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Cuoco JA, Strohman AC, Stopa BM, Stump MS, Entwistle JJ, Witcher MR, Olasunkanmi AL. Supratentorial cortical ependymoma: A systematic literature review and case illustration. Rare Tumors 2022; 14:20363613221112432. [PMID: 35836750 PMCID: PMC9274435 DOI: 10.1177/20363613221112432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 06/10/2022] [Indexed: 11/26/2022] Open
Abstract
Cortical ependymomas are currently not considered a subgroup of supratentorial
ependymomas; however, there is a growing body of literature investigating the
natural history of these lesions compared to supratentorial ependymomas. We
performed a systematic literature review of cortical ependymomas with a focus on
the natural history, clinical characteristics, and clinical outcomes of these
lesions as compared to supratentorial ependymomas. Our search revealed 153
unique cases of cortical ependymomas. The mean age on presentation was
21.2 years. Males and females comprised 58.8% (90/153) and 41.2% (63/153) of
cases, respectively. The most common presenting symptom was seizure activity
occurring in 44.4% of the cohort (68/153). The recently recognized
C11orf95-RELA fusion was identified in 13.7% of the cohort
(21/153) and 95.5% of cases (21/22) reporting molecular characterization. World
Health Organization grades 2 and 3 were reported in 52.3% (79/151) and 47.7%
(72/151) of cases, respectively. The frontal lobe was involved in the majority
of cases (54.9%, 84/153). Gross total resection was achieved in 80.4% of cases
(123/153). Tumor recurrence was identified in 27.7% of cases (39/141). Mean
clinical follow-up was 41.3 months. Mean overall survival of patients who
expired was 27.4 months whereas mean progression-free survival was 15.0 months.
Comparatively, cortical ependymomas with
C11orf95-RELA fusions and supratentorial
ependymomas with C11orf95 RELA fusions exhibited differing
clinical outcomes. Further studies with larger sample sizes are necessary to
investigate the significance of RELA fusions on survival in
cortical ependymomas and to determine whether cortical ependymomas with
C11orf95-RELA fusions should be classified
as a distinct entity.
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Affiliation(s)
- Joshua A Cuoco
- Section of Neurosurgery, Carilion Clinic, Roanoke, VA, USA.,School of Neuroscience, Virginia Polytechnic Institute and State University, Blacksburg, VA, USA.,Virginia Tech Carilion School of Medicine, Roanoke, VA, USA
| | - Andrew C Strohman
- Section of Neurosurgery, Carilion Clinic, Roanoke, VA, USA.,Virginia Tech Carilion School of Medicine, Roanoke, VA, USA
| | - Brittany M Stopa
- Section of Neurosurgery, Carilion Clinic, Roanoke, VA, USA.,Virginia Tech Carilion School of Medicine, Roanoke, VA, USA
| | - Michael S Stump
- Virginia Tech Carilion School of Medicine, Roanoke, VA, USA.,Department of Pathology, Carilion Clinic, Roanoke, VA, USA
| | - John J Entwistle
- Section of Neurosurgery, Carilion Clinic, Roanoke, VA, USA.,School of Neuroscience, Virginia Polytechnic Institute and State University, Blacksburg, VA, USA.,Virginia Tech Carilion School of Medicine, Roanoke, VA, USA
| | - Mark R Witcher
- Section of Neurosurgery, Carilion Clinic, Roanoke, VA, USA.,School of Neuroscience, Virginia Polytechnic Institute and State University, Blacksburg, VA, USA.,Virginia Tech Carilion School of Medicine, Roanoke, VA, USA
| | - Adeolu L Olasunkanmi
- Section of Neurosurgery, Carilion Clinic, Roanoke, VA, USA.,School of Neuroscience, Virginia Polytechnic Institute and State University, Blacksburg, VA, USA.,Virginia Tech Carilion School of Medicine, Roanoke, VA, USA
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Zhao L, Jiang Y, Wang Y, Bai Y, Liu L, Li Y. Case Report: Sellar Ependymomas: A Clinic-Pathological Study and Literature Review. Front Endocrinol (Lausanne) 2021; 12:551493. [PMID: 34168614 PMCID: PMC8218727 DOI: 10.3389/fendo.2021.551493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 04/19/2021] [Indexed: 11/20/2022] Open
Abstract
Ependymomas are primary glial tumors arising from cells related to the ependymal lining of the ventricular system. They are classified into at least nine different molecular subtypes according to molecular phenotype, histological morphology, and tumor location. Primary sellar ependymoma is an extremely rare malignancy of the central nervous system, with only 12 known cases reported in humans. We herein report a case of ependymoma located at the pituitary region in a 44-year-old female patient and discuss the molecular subtype, natural history, clinical presentation, radiological findings, histological features, immunohistochemical characteristics, ultrastructural examinations, treatment, and prognosis of sellar ependymoma. This case report may serve as a helpful reference for clinicians and radiologists in clinical practice.
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Affiliation(s)
- Liyan Zhao
- Department of Clinical Laboratory, Second Hospital of Jilin University, Changchun, China
| | - Yining Jiang
- Department of Neurosurgery, First Hospital of Jilin University, Changchun, China
| | - Yubo Wang
- Department of Neurosurgery, First Hospital of Jilin University, Changchun, China
| | - Yang Bai
- Department of Neurosurgery, First Hospital of Jilin University, Changchun, China
| | - Liping Liu
- Department of Clinical Laboratory, Second Hospital of Jilin University, Changchun, China
| | - Yunqian Li
- Department of Neurosurgery, First Hospital of Jilin University, Changchun, China
- *Correspondence: Yunqian Li,
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Adult cerebellopontine angle ependymoma presenting as an isolated cisternal mass: A case report. J Med Imaging Radiat Sci 2020; 51:689-693. [PMID: 32888857 DOI: 10.1016/j.jmir.2020.08.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2019] [Revised: 08/02/2020] [Accepted: 08/09/2020] [Indexed: 11/23/2022]
Abstract
INTRODUCTION Ependymomas represent approximately 2%-8% of all primary intracranial brain tumors. The occurrence of extra-axial posterior fossa ependymomas in adults is rare. CASE AND OUTCOMES We report a case of extra-axial cerebellopontine (CP) angle ependymoma in an adult patient, managed through gross total resection (GTR) and adjuvant radiotherapy. At her one-year postoperative visit, the patient remained clinically stable without any symptoms or focal neurological deficit and a follow up MRI showed no evidence of tumor recurrence. DISCUSSION Only six cases of adult cerebellopontine angle ependymomas have been reported in the English literature, with the left side affected more commonly. Including this case, the mean age of the reported cases of adult extra-axial CP angle ependymoma is 44.14 years (range 22-66 years). Men accounted for five out of seven cases (71.4%). Maximal surgical resection is the mainstay of treatment in extra-axial CP angle ependymomas. Among seven reported cases, five received GTR and two had subtotal resection (STR). Patients were followed an average of 13.6 months (range 2-30 months) and only two patients with STR died during the follow-up period (6 weeks and 2 months after surgery). Six of the seven reported cases (including this one) received adjuvant radiotherapy. CONCLUSION Although rare, extra-axial CP angle ependymomas should be considered as a differential diagnosis to other lesions of the CPA. Radical resection, whenever possible, is usually associated with a good outcome. Adjuvant radiotherapy remains an optional treatment with an unknown impact on overall and progression-free survival.
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Asa SL, Mete O. Hypothalamic Endocrine Tumors: An Update. J Clin Med 2019; 8:E1741. [PMID: 31635149 PMCID: PMC6833118 DOI: 10.3390/jcm8101741] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Revised: 10/05/2019] [Accepted: 10/10/2019] [Indexed: 01/10/2023] Open
Abstract
The hypothalamus is the site of synthesis and secretion of a number of endocrine peptides that are involved in the regulation of hormonal activity of the pituitary and other endocrine targets. Tumors of the hypothalamus have been recognized to have both structural and functional effects including hormone hypersecretion. The classification of these tumors has advanced over the last few years, and biomarkers are now available to classify these tumors and provide accurate structure-function correlations. This review provides an overview of tumors in this region that is critical to metabolic homeostasis with a focus on advances in the diagnosis of gangliocytomas, neurocytomas, and pituicytomas that are unique to this region.
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Affiliation(s)
- Sylvia L Asa
- Department of Pathology, Case Western University and University Hospitals, Cleveland, OH 44106, USA.
- Department of Pathology, University Health Network, Toronto, ON M5G 2C4, Canada.
| | - Ozgur Mete
- Department of Pathology, University Health Network, Toronto, ON M5G 2C4, Canada.
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON M5G 1L7, Canada.
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Guerrero-Pérez F, Marengo AP, Vidal N, Iglesias P, Villabona C. Primary tumors of the posterior pituitary: A systematic review. Rev Endocr Metab Disord 2019; 20:219-238. [PMID: 30864049 DOI: 10.1007/s11154-019-09484-1] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
In 2017, the World Health Organization established that pituicytoma, granular cell tumor (GCT), spindle cell oncocytoma (SCO) and sellar ependymomas (SE) are posterior pituitary tumors (PPT). They probably arise from the pituicytes and may constitute a unique histopathological entity. We carried out a systematic review using PubMed's database. A total of 266 patients with pathological diagnosis of PPT (135 pituicytomas, 69 GCT, 47 SCO, 8 SE and 7 mixed histology tumors) were analyzed. Gender distribution was identical and median age at diagnosis was 48 ± 21.8 years. Main presentation symptoms were visual disorders (n = 142; 58.1%), headache (n = 99; 40.5%), hypopituitarism (n = 84; 34.4%), hypercortisolism (n = 10; 4.1%), polyuriapolydipsia (n = 6; 2.4%) and acromegaly features (n = 5; 2.0%). On MRI, 122 (47.6%) patients showed sellar with suprasellar extension masses, 67 (23.1%) were suprasellar and 63 (24.6%) exclusively sellar. Median tumor size was 22.0 ± 14.2 mm. Two hundred sixty four patients underwent surgery, transphenoidal access was selected in 132 (64.4%) and craniotomy in 58 (28.3%). Complications were hypopituitarism (n = 70; 42.1%), diabetes insipidus (n = 55; 33.1%) and hemorrhage (n = 50; 30.1%). Tumor persisted in 93 patients (45.6%) and recurred in 13 (6.4%). Regarding comparison between main types of PPT, SCO patients were diagnosed later (60.0 vs 47.0 vs 47.0 years, p = 0.023), the tumor was larger 25.0 mm [10.8] vs 20.0 mm [14.2] vs 2.0 mm [15.0] and they were frequently sellar with suprasellar extension tumors (71.7% vs 46.2% vs 32.8%, p = 0.003) compared to pituicytoma and GCT. In conclusion, PPT are rare tumors and have been misdiagnosed mainly as non-functioning pituitary adenomas. Different types of PPT share similar epidemiology, clinical manifestations and surgical outcomes. Surgery is the only curative option but complications and subtotal resection are common.
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Affiliation(s)
- Fernando Guerrero-Pérez
- Department of Endocrinology, Bellvitge University Hospital, Carrer de la Feixa Llarga, s/n, 08907 L'Hospitalet de Llobregat, Barcelona, Spain.
| | - Agustina Pia Marengo
- Department of Endocrinology, Bellvitge University Hospital, Carrer de la Feixa Llarga, s/n, 08907 L'Hospitalet de Llobregat, Barcelona, Spain
| | - Noemi Vidal
- Department of Pathology, Bellvitge University Hospital, Carrer de la Feixa Llarga, s/n, 08907 L'Hospitalet de Llobregat, Barcelona, Spain
| | - Pedro Iglesias
- Department of Endocrinology, Puerta de Hierro Majadahonda University Hospital, Calle Manuel de Falla, 1, 28222, Majadahonda, Madrid, Spain
| | - Carles Villabona
- Department of Endocrinology, Bellvitge University Hospital, Carrer de la Feixa Llarga, s/n, 08907 L'Hospitalet de Llobregat, Barcelona, Spain
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Wang M, Zhang R, Liu X, Li D, Zhao P, Zuo Y, Zhang P, Wang J, Sun H. Supratentorial Cortical Ependymomas: A Retrospective Series of 13 Cases at a Single Center. World Neurosurg 2018; 112:e772-e777. [PMID: 29408575 DOI: 10.1016/j.wneu.2018.01.153] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Revised: 01/18/2018] [Accepted: 01/19/2018] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Cortical ependymomas (CEs), supratentorial ependymomas that selectively involve the cerebral cortex, are relatively rare neoplasms that have not been extensively described. The purpose of our study was to identify the clinical features, radiologic characteristics, and treatment of a series of such tumors. METHODS Thirteen patients with CEs from our hospital were included in this study. Epidemiologic characteristics, clinical features, imaging findings, treatment methods, and clinical outcomes were reviewed retrospectively. RESULTS The patients consisted of 7 men and 6 women with mean age of 31.1 ± 23.2 years (range, 4-74 years). The most common clinical manifestation was seizure (n = 11; 85%), followed by headache (n = 2; 15%). None of the tumors were incidentally detected. Eight CEs were located in the right hemisphere and 5 in the left side. The 2 most common tumor locations were the frontal (n = 5; 38%) and parietal lobe (n = 5; 38%). All patients underwent surgical resection. Gross total resection was achieved in 12 patients (92%), and subtotal resection was performed in 1 patient (8%). Ten of the 11 patients who presented with seizure are seizure-free after surgery (91% seizure-free rate). According to the World Health Organization classification system, 9 tumors (69%) were Grade II (ependymoma) and 4 (31%) were Grade III (anaplastic ependymoma). The mean follow-up was 52 months (range, 20-88 months). No recurrence was observed in patients with Grade II CEs. Of 4 patients with Grade III CEs, 2 (50%) suffered from tumor recurrence after initial treatment. CONCLUSIONS CEs are a rare subset of supratentorial ependymomas that selectively involve the cerebral cortex. Most CEs are low grade and present with seizures. Anaplastic CEs show a greater recurrence rate and a relatively poor prognosis. Gross total resection with or without adjuvant radiotherapy is currently the optimal treatment for CEs. CEs seem to have a more favorable prognosis than other supratentorial ependymomas.
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Affiliation(s)
- Mengmeng Wang
- Department of Neurosurgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Rende Zhang
- Department of Neurosurgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Xueyou Liu
- Department of Neurosurgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Dongming Li
- Department of Neurosurgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Peichao Zhao
- Department of Neurosurgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yuchao Zuo
- Department of Neurosurgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Peng Zhang
- Department of Neurosurgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Junkuan Wang
- Department of Neurosurgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Hongwei Sun
- Department of Neurosurgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.
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Wang S, Zong W, Li Y, Wang B, Ke C, Guo D. Pituitary Ependymoma: A Case Report and Review of the Literature. World Neurosurg 2017; 110:43-54. [PMID: 29102750 DOI: 10.1016/j.wneu.2017.10.134] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2017] [Revised: 10/22/2017] [Accepted: 10/24/2017] [Indexed: 11/26/2022]
Abstract
BACKGROUND Pituitary ependymoma is exceptionally rare. Its etiology, clinical presentation, radiologic feature, and treatment strategy are still a matter of debate. Only 7 human cases with limited data were reported in the English literature, and now we described another case of pituitary ependymoma. We also systematically reviewed previously reported cases and described its potential etiology, clinical presentation, radiologic features, pathology, immunohistochemical analysis, and ultrastructural examinations. CASE DESCRIPTION A lesion in pituitary fossa was discovered in a 40-year-old man after suffering a progressive deterioration of vision in his right eye for >1 year with intermittent headache. The lesion was microsurgically resected and proved to be ependymoma upon pathologic and histologic examination. The patient made a fully recovery after surgery. CONCLUSIONS To our knowledge, only 7 patients with ependymoma in the sellar region have been described in the English literature. We reported 1 more case of pituitary ependymoma and discussed the potential etiology, clinical presentation, radiologic features, pathology, immunohistochemical analysis, ultrastructural examinations, treatment, surgery, radiotherapy, chemotherapy, and prognosis of pituitary ependymoma. The case report may serve as a helpful reference for clinicians and radiologists.
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Affiliation(s)
- Sheng Wang
- Department of Neurosurgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, People's Republic of China
| | - Weifeng Zong
- Department of Neurosurgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, People's Republic of China
| | - Youwei Li
- Department of Neurosurgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, People's Republic of China
| | - Baofeng Wang
- Department of Neurosurgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, People's Republic of China
| | - Changsu Ke
- Department of Pathology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, People's Republic of China
| | - Dongsheng Guo
- Department of Neurosurgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, People's Republic of China.
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Lee JS, Cho KH, Hong EK, Shin SH. Pituitary Ependymoma, 10-Year Follow-Up after Partial Resection and Radiation Therapy. Brain Tumor Res Treat 2017; 5:94-98. [PMID: 29188210 PMCID: PMC5700033 DOI: 10.14791/btrt.2017.5.2.94] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Revised: 06/11/2017] [Accepted: 06/19/2017] [Indexed: 11/23/2022] Open
Abstract
Ependymoma usually arises within the ventricles and central canal of the spinal cord. These tumors, found in the sellar region, are extremely rare. We report a case of pituitary ependymoma followed up over 10 years. A 59-year-old male patient presented with fatigue, general weakness, erectile dysfunction, and loss of body hair, including pubic hair. Brain magnetic resonance imaging (MRI) revealed a 3.3×3.5×2.3-cm sellar and suprasellar snowman-shaped enhancing mass. The tumor was partially resected via the trans-sphenoidal approach followed by postoperative radiation therapy. The pathologic confirmation was pituitary ependymoma. At the 10-year follow up, MRI revealed no evidence of tumor progression. With lack of knowledge about pituitary ependymoma, our case is the only case in which the disease has been well controlled over a long period of time without tumor progression.
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Affiliation(s)
- Jong Seok Lee
- Department of Neurosurgery, Seoul National University College of Medicine, Seoul, Korea
| | - Kwan Ho Cho
- Proton Therapy Center, National Cancer Center, Goyang, Korea
| | - Eun Kyung Hong
- Department of Pathology, National Cancer Center, Goyang, Korea
| | - Sang-Hoon Shin
- Neuro-Oncology Clinic, National Cancer Center, Goyang, Korea
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Berhili S, Aissa A, Kadiri S, Cherradi N, El Majjaoui S, El Kacemi H, Kebdani T, Benjaafar N. Extra-axial ependymoma of the cerebral convexity: A very rare intracranial adult tumor. Neuroradiol J 2017; 30:281-285. [PMID: 28059629 DOI: 10.1177/1971400916687584] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background Ependymomas are rare adult tumors that originate from the ventricular system or the ependymal surface of the central canal. Extra-axial supratentorial ependymomas are extremely rare, and only five cases have been reported to date in the English literature. Case presentation A 46-year-old previously healthy male presented with a gradual painless loss of vision in the right eye. Cerebral MRI showed a right parietal-occipital lesion resembling an atypical meningioma. Surgical resection was performed, and immunohistochemical staining results concluded that it was a very uncommon location of a grade 3 ependymoma. Favorable outcome was observed one year after completion of postoperative radiotherapy. Conclusion Clinical and imaging aspects are misleading in rare brain tumors, and immunohistochemistry is essential to re-address diagnosis.
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Affiliation(s)
- Soufiane Berhili
- 1 Radiotherapy Department, National Oncology Institute, Mohamed V University in Rabat, Morocco
| | - Abdellah Aissa
- 1 Radiotherapy Department, National Oncology Institute, Mohamed V University in Rabat, Morocco
| | - Selma Kadiri
- 1 Radiotherapy Department, National Oncology Institute, Mohamed V University in Rabat, Morocco
| | - Nadia Cherradi
- 2 Cytopathology Laboratory, Ibn Sina Specialty Hospital, Mohamed V University in Rabat, Morocco
| | - Sanae El Majjaoui
- 1 Radiotherapy Department, National Oncology Institute, Mohamed V University in Rabat, Morocco
| | - Hanan El Kacemi
- 1 Radiotherapy Department, National Oncology Institute, Mohamed V University in Rabat, Morocco
| | - Tayeb Kebdani
- 1 Radiotherapy Department, National Oncology Institute, Mohamed V University in Rabat, Morocco
| | - Noureddine Benjaafar
- 1 Radiotherapy Department, National Oncology Institute, Mohamed V University in Rabat, Morocco
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Yang Y, Tian KB, Hao SY, Wu Z, Li D, Zhang JT. Primary Intracranial Extra-Axial Anaplastic Ependymomas. World Neurosurg 2016; 90:704.e1-704.e9. [PMID: 26947725 DOI: 10.1016/j.wneu.2016.02.095] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2016] [Revised: 02/23/2016] [Accepted: 02/24/2016] [Indexed: 11/30/2022]
Abstract
BACKGROUND Ependymomas are usually located in the ventricular system or in the central canal of the spinal cord; intracranial extra-axial ependymomas (IEAEs) are rare. To date, only 17 cases of IEAEs have been reported. CASE DESCRIPTION We report 2 cases with 3 IEAEs (anaplastic) that were initially misdiagnosed. In Case 1 (47-year-old male), the para-falcine lesion was initially refractory to radiosurgery and gross total resection (GTR) was required due to relentless growth. The lesion had adhered to the falx and was well demarcated from the surrounding cortex. It was then correctly diagnosed as an anaplastic ependymoma on the basis of histopathology, and the patient received radiotherapy. No recurrence was observed after the 53-month follow-up. In Case 2 (30-year-old male), 2 IEAEs underwent staged surgeries and were identified as extra-axial lesions without connection to the ventricular system. Near total resection (NTR) and GTR were achieved in the right temporal and right occipital lesions, respectively, but the patient declined radiotherapy. The residual tumor after NTR regrew rapidly, and aggressive resection was performed followed by radiotherapy. No further recurrence was observed after 28 months. The previous 17 cases were male predominant (76.5%) without correct preoperative diagnoses; no recurrence was observed after total resection in the 9 patients reported in the literature. CONCLUSIONS IEAEs are rare and have a wide spectrum of clinical and radiological phenotypes. Preoperative diagnosis is difficult. Favorable outcomes for IEAEs can be achieved by GTR plus radiotherapy. Multiple IEAEs benefit from tailored staged surgical resection plus radiotherapy.
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Affiliation(s)
- Yang Yang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, People's Republic of China; China National Clinical Research Center for Neurological Diseases; Center of Brain Tumor, Beijing Institute for Brain Disorders; Beijing Key Laboratory of Brian Tumor
| | - Kai-Bing Tian
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, People's Republic of China; China National Clinical Research Center for Neurological Diseases; Center of Brain Tumor, Beijing Institute for Brain Disorders; Beijing Key Laboratory of Brian Tumor
| | - Shu-Yu Hao
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, People's Republic of China; China National Clinical Research Center for Neurological Diseases; Center of Brain Tumor, Beijing Institute for Brain Disorders; Beijing Key Laboratory of Brian Tumor
| | - Zhen Wu
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, People's Republic of China; China National Clinical Research Center for Neurological Diseases; Center of Brain Tumor, Beijing Institute for Brain Disorders; Beijing Key Laboratory of Brian Tumor
| | - Da Li
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, People's Republic of China; China National Clinical Research Center for Neurological Diseases; Center of Brain Tumor, Beijing Institute for Brain Disorders; Beijing Key Laboratory of Brian Tumor.
| | - Jun-Ting Zhang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, People's Republic of China; China National Clinical Research Center for Neurological Diseases; Center of Brain Tumor, Beijing Institute for Brain Disorders; Beijing Key Laboratory of Brian Tumor.
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Keskin F, Erdi F, Kaya B, Toy H. Sellar-Suprasellar Extraventricular Choroid Plexus Papilloma : A Case Report and Review of the Literature. J Korean Neurosurg Soc 2016; 59:58-61. [PMID: 26885287 PMCID: PMC4754588 DOI: 10.3340/jkns.2016.59.1.58] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2014] [Revised: 11/18/2014] [Accepted: 12/05/2014] [Indexed: 11/30/2022] Open
Abstract
Choroid plexus papillomas (CPPs) are relatively rare neuroectodermal tumors that develop from choroid plexus epithelial cells and are usually restricted to the ventricles. Extraventricular CPPs are very unusual and can be difficult to diagnose and treat. A 50-year-old male patient was admitted to our clinic complaining of headache and visual deterioration. Neurological examination found no abnormalities except decreased light perception and secondary optic atrophy in the left eye. Endocrine testing revealed normal levels of hormones produced by the pituitary and target glands. Magnetic resonance imaging of the brain revealed a huge regular-shaped lesion in the sellar-suprasellar region occupying the sella turcica and extending into the suprasellar cistern and planum sphenoidale. The lesion was completely excised by microsurgery via an ordinary left-sided pterional approach. Histopathology identified the lesion as a choroid plexus papilloma. Following the case report, literature on the origin, differential diagnosis, and treatment of this rare tumor is reviewed.
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Affiliation(s)
- Fatih Keskin
- Department of Neurosurgery, Meram Faculty of Medicine, Necmettin Erbakan University, Konya, Turkey
| | - Fatih Erdi
- Department of Neurosurgery, Meram Faculty of Medicine, Necmettin Erbakan University, Konya, Turkey
| | - Bülent Kaya
- Department of Neurosurgery, Meram Faculty of Medicine, Necmettin Erbakan University, Konya, Turkey
| | - Hatice Toy
- Department of Pathology, Meram Faculty of Medicine, Necmettin Erbakan University, Konya, Turkey
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Parish JM, Bonnin JM, Goodman JM, Cohen-Gadol AA. Intrasellar ependymoma: Clinical, imaging, pathological, and surgical findings. J Clin Neurosci 2015; 22:638-41. [DOI: 10.1016/j.jocn.2014.10.026] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2014] [Accepted: 10/17/2014] [Indexed: 10/23/2022]
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Yang X, Ren Y, Wu W, Wang X, Liu X, Zhang Y. Intracranial extra-axial ependymoma involving the petroclival region: a rare case report. INTERNATIONAL JOURNAL OF CLINICAL AND EXPERIMENTAL PATHOLOGY 2014; 7:9067-9071. [PMID: 25674289 PMCID: PMC4314015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 10/03/2014] [Accepted: 11/26/2014] [Indexed: 06/04/2023]
Abstract
Intracranial extraaxial ependymomas (IEAEs) are very rare, and extra-axial petroclival ependymoma (EAPE) has not been reported in the reviewed English-language literature by now. We present a male patient with EAPE misdiagnosed as a petroclival meningioma preoperatively, and involved recurrence at 4th months after operation though totally resection. Thereafter, we report this case and discuss the clinical characteristics of the disease by briefly review.
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Affiliation(s)
- Xiang Yang
- Department of Neurosurgery, West China Hospital of Sichuan University37, Guoxue Alley, Chengdu 610041, Sichuan Province, P.R. China
| | - Yanming Ren
- Department of Neurosurgery, West China Hospital of Sichuan University37, Guoxue Alley, Chengdu 610041, Sichuan Province, P.R. China
| | - Weilu Wu
- Department of Pathology, West China Hospital of Sichuan University37, Guoxue Alley, Chengdu 610041, Sichuan Province, P.R. China
| | - Xiang Wang
- Department of Neurosurgery, West China Hospital of Sichuan University37, Guoxue Alley, Chengdu 610041, Sichuan Province, P.R. China
| | - Xuesong Liu
- Department of Neurosurgery, West China Hospital of Sichuan University37, Guoxue Alley, Chengdu 610041, Sichuan Province, P.R. China
| | - Yuekang Zhang
- Department of Neurosurgery, West China Hospital of Sichuan University37, Guoxue Alley, Chengdu 610041, Sichuan Province, P.R. China
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Bian LG, Sun QF, Wu HC, Jiang H, Sun YH, Shen JK. Primary choroid plexus papilloma in the pituitary fossa: case report and literature review. Acta Neurochir (Wien) 2011; 153:851-7. [PMID: 21140177 DOI: 10.1007/s00701-010-0884-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2010] [Accepted: 11/12/2010] [Indexed: 11/30/2022]
Abstract
Choroid plexus papillomas are rare tumors of the central nervous system and are usually confined to the ventricular system. We illustrated a primary choroid plexus papilloma in the pituitary fossa. A 31-year-old female presented with amenorrhea and intermittent galactorrhoea, with no visual complaints in the last 2 years. Endocrine testing showed no hormone excess or deficiency of the pituitary and target glands, except for a higher prolactin level (56 ng/ml). A sharply circumscribed regular mass in the sellar region occupying the entire sella turcica and extending into the suprasellar cistern was demonstrated on MR imaging with gadolinium diethylenetriamine pentaacetic acid. The patient underwent an endonasal trans-sphenoidal approach. Complete microsurgical excision and complete preservation of the normal pituitary gland was achieved, with normal prolactin level. The histopathology showed that the lesion was a choroid plexus papilloma. Theories of the origin, the differential diagnosis, and treatment of the rare tumor are discussed.
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Affiliation(s)
- Liu-Guan Bian
- Department of Neurosurgery, Rui Jin Hospital, Shanghai Jiao Tong University School of Medicine, People's Republic of China.
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Belcher R, Chahal HS, Evanson J, Afshar F, Marino S, Grossman AB. Recurrent pituitary ependymoma: a complex clinical problem. Pituitary 2010; 13:176-82. [PMID: 18704689 DOI: 10.1007/s11102-008-0139-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Ependymomas rarely arise from the region of the pituitary fossa, with only four cases previously reported in the literature. We present a complex case of a recurrent ependymoma of the parasellar region which has been difficult to clinically manage due to its tendency to recurrence. Our patient has had four operations over the last 28 years, with external beam radiotherapy, but still has residual tumor and is currently panhypopituitary and with significant visual loss. We believe there is considerable uncertainty as to the optimal management of any future progression, which seems likely, and are currently considering the use of radiosurgery with careful sparing of the optic chiasm, or possibly the chemotherapeutic agent temozolomide. Our case emphasises the recurrent nature of this rare but difficult tumor.
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Affiliation(s)
- Rosie Belcher
- Department of Endocrinology, Barts and the London School of Medicine, London, UK
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Scheithauer BW, Swearingen B, Whyte ETH, Auluck PK, Stemmer-Rachamimov AO. Ependymoma of the sella turcica: a variant of pituicytoma. Hum Pathol 2008; 40:435-40. [PMID: 18992914 DOI: 10.1016/j.humpath.2008.08.013] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2008] [Revised: 08/19/2008] [Accepted: 08/26/2008] [Indexed: 01/09/2023]
Abstract
A broad spectrum of neoplasms affects the sellar region. Among these, gliomas are rare, most being tumors of pituicytes such as granular cell tumor and pituicytoma. Only 4 ependymomas of the human sellar region have been reported to date and all have had classic histologic features. Herein, we describe the clinicopathologic features of a sellar, low-grade ependymoma with unusual histology, but classic ultrastructural features, occurring in an elderly patient and thus expanding the spectrum of reported cases. The literature is reviewed and concepts of histogenesis are explored, particularly an origin in "ependymal pituicytes." The concept that sellar ependymoma is pituicyte-derived is explored.
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Affiliation(s)
- Bernd W Scheithauer
- Department of Pathology and Laboratory Medicine, Mayo Clinic, Rochester, MN 55905, USA.
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Abstract
✓The authors describe a case of pituitary fossa ependymoma and discuss its immunohistochemical and ultrastructural characteristics. A 43-year-old man presented with decreased libido and panhypopituitarism. Magnetic resonance imaging demonstrated a well-demarcated enhancing lesion of the pituitary fossa that was completely resected via a trans-sphenoidal approach. Ependymomas rarely occur in the pituitary fossa, and have been reported in this location only three times in humans and once in a horse. This is the first study in which investigators examined the appearance of a pituitary ependymoma by using electron microscopy. Theories of the origin and treatment of these rare tumors are discussed as they relate to other articles on intracranial ependymomas.
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Affiliation(s)
- Karim Mukhida
- Division of Neurosurgery, University of Toronto and Toronto Western Hospital, Toronto, Ontario, Canada.
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Roncaroli F, Consales A, Fioravanti A, Cenacchi G. Supratentorial Cortical Ependymoma: Report of Three Cases. Neurosurgery 2005; 57:E192; discussion E192. [PMID: 15987557 DOI: 10.1227/01.neu.0000164171.29292.d6] [Citation(s) in RCA: 61] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2003] [Accepted: 01/10/2005] [Indexed: 11/19/2022] Open
Abstract
Abstract
OBJECTIVE AND IMPORTANCE:
Extraventricular ependymomas account for 50% of supratentorial ependymomas. Some tumors may extend to the gray matter reaching the pial surface, but pure cortical ependymomas are uncommon. Here, we report three patients with supratentorial intracortical ependymoma.
CLINICAL PRESENTATION:
We reviewed the clinicopathological findings of all patients operated on for ependymomas at the Bellaria Hospital during an 11-year period and found three lesions described as cortical ependymomas. The three lesions represented 2.5% of all ependymal tumors and 21.4% of supratentorial tumors operated on during the study period. The patient were aged 52, 24, and 11 years (mean, 32.3 yr). One was female. All presented with seizures. On imaging, the lesions were confined to the gray matter, were solid, and demonstrated diffuse enhancement.
INTERVENTION:
Gross total resection was achieved in all instances. Two patients were treated with surgery, and one was treated with surgery and postoperative radiotherapy. All tumors were low grade. After a mean follow-up of 92.6 months, no patient had recurrence or leptomeningeal dissemination. Review of preoperative magnetic resonance imaging scans confirmed an intracortical location. Routine sections were reviewed, and additional immunoreactions for epithelial membrane antigen, glial fibrillary acidic protein, synaptophysin, neurofilament proteins, S-100 protein, and Ki-67 and electron microscopy were performed.
CONCLUSION:
Cortical ependymomas seem to behave as benign tumors amenable to surgical removal. Local recurrence and leptomeningeal dissemination seem to be unlikely. Postoperative radiotherapy is unnecessary.
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Affiliation(s)
- Federico Roncaroli
- Division of Neuroscience and Mental Health, Department of Neuropathology, Imperial College of London, Faculty of Medicine, Charing Cross Campus, London, England.
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Donich D, Lee JH, Prayson R. Giant extra-axial cerebellopontine angle/cavernous sinus ependymoma: case report. Neurosurgery 1999; 44:195-8. [PMID: 9894981 DOI: 10.1097/00006123-199901000-00116] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE AND IMPORTANCE The presentation, diagnosis, and treatment are described for a patient with a giant ependymoma involving the right cerebellopontine angle extending into the cavernous sinus. This case presents the unusual occurrence of a large extra-axial intracranial ependymoma and is the first reported case of cavernous sinus extension of this tumor. CLINICAL PRESENTATION The patient was a 22-year-old woman who presented with a 3-day history of generalized headache and right-sided facial droop. Magnetic resonance imaging revealed a nonhomogeneously enhancing cystic mass that was primarily in the posterior fossa with significant supratentorial extension and no apparent intra-axial or intraventricular involvement. INTERVENTION Gross total resection of this mass was achieved via two-staged resections using an initial presigmoid transpetrous, transtentorial approach and a subsequent pterional craniotomy. Pathological evaluation confirmed the diagnosis of ependymoma, and adjuvant radiation therapy to the resection bed was administered. CONCLUSION Ependymomas can present as entirely extra-axial intracranial masses and rarely may involve the confines of the cavernous sinus.
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Affiliation(s)
- D Donich
- Department of Neurological Surgery, The Cleveland Clinic Foundation, Ohio 44195, USA
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