Ependymomas in Children and Adults

Beyond the expected: a supratentorial ependymoma imitating a meningioma

INTRODUCTION

Supratentorial ependymomas are rare tumors, particularly in adults, and can present similarly to more common extra-axial masses like meningiomas on imaging. Differentiating between these lesions is crucial for appropriate management.

CASE PRESENTATION

A 16-year-old girl presented with a 1.5-year history of headaches, occasional blurring of vision, and a recent seizure. MRI revealed a 4.7 × 4.0 × 6.9 cm dural-based, extra-axial lesion in the left parietal-temporal region, initially presumed to be a meningioma. The patient underwent a neuronavigation-guided craniotomy with excision of the lesion. Intraoperative findings described a soft, vascular, solid-cystic extra-axial mass, which was initially diagnosed as a meningioma based on preoperative imaging but later confirmed to be a supratentorial ependymoma, ZFTA fusion-positive, CNS WHO grade 3, through histopathological and molecular analysis. Postoperatively, the patient showed no neurological deficits, and a residual tumor was identified on follow-up imaging.

DISCUSSION

This case illustrates the diagnostic challenge posed by the rare presentation of supratentorial, extra-axial ependymomas mimicking meningiomas. Although meningiomas are the most common extra-axial intracranial tumors, some radiological features such as cystic appearance and multiloculation on imaging should raise suspicion for ependymoma or other mimics. However, a definitive diagnosis can only be made through histopathological examination.

CONCLUSION

Supratentorial, extra-axial masses are often misdiagnosed as meningiomas. Such ependymomas can closely resemble meningiomas on imaging. This case underscores the importance of maintaining a broad differential diagnosis for extra-axial masses and highlights the role of certain radiological features that can help with accurate diagnosis or at least raise suspicion of meningioma mimics.

Spinal Ependymomas: An Updated WHO Classification and a Narrative Review

Ependymomas are neuroepithelial tumors that develop from ependymal cells found in the brain parenchyma and can spread to any part of the spinal cord. Three to six percent of all malignancies affecting the central nervous system (CNS) are ependymomas. Even the most talented surgeons are challenged by spinal cord ependymomas; as a result, research into this clinical phenomenon should continue. Since 1979, the World Health Organization (WHO) has published a classification and grading system for CNS malignancies to ensure consistent diagnostic standards worldwide. The WHO prepared an update on these tumors, paying particular attention to molecular techniques to categorize the therapeutic management of each patient with greater accuracy and clarity. We thoroughly reviewed the literature on the epidemiology, etiology, diagnosis, and treatment of spinal ependymomas since there has not been a recent review of these tumors. This included modifications to the 2021 WHO Classification of Tumors of the Central Nervous System.