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Inflammatory lesion mimicking a metastatic ependymoma
H S Friedman1, S L Tuori, H P Hatten
1Department of Pediatrics, Duke University Medical Center, Durham, North Carolina.
Insights
A new brain lesion in a child treated for ependymoma was initially suspected to be metastatic. However, biopsy confirmed it was an inflammatory process, not cancer spread.
Area of Science:
- Pediatric Oncology
- Neuro-oncology
- Diagnostic Imaging
Background:
- Ependymoma is a common primary brain tumor in children.
- Adjuvant chemotherapy is frequently used after surgical resection.
- Distinguishing post-treatment changes from tumor recurrence is critical.
Observation:
- A 2.5-year-old child with infratentorial ependymoma developed a new enhancing lesion post-chemotherapy.
- Radiographic findings were suspicious for metastasis, but the primary tumor showed regression.
- Spinal imaging and cerebrospinal fluid analysis ruled out other metastatic sites.
Findings:
- Biopsy of the new lesion revealed an inflammatory process, not metastatic ependymoma.
- This finding was unexpected given the lesion's characteristics.
Implications:
- Highlights the importance of histopathological confirmation for new lesions after cancer treatment.
- Suggests inflammatory processes can mimic metastatic disease in pediatric neuro-oncology.
- May influence diagnostic algorithms and treatment decisions in similar cases.
Abstract:
A 2.5-year-old child who had undergone nearly total resection of an infratentorial ependymoma demonstrated a new enhancing lesion on the undersurface of the right cerebellar hemisphere 7 weeks after the initiation of adjuvant chemotherapy. The residual primary tumor demonstrated continued regression during chemotherapy, and magnetic resonance imaging of the spine and cytopathological examination of the cerebrospinal fluid showed no evidence for other sites of metastatic tumor. Because of the unusual anatomic and temporal characteristics of this lesion and despite radiographic criteria highly suspicious for a metastatic lesion, a biopsy was performed, revealing histological evidence of an inflammatory process.