1 March 2007 – Case of the Week #75

 

These cases can also be accessed by clicking on the Case of the Week button on the left hand side of our Home Page at www.PathologyOutlines.com.  This email is sent only to those who subscribe in writing or by email.  To view the images or references, you must click on the links in blue.

 

To subscribe or unsubscribe, email info@PathologyOutlines.com, indicating subscribe or unsubscribe to Case of the Week.  We do not sell, share or use your email address for any other purpose.  We also maintain three other email lists: to receive a biweekly update of new Pathologist jobs added to our Jobs pages, to receive a biweekly update of new Pathology related (but not Pathologist) jobs added to our Jobs pages, and to receive a monthly update of changes made to the website.  You must subscribe or unsubscribe separately to these email lists.

 

 

The Business Solution for Pathology™

 

This email is sponsored by Pathology Service Associates, LLC (PSA).  Visit PSA at the American Pathology Foundation Spring Conference, March 1-2, 2007.

 

Is Your Pathology Practice Seeking to Gain a Competitive Advantage?  PSA supports visionaries and leading pathology practices seeking to gain a competitive advantage within their markets.  Formed exclusively for pathologists by pathologists, PSA is a leading provider of Pathology Billing and Collection Services, Pathology Practice Marketing Support, and Pathology Business Support Services.  For further information, visit http://www.psapath.com.

 

We thank Dr. Sungmi Jung, University of Pennsylvania Health System, Philadelphia, Pennsylvania (USA) for contributing this case.  We invite you to contribute a Case of the Week by emailing NPernick@PathologyOutlines.com with microscopic images (any size, we will shrink if necessary) in JPG format, a clinical history, your diagnosis and any other images (gross, immunostains, EM, etc.) that may be helpful or interesting.  We will write the discussion (unless you want to), list you as the contributor, and send you a check for $35 (US) for your time after we send out the case.  Please only send cases with a definitive diagnosis. 

 

Case of the Week #75

 

Clinical history

 

A 57 year old man had a history of worsening headache with no focal neurologic signs.  An MRI showed a 4.5 cm heterogeneous intraventricular mass causing obstructive hydrocephalus.  The radiologic impression was a central neurocytoma.

 

MRI image: #1

Micro images: #2#3#4 

 

What is your diagnosis? 

 

(scroll down to continue)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Diagnosis:

 

Subependymoma

 

Discussion

 

Subependymoma is a low grade CNS glial tumor of middle-aged to elderly adults with a distinctive appearance and benign behavior (WHO grade I of IV).  It usually occurs in the fourth ventricle or lateral ventricles, where it is often an incidental finding at autopsy, or in the spinal cord, where it presents as a myelopathy.

 

Grossly, the tumors are well circumscribed, solid, gray-white and protrude into the lateral ventricles or fourth ventricle.  Calcification is common.  The tumors consist of small ependymal type cells in a dense glial, fibrillary background with prominent microcysts and mild nuclear pleomorphism.  There may be occasional ependymal rosettes.  There is no endothelial proliferation or necrosis.  Cytology smears show bland tumor cells with prominent microcysts (Acta Cytol 2001;45:636).  Tumor cells are almost uniformly immunoreactive for GFAP, NSE and NCAM (J Neurooncol 2005;74:1), but have a low Ki-67 index.  Tumors with a prominent ependymal component are often classified as mixed tumors, and are more aggressive than subependymomas, with a WHO grade of II of IV. 

 

The differential diagnosis includes tanycytic ependymoma (grade II of IV), which also has astrocytic features, as well as distinctive zones either with abundant nuclei and relatively free of nuclei.

 

Excision is usually curative, although radiation is occasionally given.

 

Additional references: Neurol India 2003;51:98 (childhood cases), Neurol Med Chir (Tokyo) 2002;42:349 (case report-spinal cord), online case report of 65 year old woman with intraventricular mass

 

 

Nat Pernick, M.D., President
PathologyOutlines.com, Inc.

30100 Telegraph Road, Suite 404
Bingham Farms, Michigan (USA) 48025

Telephone: 248/646-0325
Fax: 248/646-1736
Email: NPernick@PathologyOutlines.com