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Intraparenchymal supratentorial anaplastic ependymoma with massive intratumoral hemorrhage: a case report
Author(s) -
Rishi Kirtee,
Cherqui Alice,
Zhang Yi,
Takei Hidehiro,
Powell Suzanne Z
Publication year - 2008
Publication title -
the faseb journal
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.709
H-Index - 277
eISSN - 1530-6860
pISSN - 0892-6638
DOI - 10.1096/fasebj.22.1_supplement.706.12
Subject(s) - ependymoma , medicine , intraparenchymal hemorrhage , pathology , craniotomy , radiology , subarachnoid hemorrhage , surgery
Supratentorial intraparenchymal ependymomas with no attachment to the ventricular system are rare and generally do not present with hemorrhage which may be the presenting finding in oligodendrogliomas. We report an unusual case of a 60 year old female with a large frontoparietal supratentorial anaplastic ependymoma with massive hemorrhage. The patient presented to our institution with progressive right sided weakness after having been treated elsewhere for an intraparenchymal hemorrhage several weeks prior. Computed tomography, magnetic resonance imaging and cerebral angiography on presentation revealed a 7 cm partly calcified right frontoparietal lesion with acute hemorrhage and significant mass effect. The patient underwent a craniotomy for hematoma evacuation and resection of possible neoplasm. The frozen and permanent sections revealed tumor forming pseudorosettes with mitoses and focal areas of necrosis. The MIB‐1 labeling index was 14% and a diagnosis of anaplastic ependymoma was rendered. The tumor cells stained positively with GFAP and showed dot like immunoreactivity with epithelial membrane antigen (EMA). Ependymomas usually arise from the cells lining the ventricles or central canal of the spinal cord. Anaplastic ependymoma should be included in the differential diagnosis of parenchymal hemorrhagic masses and may confer a higher risk for intratumoral hemorrhage.