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Classification and controversies in pathology of ependymomas
1Institute of Neuroscience, Laboratory of Pathology, Université catholique de Louvain, Avenue Hippocrate 10, 1200, Brussels, Belgium. catherine.godfraind@uclouvain.be
Purpose:
Bailey and Cushing established ependymoma as a brain tumour entity in the first brain tumour classification (1926). Diagnosis of ependymomas is not subject to controversy as long as other tumours presenting ependymoma-like features have been ruled out. Grading conversely is a source of debate. Description of histological features establishing diagnosis and grading of ependymomas may help to better understand this controversy.
Methods:
Literature has been reviewed using PubMed with the following key words: ependymoma, +/- prognosis, +/- biomaker, +/- grading, +/- immunohistochemistry, +/- proliferative index.
Results:
Grading controversy arises from elusive WHO features and individual characteristics of ependymomas including tumour location, tumour pattern/variant and variable expression of biomarkers.
Conclusion:
There is a need for a grading scheme with a proven general ability to dissociate grades, and to predict individual clinical evolution. Only then will stratified and targeted therapeutics for ependymal tumours be possible.
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