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Malignant Transformation of Grade II Ependymoma in a 2-Year-Old Child: Case Report.

Sarıkafa Ş, Çelik SE, Yarikkaya E, Sayılgan A - J Neurol Surg Rep (2015)

Bottom Line: After a second operation, a histopathologic study was performed.The second specimen was defined as a grade III anaplastic ependymoma.Surgical treatment remains the mainstay of the treatment for all cases.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurosurgery, Okmeydanı Training and Research Hospital, Istanbul, Turkey.

ABSTRACT
Ependymomas are central nervous system neoplasms that account for a third of all posterior fossa tumors in children. The most common location for infratentorial ependymoma is within the fourth ventricle. We present a case report of malignant transformation of an infratentorial grade II ependymoma in a 2-year-old child who presented with vomiting and visual disturbance. An infratentorial brain tumor in the left cerebellar area was totally removed, and the initial pathologic diagnosis was grade II ependymoma. The tumor recurred aggressively 1 year later; subtotal removal and adjuvant chemotherapy were performed. After a second operation, a histopathologic study was performed. The second specimen was defined as a grade III anaplastic ependymoma. Transformation to grade III anaplastic ependymoma is possible for a grade II ependymoma but very rare. The diagnosis of the anaplastic variant of intracranial ependymomas is difficult. Surgical treatment remains the mainstay of the treatment for all cases. Ependymomas in young infants have a worse prognosis than older children, so we need individual clinical evaluation and close follow-up of such cases. This article highlights the requirement of a close follow-up for grade II ependymomas for anaplastic transformation.

No MeSH data available.


Related in: MedlinePlus

Axial initial magnetic resonance imaging scans show posterior fossa mass filled in fourth ventricle (A) with nonhomogeneous slight contrast enhancement (B). Severe hydrocephalus can be seen with temporal horn filling secondary to the obstruction of the fourth ventricle. Postoperative axial (C) and coronal contrasted images (D) show complete resection of the mass with opening of the fourth ventricle and relaxation of the temporal horns. The shunt valve can be seen subcutaneously on axial images.
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FI140110-1: Axial initial magnetic resonance imaging scans show posterior fossa mass filled in fourth ventricle (A) with nonhomogeneous slight contrast enhancement (B). Severe hydrocephalus can be seen with temporal horn filling secondary to the obstruction of the fourth ventricle. Postoperative axial (C) and coronal contrasted images (D) show complete resection of the mass with opening of the fourth ventricle and relaxation of the temporal horns. The shunt valve can be seen subcutaneously on axial images.

Mentions: A 1-year-old boy presented with visual disturbances. His conscious level was normal, and he responded to painful stimuli with crying. He was oriented and followed colorful objects. His eyes were open spontaneously; however, his left eye was looking at medial and downside, and his left eye gaze was limited to upside and lateral. He had no motor deficits. He was not walking, but he had normal head and neck movements. An infratentorial brain tumor in the median and right cerebellar area was found on contrast MRI. The tumor was totally removed by surgical approach via a suboccipital craniotomy. After surgery, hydrocephalus developed, and a ventriculoperitoneal shunt was inserted. Pathologic diagnosis was grade II ependymoma. In the following months there was no recurrence on control MRIs (Fig. 1).


Malignant Transformation of Grade II Ependymoma in a 2-Year-Old Child: Case Report.

Sarıkafa Ş, Çelik SE, Yarikkaya E, Sayılgan A - J Neurol Surg Rep (2015)

Axial initial magnetic resonance imaging scans show posterior fossa mass filled in fourth ventricle (A) with nonhomogeneous slight contrast enhancement (B). Severe hydrocephalus can be seen with temporal horn filling secondary to the obstruction of the fourth ventricle. Postoperative axial (C) and coronal contrasted images (D) show complete resection of the mass with opening of the fourth ventricle and relaxation of the temporal horns. The shunt valve can be seen subcutaneously on axial images.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4520988&req=5

FI140110-1: Axial initial magnetic resonance imaging scans show posterior fossa mass filled in fourth ventricle (A) with nonhomogeneous slight contrast enhancement (B). Severe hydrocephalus can be seen with temporal horn filling secondary to the obstruction of the fourth ventricle. Postoperative axial (C) and coronal contrasted images (D) show complete resection of the mass with opening of the fourth ventricle and relaxation of the temporal horns. The shunt valve can be seen subcutaneously on axial images.
Mentions: A 1-year-old boy presented with visual disturbances. His conscious level was normal, and he responded to painful stimuli with crying. He was oriented and followed colorful objects. His eyes were open spontaneously; however, his left eye was looking at medial and downside, and his left eye gaze was limited to upside and lateral. He had no motor deficits. He was not walking, but he had normal head and neck movements. An infratentorial brain tumor in the median and right cerebellar area was found on contrast MRI. The tumor was totally removed by surgical approach via a suboccipital craniotomy. After surgery, hydrocephalus developed, and a ventriculoperitoneal shunt was inserted. Pathologic diagnosis was grade II ependymoma. In the following months there was no recurrence on control MRIs (Fig. 1).

Bottom Line: After a second operation, a histopathologic study was performed.The second specimen was defined as a grade III anaplastic ependymoma.Surgical treatment remains the mainstay of the treatment for all cases.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurosurgery, Okmeydanı Training and Research Hospital, Istanbul, Turkey.

ABSTRACT
Ependymomas are central nervous system neoplasms that account for a third of all posterior fossa tumors in children. The most common location for infratentorial ependymoma is within the fourth ventricle. We present a case report of malignant transformation of an infratentorial grade II ependymoma in a 2-year-old child who presented with vomiting and visual disturbance. An infratentorial brain tumor in the left cerebellar area was totally removed, and the initial pathologic diagnosis was grade II ependymoma. The tumor recurred aggressively 1 year later; subtotal removal and adjuvant chemotherapy were performed. After a second operation, a histopathologic study was performed. The second specimen was defined as a grade III anaplastic ependymoma. Transformation to grade III anaplastic ependymoma is possible for a grade II ependymoma but very rare. The diagnosis of the anaplastic variant of intracranial ependymomas is difficult. Surgical treatment remains the mainstay of the treatment for all cases. Ependymomas in young infants have a worse prognosis than older children, so we need individual clinical evaluation and close follow-up of such cases. This article highlights the requirement of a close follow-up for grade II ependymomas for anaplastic transformation.

No MeSH data available.


Related in: MedlinePlus