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[Clear cell ependymoma--a case report]
1Department of Neurosurgery, Showa General Hospital, Tokyo, Japan.
Abstract:
A case of intraaxial clear cell ependymoma is reported. A 46-year-old man complained of right hemiparesis. CT scan showed a mass lesion on the median plane with a huge cyst in the left frontal lobe. MRI showed an iso-low intensity mass by T1-weighted image. The tumor was heterogeneously enhanced by Gd-DTPA and the wall was enhanced as well. Angiogram revealed a tumor stain from the right internal carotid artery. The main mass of the tumor was totally removed but the cystic wall was left removed. Histopathological examination revealed clear cell ependymoma. Immunohistochemical examination revealed that, although vimentin and NSE were positive, GFAP, synaptophysin and S-100 were negative. Ultrastructual examination revealed cilia, microvilli and desmosomal junctions. The patient fully recovered after operation and showed no sign of recurrence after an year of follow-up. Clear cell ependymoma is a rare variant of ependymoma. Ultrastructual examination was more useful than immunohistochemical examination for diagnosis.
Insights
This report details a rare intraaxial clear cell ependymoma case in a 46-year-old male. Ultrastructural examination proved more diagnostic than immunohistochemistry for this rare brain tumor.
Area of Science:
- Neuro-oncology
- Neurosurgery
- Neuropathology
Background:
- Ependymomas are glial tumors arising from ependymal cells.
- Clear cell ependymoma is a rare histological variant, often presenting in adults.
- Intraaxial tumors require precise diagnostic and surgical approaches.
Observation:
- A 46-year-old male presented with right hemiparesis due to a left frontal lobe mass with a large cyst.
- Imaging revealed a heterogeneous, enhancing intraaxial lesion with specific MRI signal characteristics.
- Angiography demonstrated tumor vascularity supplied by the internal carotid artery.
Findings:
- Histopathology confirmed clear cell ependymoma.
- Immunohistochemistry showed positive vimentin and NSE, but negative GFAP, synaptophysin, and S-100.
- Ultrastructural analysis revealed diagnostic features like cilia, microvilli, and desmosomal junctions.
Implications:
- Ultrastructural examination is crucial for diagnosing rare ependymoma variants when immunohistochemistry is inconclusive.
- Complete surgical resection of the main tumor mass led to full recovery and no recurrence at one year.
- This case highlights the importance of multimodal diagnostic techniques for intraaxial brain tumors.