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Presented by Pedram Argani, M.D. and prepared by Wang (Steve) Cheung, M.D., Ph.D.
Case 6: A spinal cord lesion in a patient with myelopathy.
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1. Question
Week 334: Case 6
A spinal cord lesion in a patient with myelopathy.images/1210076a.jpg
images/1210076b.jpg
images/1210076c.jpg
images/1210076d.jpgCorrect
Answer: Ependymoma
Histology: This is a solid neoplasm composed of fairly uniform cells separated by gliovascular stroma. Within the lobules, one can see focal areas of true luminal formations: these are referred to as Flexner-Wintersteiner rosettes. The mass is well delineated and non-infiltrative. Tumor cells are separated from the blood vessels by glial processes. These are typical features of ependymoma.
Discussion: A neurocytoma would label for neuronal markers and not for GFAP like an ependymoma. Oligodendroglioma would be an infiltrative process. It would lack the ependymal rosettes seen in the current case, which would label for EMA. Papilloma is typically not as solid as the current lesion. It would also not label for GFAP.
The main prognostic factor for ependymoma is completeness of resection.
Incorrect
Answer: Ependymoma
Histology: This is a solid neoplasm composed of fairly uniform cells separated by gliovascular stroma. Within the lobules, one can see focal areas of true luminal formations: these are referred to as Flexner-Wintersteiner rosettes. The mass is well delineated and non-infiltrative. Tumor cells are separated from the blood vessels by glial processes. These are typical features of ependymoma.
Discussion: A neurocytoma would label for neuronal markers and not for GFAP like an ependymoma. Oligodendroglioma would be an infiltrative process. It would lack the ependymal rosettes seen in the current case, which would label for EMA. Papilloma is typically not as solid as the current lesion. It would also not label for GFAP.
The main prognostic factor for ependymoma is completeness of resection.
