Extra-axial ependymoma of the cerebral convexity: A very rare intracranial adult tumor

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.

Keywords

Ependymoma extra-axial MRI immunohistochemistry radiotherapy

Get full access to this article

View all access options for this article.

References

Central Brain Tumor Registry of the United States. CBTRUS statistical report: Primary brain and central nervous system tumors diagnosed in the United States in 2004–2007, Hinsdale, IL: Central Brain Tumor Registry of the United States, 2011.

Cosgrove

Villemure

Robitaille

. Extra-axial ependymoma of the posterior fossa. Surg Neurol 1985; 24: 433–436.

Lyons

Kelly

. Posterior fossa ependymomas: Report of 30 cases and review of the literature. Neurosurgery 1991; 28: 659–665.

Youkilis

Park

McKeever

. Parasagittal ependymoma resembling falcine meningioma. Am J Neuroradiol 2001; 22: 1105–1108.

Seo

Byun

Kim

. Intracranial extra-axial ependymoma in the ambient cistern that initially presented as calcification: A report of case. J Korean Soc Radiol 2013; 68: 5–8.

Salunke

Kovai

Sura

. Extra-axial ependymoma mimicking a parasagittal meningioma. J Clin Neurosci 2011; 18: 418–420.

Fukui

Hogg

Martinez

. Extraaxial ependymoma of the posterior fossa. AJNR Am J Neuroradiol 1997; 18: 1179–1181.

Little

Morgan

Eckstein

. Primary ependymoma of a cranial nerve. Case report. J Neurosurg 1994; 81: 792–794.

Donich

Lee

Prayson

. Giant extra-axial cerebello-pontine angle/cavernous sinus ependymoma: Case report. Neurosurgery 1999; 44: 195–198.

10.

Hayashi

Tamura

Shimozuru

. Extra-axial ependymoma—case report. Neurol Med Chir (Tokyo) 1994; 34: 295–299.

11.

Armington

Osborn

Cubberley

. Supratentorial ependymoma: CT appearance. Radiology 1985; 157: 367–372.

12.

Choi

Chang

. Intracranial and spinal ependymomas: Review of MR images in 61 patients. Korean J Radiol 2002; 3: 219–228.

13.

Hanchey

Stears

Lehman

. Interhemispheric ependymoma mimicking falx meningioma: Case report. J Neurosurg 1976; 45: 108–112.

14.

Winer

Lidov

Scaravilli

. An ependymoma involving the pituitary fossa. J Neurol Neurosurg Psychiatry 1989; 52: 1443.

15.

Kasliwal

Chandra

Sharma

. Images in neuro-oncology: Primary extraaxial cerebellopontine angle ependymoma. J Neurooncol 2007; 83: 31–32.

16.

Yang

Ren

. Intracranial extra-axial ependymoma involving the petroclival region: A rare case report. Int J Clin Exp Pathol 2014; 7: 9067–9071.

17.

Salazar

Castro-Vita

VanHoutte

. Improved survival in cases of intracranial ependymoma after radiation therapy. Late report and recommendations. J Neurosurg 1983; 59: 652–659.

18.

Donahue

Steinfeld

. Intracranial ependymoma in the adult patient: Successful treatment with surgery and radiotherapy. J Neurooncol 1998; 37: 131–133.

19.

Garrett

Simpson

. Ependymomas: Results of radiation treatment. Int J Radiat Oncol Biol Phys 1983; 9: 1121–1124.

20.

Gondi

Vogelbaum

Grim

Central nervous system. In: Halperin

Wazer

Perez

(eds). Perez and Brady’s principles and practice of radiation oncology, 6th ed. Philadelphia: Wolters Kluwer, Lippincott Williams & Wilkins, 2013, pp. 649–676.

21.

Reni

Brandes

Vavassori

. A multicenter study of the prognosis and treatment of adult brain ependymal tumors. Cancer 2004; 100: 1221–1229.

22.

Metellus

Guyotat

Chinot

. Adult intracranial WHO grade II ependymomas: Long-term outcome and prognostic factor analysis in a series of 114 patients. Neuro Oncol 2010; 12: 976–984.