Open AccessHistological Predictors of Outcome in Ependymoma are Dependent on Anatomic Site Within the Central Nervous System
Author(s) -
Raghunathan Aditya,
Wani Khalida,
Armstrong Terri S.,
VeraBolanos Elizabeth,
Fouladi Maryam,
Gilbertson Richard,
Gajjar Amar,
Goldman Stewart,
Lehman Norman L.,
Metellus Phillipe,
Mikkelsen Tom,
NecesitoReyes Mary Jo T.,
Omuro Antonio,
Packer Roger J.,
Partap Sonia,
Pollack Ian F.,
Prados Michael D.,
Robins H. Ian,
Soffietti Riccardo,
Wu Jing,
Miller C. Ryan,
Gilbert Mark R.,
Aldape Kenneth D.
Publication year - 2013
Publication title -
brain pathology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.986
H-Index - 132
eISSN - 1750-3639
pISSN - 1015-6305
DOI - 10.1111/bpa.12050
Subject(s) - ependymoma , grading (engineering) , pathology , medicine , ependymal cell , clinical significance , biology , immunohistochemistry , ecology
Ependymomas originate in posterior fossa ( PF ), supratentorial ( ST ) or spinal cord ( SC ) compartments. At present, grading schemes are applied independent of anatomic site. We performed detailed histological examination on 238 W orld H ealth O rganization grade II and III ependymomas. Among PF ependymomas, the presence of hypercellular areas, necrosis, microvascular proliferation and elevated mitotic rate (all P < 0.01) were significantly associated with worse progression‐free survival ( PFS ), while extensive ependymal canal formation was not ( P = 0.89). Similar to the PF tumors, microvascular proliferation ( P = 0.01) and elevated mitotic rate ( P = 0.03) were significantly associated with worse PFS in the ST tumors. However, in contrast to PF tumors, extensive ependymal canals ( P = 0.03) were associated with worse clinical outcome in ST ependymomas, but hypercellularity ( P = 0.57) and necrosis ( P = 0.47) were not. On multivariate C ox regression, after adjusting for relevant clinical variables, individual histological factors and a composite histological score remained significant among ST and PF ependymoma. In contrast to both PF and ST ependymoma, histological features were not found to be associated with PFS in SC tumors. Taken together, the clinical relevance of specific histological features in ependymoma appears to be related to the anatomic site of origin and suggests that site‐specific grading criteria be considered in future classification systems.