A rare case of the supratentorial extraventricular anaplastic ependymoma. Case report and literature review

Abstract

Ependymoma is a brain tumor accounting for 1.9 % of all benign brain tumors and 3.1 % of glial tumors and 2–9 % of all neuroepithelial tumors. Approximately one third of intracranial ependymal tumors are supratentorial. They may be attached to the ependymal walls of the III ventricle and lateral ventricles or may be sited in the white matter without direct connection to the ventricular system pressing the adjacent cortex. In very rare cases ependymomas may lie cortically with blood supply from the dura – so-called «cortical» ependymomas.Posterior fossa ependymomas are more common in pediatric population with mean age of 6 years, whereas supratentorial ependymomas manifest in adults. In adults Grade III anaplastic ependymomas are most commonly seen.These tumors have no specific features and clinical manifestations of extraventricular anaplastic ependymomas may vary greatly depending on localization and size of the tumor.Supratentorial anaplastic ependymomas have no specific neuroimaging features either. Tumors are often hypo- and isointense in T1 and iso- or hyperintense in T2 sequence, Gd -inhancement is variable.Ependymomas are considered to be non-invasive and to have a strict border with brain tissue thus leading to clinical manifestations because of mass-effect.Surgical resection is the main treatment option for ependymoma. Patients with local Grade II tumor recurrence and patients with Grade III ependymomas should under go radiotherapy on the tumor r esection cavity.We present a rare case of a supratentorial extraventricular anaplastic ependymoma. A 21‑year-old female presented to the clinic with paresthesia and numbness in right hand, right half of lower lip and astereognosis. The magnetic resonance imaging of the brain showed a mass lesion in left fronto-parietal region. At 10.10.2017 surgery was performed and tumor was resected. Histological findings matched with features of anaplastic ependimoma, WHO Grade III. There was no tumor progression during 3 months after surgery.