Brain Tumor Res Treat.  2019 Apr;7(1):44-47. 10.14791/btrt.2019.7.e26.

A Case of Recurrent Supratentorial Extraventricular Anaplastic Ependymoma in Adult

• Seo SW
• Kang HJ
• Lee MS
• Suh SJ
• Lee YS
• Lee JH
• Kang DG

• KMID: 2444795
• DOI: http://doi.org/10.14791/btrt.2019.7.e26

Abstract

Supratentorial extraventricular anaplastic ependymoma (SEAE) in adults is a relatively rare intracranial tumor. Because of the very low prevalence, only a few cases have been reported. According to a recent study, SEAE is associated with a poor prognosis and there is no definite consensus on optimal treatment. We report a case of an adult SEAE patient who had no recurrence until seven years after a gross total resection (GTR) followed by conventional radiotherapy. A 42-year-old male had a persistent mild headache, left facial palsy, dysarthria, and left hemiparesis. Preoperative neuroimaging revealed an anaplastic astrocytoma or supratentorial ependymoma in the right frontal lobe. A GTR was performed, followed by adjuvant radiotherapy. Histologic and immunohistochemical results revealed anaplastic ependymoma. After seven years of initial therapy, a regular follow-up MRI showed a 3-cm-sized partially cystic mass in the same area as the initial tumor. The patient underwent a craniotomy, and a GTR was performed. Histopathologic examination revealed recurrence of the SEAE. External radiotherapy was performed. The patient has been stable without any disease progression or complications for 12 months since the surgery for recurrent SEAE.

Keyword

Supratentorial neoplasms; Anaplastic ependymoma; Recurrence

MeSH Terms

Adult*
Astrocytoma
Consensus
Craniotomy
Disease Progression
Dysarthria
Ependymoma*
Facial Paralysis
Follow-Up Studies
Frontal Lobe
Headache
Humans
Magnetic Resonance Imaging
Male
Neuroimaging
Paresis
Prevalence
Prognosis
Radiotherapy
Radiotherapy, Adjuvant
Recurrence
Supratentorial Neoplasms

Figure

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  Fig. 1 Preoperative imaging studies and a follow-up MRI after surgery. A: The tumor had a heterogenous signal intensity with vasogenic edema on T2-weighted imaging, B: The tumor had a isodense intensity on T1-weighted imaging, C: The tumor showed a heterogenous and peripheral rim enhancement on contrast-enhanced T1-weighted imaging, D: A follow-up MRI in 1 days after surgery showed no definite remnant mass lesion on contrast-enhanced T1-weighted imaging.

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  Fig. 2 Histopathological findings. A: Hematoxylin and eosin-stained section express increased cellularity with perivascualr pseudorosettes (original magnification ×100). B: Immunohistochemical stainings for Ki-67 revealed strong proliferative activity and aggressiveness as 10–20% (original magnification ×100). C: Immunohistochemical stainings for glial fibrillary acidic protein revealed strong positivity in the tumor cells (original magnification ×100).

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  Fig. 3 Magnetic resonance images expressed a recurrent tumor in right frontal lobe. A: T2-weighted image demonstrated a recurrent tumor with heterogenous signal intensity and vasogenic edema. B, C: Contrast-enhanced T1-weighted MRI axial and coronal image showing a partially cystic mass with enhancing nodule on peripheral portion. D: A follow-up MRI in 1 day after surgery showed no definite remnant mass lesion on contrast-enhanced T1-weighted imaging.

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