disclose.

Chief Editor

Jules E Harris, MD  Clinical Professor of Medicine, Section of Hematology/Oncology, University of Arizona College of Medicine, Arizona Cancer Center

Jules E Harris, MD is a member of the following medical societies: American Association for Cancer Research, American Association for the Advancement of Science, American Association of Immunologists, American Society of Hematology, and Central Society for Clinical Research

Disclosure: GlobeImmune Salary Consulting

Additional Contributors

We wish to acknowledge previous contributions to this article by Paul C McCormick, MD, and Allen Waziri, MD.

References

  1. Applegate GL, Marymont MH. Intracranial ependymomas: a review. Cancer Invest. 1998;16(8):588-93. [Medline].

  2. Schwartz TH, Kim S, Glick RS, et al. Supratentorial ependymomas in adult patients. Neurosurgery. Apr 1999;44(4):721-31. [Medline].

  3. Verma A, Zhou H, Chin S, Bruggers C, Kestle J, Khatua S. EGFR as a predictor of relapse in myxopapillary ependymoma. Pediatr Blood Cancer. Dec 20 2011;[Medline].

  4. Tripathy P, Mohapatra D, Mohapatra S. Primary intradural extramedullary ependymoma: report of two cases and review of the literature. Neurol Neurochir Pol. Jul-Aug 2011;45(4):397-401. [Medline].

  5. Costa FF, Bischof JM, Vanin EF, Lulla RR, Wang M, Sredni ST, et al. Identification of microRNAs as potential prognostic markers in ependymoma. PLoS One. 2011;6(10):e25114. [Medline]. [Full Text].

  6. Son DW, Song GS, Han IH, Choi BK. Primary extramedullary ependymoma of the cervical spine : case report and review of the literature. J Korean Neurosurg Soc. Jul 2011;50(1):57-9. [Medline]. [Full Text].

  7. Poppleton H, Gilbertson RJ. Stem cells of ependymoma. Br J Cancer. Jan 15 2007;96(1):6-10. [Medline].

  8. Taylor MD, Poppleton H, Fuller C, Su X, Liu Y, Jensen P, et al. Radial glia cells are candidate stem cells of ependymoma. Cancer Cell. Oct 2005;8(4):323-35. [Medline].

  9. Dal Cin P, Sandberg AA. Cytogenetic findings in a supratentorial ependymoma. Cancer Genet Cytogenet. Feb 1988;30(2):289-93. [Medline].

  10. Metzger AK, Sheffield VC, Duyk G, et al. Identification of a germ-line mutation in the p53 gene in a patient with an intracranial ependymoma. Proc Natl Acad Sci U S A. Sep 1 1991;88(17):7825-9. [Medline].

  11. Sainati L, Montaldi A, Putti MC, et al. Cytogenetic t(11;17)(q13;q21) in a pediatric ependymoma. Is 11q13 a recurring breakpoint in ependymomas?. Cancer Genet Cytogenet. Apr 1992;59(2):213-6. [Medline].

  12. Mazewski C, Soukup S, Ballard E, et al. Karyotype studies in 18 ependymomas with literature review of 107 cases. Cancer Genet Cytogenet. Aug 1999;113(1):1-8. [Medline].

  13. Nijssen PC, Deprez RH, Tijssen CC, et al. Familial anaplastic ependymoma: evidence of loss of chromosome 22 in tumour cells. J Neurol Neurosurg Psychiatry. Oct 1994;57(10):1245-8. [Medline].

  14. Yokota T, Tachizawa T, Fukino K, Teramoto A, Kouno J, Matsumoto K. A family with spinal anaplastic ependymoma: evidence of loss of chromosome 22q in tumor. J Hum Genet. 2003;48(11):598-602. [Medline].

  15. Ebert C, von Haken M, Meyer-Puttlitz B, et al. Molecular genetic analysis of ependymal tumors. NF2 mutations and chromosome 22q loss occur preferentially in intramedullary spinal ependymomas. Am J Pathol. Aug 1999;155(2):627-32. [Medline].

  16. Hulsebos TJ, Oskam NT, Bijleveld EH, Westerveld A, Hermsen MA, van den Ouweland AM. Evidence for an ependymoma tumour suppressor gene in chromosome region 22pter-22q11.2. Br J Cancer. Dec 1999;81(7):1150-4. [Medline].

  17. James CD, He J, Carlbom E, et al. Loss of genetic information in central nervous system tumors common to children and young adults. Genes Chromosomes Cancer. Jul 1990;2(2):94-102. [Medline].

  18. Yao Y, Mack SC, Taylor MD. Molecular genetics of ependymoma. Chin J Cancer. Oct 2011;30(10):669-81. [Medline].

  19. McGuire CS, Sainani KL, Fisher PG. Incidence patterns for ependymoma: a Surveillance, Epidemiology, and End Results study. J Neurosurg. Dec 5 2008;[Medline].

  20. Bouffet E, Perilongo G, Canete A, Massimino M. Intracranial ependymomas in children: a critical review of prognostic factors and a plea for cooperation. Med Pediatr Oncol. Jun 1998;30(6):319-29; discussion 329-31. [Medline].

  21. Polednak AP, Flannery JT. Brain, other central nervous system, and eye cancer. Cancer. Jan 1 1995;75(1 Suppl):330-7. [Medline].

  22. Macdonald J. Advances in imaging techniques in neuroendocrine tumors: miscellaneous papers of interest. Curr Opin Oncol. Feb 1990;2(1):117-8. [Medline].

  23. Chamberlain MC, Kormanik PA. Practical guidelines for the treatment of malignant gliomas. West J Med. Feb 1998;168(2):114-20. [Medline].

  24. Merchant TE. Current management of childhood ependymoma. Oncology (Williston Park). 2002/05;16(5):629-42, 644; discussion 645-6, 648.

  25. Timmermann B, Kortmann RD, Kühl J, Meisner C, Slavc I, Pietsch T. Combined postoperative irradiation and chemotherapy for anaplastic ependymomas in childhood: results of the German prospective trials HIT 88/89 and HIT 91. Int J Radiat Oncol Biol Phys. Jan 15 2000;46(2):287-95. [Medline].

  26. National Comprehensive Cancer Network. NCCN Practice Guidelines in Oncology: Adult Intracranial Ependymomas. Available at http://www.nccn.org/professionals/physician_gls/PDF/cns.pdf. Accessed Jan 2009.

  27. Rogers L, Pueschel J, Spetzler R, et al. Is gross-total resection sufficient treatment for posterior fossa ependymomas?. J Neurosurg. Apr 2005;102(4):629-36. [Medline].

  28. Merchant TE, Li C, Xiong X, Gaber MW. Cytokine and Growth Factor Responses After Radiotherapy for Localized Ependymoma. Int J Radiat Oncol Biol Phys. Nov 17 2008;[Medline].

  29. Goldwein JW, Glauser TA, Packer RJ, et al. Recurrent intracranial ependymomas in children. Survival, patterns of failure, and prognostic factors. Cancer. Aug 1 1990;66(3):557-63. [Medline].

  30. Chiu JK, Woo SY, Ater J, et al. Intracranial ependymoma in children: analysis of prognostic factors. J Neurooncol. Jul 1992;13(3):283-90. [Medline].

  31. Stafford SL, Pollock BE, Foote RL, Gorman DA, Nelson DF, Schomberg PJ. Stereotactic radiosurgery for recurrent ependymoma. Cancer. Feb 15 2000;88(4):870-5. [Medline].

  32. Partap S, Fisher PG. Update on new treatments and developments in childhood brain tumors. Curr Opin Pediatr. Dec 2007;19(6):670-4. [Medline].

  33. Reni M, Gatta G, Mazza E, Vecht C. Ependymoma. Crit Rev Oncol Hematol. Jul 2007;63(1):81-9. [Medline].

  34. Tabori U, Ma J, Carter M, Zielenska M, Rutka J, Bouffet E, et al. Human telomere reverse transcriptase expression predicts progression and survival in pediatric intracranial ependymoma. J Clin Oncol. Apr 1 2006;24(10):1522-8. [Medline].

  35. Sowar K, Straessle J, Donson AM, Handler M, Foreman NK. Predicting which children are at risk for ependymoma relapse. J Neurooncol. May 2006;78(1):41-6. [Medline].

  36. Modena P, Lualdi E, Facchinetti F, Veltman J, Reid JF, Minardi S, et al. Identification of tumor-specific molecular signatures in intracranial ependymoma and association with clinical characteristics. J Clin Oncol. Nov 20 2006;24(33):5223-33. [Medline].

  37. Catsman-Berrevoets CE, Van Dongen HR, Mulder PG, et al. Tumour type and size are high risk factors for the syndrome of "cerebellar" mutism and subsequent dysarthria. J Neurol Neurosurg Psychiatry. Dec 1999;67(6):755-7. [Medline].

  38. Doxey D, Bruce D, Sklar F, et al. Posterior fossa syndrome: identifiable risk factors and irreversible complications. Pediatr Neurosurg. Sep 1999;31(3):131-6. [Medline].

  39. Healey EA, Barnes PD, Kupsky WJ, Scott RM, Sallan SE, Black PM. The prognostic significance of postoperative residual tumor in ependymoma. Neurosurgery. May 1991;28(5):666-71; discussion 671-2. [Medline].

  40. Carrie C, Mottolese C, Bouffet E, Negrier S, Bachelot TH, Lasset C. Non-metastatic childhood ependymomas. Radiother Oncol. Aug 1995;36(2):101-6. [Medline].

  41. McGuire CS, Sainani KL, Fisher PG. Both location and age predict survival in ependymoma: a SEER study. Pediatr Blood Cancer. Jan 2009;52(1):65-9. [Medline].

  42. Amirian ES, Armstrong TS, Gilbert MR, Scheurer ME. Predictors of survival among older adults with ependymoma. J Neurooncol. Sep 28 2011;[Medline].

  43. Tomita T, McLone DG, Das L, Brand WN. Benign ependymomas of the posterior fossa in childhood. Pediatr Neurosci. 1988;14(6):277-85. [Medline].

  44. Sutton LN, Goldwein J, Perilongo G, Lang B, Schut L, Rorke L. Prognostic factors in childhood ependymomas. Pediatr Neurosurg. 1990-1991;16(2):57-65. [Medline].

  45. Jayawickreme DP, Hayward RD, Harkness WF. Intracranial ependymomas in childhood: a report of 24 cases followed for 5 years. Childs Nerv Syst. Jul 1995;11(7):409-13. [Medline].

  46. Pollack IF, Gerszten PC, Martinez AJ, et al. Intracranial ependymomas of childhood: long-term outcome and prognostic factors. Neurosurgery. Oct 1995;37(4):655-66; discussion 666-7. [Medline].

  47. Robertson PL, Zeltzer PM, Boyett JM, et al. Survival and prognostic factors following radiation therapy and chemotherapy for ependymomas in children: a report of the Children's Cancer Group. J Neurosurg. Apr 1998;88(4):695-703. [Medline].

  48. Horn B, Heideman R, Geyer R, Pollack I, Packer R, Goldwein J. A multi-institutional retrospective study of intracranial ependymoma in children: identification of risk factors. J Pediatr Hematol Oncol. May-Jun 1999;21(3):203-11. [Medline].

  49. Merchant TE, Mulhern RK, Krasin MJ, Kun LE, Williams T, Li C. Preliminary results from a phase II trial of conformal radiation therapy and evaluation of radiation-related CNS effects for pediatric patients with localized ependymoma. J Clin Oncol. Aug 1 2004;22(15):3156-62. [Medline].

  50. Bailey P. Tumors arising from ependymal cells. Arch Neurol Psychiatr. 1924;11:1-27.

  51. Barnholtz-Sloan JS, Severson RK, Stanton B, Hamre M, Sloan AE. Pediatric brain tumors in non-Hispanics, Hispanics, African Americans and Asians: differences in survival after diagnosis. Cancer Causes Control. Jun 2005;16(5):587-92. [Medline].

  52. Bijlsma EK, Voesten AM, Bijleveld EH, et al. Molecular analysis of genetic changes in ependymomas. Genes Chromosomes Cancer. Aug 1995;13(4):272-7. [Medline].

  53. Birch BD, Johnson JP, Parsa A, et al. Frequent type 2 neurofibromatosis gene transcript mutations in sporadic intramedullary spinal cord ependymomas. Neurosurgery. Jul 1996;39(1):135-40. [Medline].

  54. Duffner PK, Krischer JP, Sanford RA, Horowitz ME, Burger PC, Cohen ME. Prognostic factors in infants and very young children with intracranial ependymomas. Pediatr Neurosurg. Apr 1998;28(4):215-22. [Medline].

  55. Goldwein JW, Leahy JM, Packer RJ, et al. Intracranial ependymomas in children. Int J Radiat Oncol Biol Phys. Dec 1990;19(6):1497-502. [Medline].

  56. Guyotat J, Signorelli F, Desme S, Frappaz D, Madarassy G, Montange MF. Intracranial ependymomas in adult patients: analyses of prognostic factors. J Neurooncol. Dec 2002;60(3):255-68. [Medline].

  57. Kramer DL, Parmiter AH, Rorke LB, et al. Molecular cytogenetic studies of pediatric ependymomas. J Neurooncol. Mar 1998;37(1):25-33. [Medline].

  58. Lyons MK, Kelly PJ. Posterior fossa ependymomas: report of 30 cases and review of the literature. Neurosurgery. May 1991;28(5):659-64; discussion 664-5. [Medline].

  59. Neumann E, Kalousek DK, Norman MG, et al. Cytogenetic analysis of 109 pediatric central nervous system tumors. Cancer Genet Cytogenet. Nov 1993;71(1):40-9. [Medline].

  60. Ransom DT, Ritland SR, Kimmel DW, et al. Cytogenetic and loss of heterozygosity studies in ependymomas, pilocytic astrocytomas, and oligodendrogliomas. Genes Chromosomes Cancer. Nov 1992;5(4):348-56. [Medline].

  61. Rogatto SR, Casartelli C, Rainho CA, Barbieri-Neto J. Chromosomes in the genesis and progression of ependymomas. Cancer Genet Cytogenet. Sep 1993;69(2):146-52. [Medline].

  62. Ross GW, Rubinstein LJ. Lack of histopathological correlation of malignant ependymomas with postoperative survival. J Neurosurg. Jan 1989;70(1):31-6. [Medline].

  63. Rubio MP, Correa KM, Ramesh V, et al. Analysis of the neurofibromatosis 2 gene in human ependymomas and astrocytomas. Cancer Res. Jan 1 1994;54(1):45-7. [Medline].

  64. Slavc I, MacCollin MM, Dunn M, et al. Exon scanning for mutations of the NF2 gene in pediatric ependymomas, rhabdoid tumors and meningiomas. Int J Cancer. Aug 22 1995;64(4):243-7. [Medline].

  65. Stratton MR, Darling J, Lantos PL, et al. Cytogenetic abnormalities in human ependymomas. Int J Cancer. Oct 15 1989;44(4):579-81. [Medline].

  66. Stüben G, Stuschke M, Kroll M, Havers W, Sack H. Postoperative radiotherapy of spinal and intracranial ependymomas: analysis of prognostic factors. Radiother Oncol. Oct 1997;45(1):3-10. [Medline].

  67. Tominaga T, Kayama T, Kumabe T, et al. Anaplastic ependymomas: clinical features and tumour suppressor gene p53 analysis. Acta Neurochir (Wien). 1995;135(3-4):163-70. [Medline].

  68. Vagner-Capodano AM, Gentet JC, Gambarelli D, et al. Cytogenetic studies in 45 pediatric brain tumors. Pediatr Hematol Oncol. Jul-Sep 1992;9(3):223-35. [Medline].

  69. Vanuytsel L, Brada M. The role of prophylactic spinal irradiation in localized intracranial ependymoma. Int J Radiat Oncol Biol Phys. Aug 1991;21(3):825-30. [Medline].

  70. von Haken MS, White EC, Daneshvar-Shyesther L, et al. Molecular genetic analysis of chromosome arm 17p and chromosome arm 22q DNA sequences in sporadic pediatric ependymomas. Genes Chromosomes Cancer. Sep 1996;17(1):37-44. [Medline].

  71. Weremowicz S, Kupsky WJ, Morton CC, Fletcher JA. Cytogenetic evidence for a chromosome 22 tumor suppressor gene in ependymoma. Cancer Genet Cytogenet. Jul 15 1992;61(2):193-6. [Medline].

  72. Wernicke C, Thiel G, Lozanova T, et al. Involvement of chromosome 22 in ependymomas. Cancer Genet Cytogenet. Feb 1995;79(2):173-6. [Medline].

  73. Yates AJ. An overview of principles for classifying brain tumors. Mol Chem Neuropathol. Oct 1992;17(2):103-20. [Medline].

 
Previous
Next
 
CT scan without contrast. Fourth ventricle ependymoma.
CT scan without contrast. Fourth ventricle ependymoma. Note blood in the fourth ventricle.
CT scan without contrast in the patient with fourth ventricle ependymoma. Blood has refluxed into the third and lateral ventricles.
CT scan without contrast in the patient with fourth ventricle ependymoma. Note blood traversing foramina.
T1-weighted MRI. Rare case of a fourth ventricle ependymoma presenting as an intraventricular bleed.
T1-weighted MRI without contrast demonstrating ependymoma located in the fourth ventricle.
T2-weighted MRI demonstrating ependymoma in the fourth ventricle.
Coronal T1-weighted MRI with contrast demonstrating ependymoma of the fourth ventricle.
Gross surgical specimen of a fourth ventricle ependymoma.
Histologic study of a classic ependymoma. Note the characteristic perivascular pseudorosettes.
Cellular ependymoma. Cells with a high nuclear-cytoplasmic ratio. Few pseudorosettes or paucicellular areas are present.
Myxopapillary ependymoma. Clusters of loosely arranged cuboidal cells separated by pools of mucin.
Clear cell ependymoma. Round cells with cytoplasmic clearing. This may mimic an oligodendroglioma.
 
 
 
All material on this website is protected by copyright, Copyright © 1994-2012 by WebMD LLC.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.