MS-09 * PROGNOSTIC IMPLICATIONS OF HISTOLOGICAL CLEAR CELLS IN HIGH GRADE INTRACRANIAL EPENDYMAL TUMORS: A RETROSPECTIVE ANALYSIS FROM A TERTIARY CARE HOSPITAL IN PAKISTAN

Abstract

Clear Cell variant in Ependymal tumors is rare. We aim to compare the features & clinical outcomes of Clear Cell variant with the Classic pathology of high grade intracranial Ependymal tumors in Pakistan. A retrospective cohort study conducted at the Department of Neurosurgery, Aga Khan University. The medical record files from 2003 - 2013 were reviewed, MRI/C.T scans and Histopathological slides of WHO grade III Ependymal tumors were reviewed. Patients lost to follow-up were contacted. Analysis was done on SPSS 20.There were 10 cases of clear cell variant and 23 cases of classic Anaplastic Ependymoma. The median age of Clear Cell variant was 52 years (range 24years-72 years),whereas of Anaplastic Ependymoma was 37 years (range 3 months to 65 years). Symptoms included Headache 66% in CCE and 63% in AE, Seizures 30% in CCE and 22% in AE, and raised ICP in 30% in CCE and 54% of AE. CCE was Supratentorial in 70% cases, intracranial Anaplastic Ependymoma was supratentorial in 58% of cases. Gross Total Resection was achieved in 55% cases in CCE and 26% cases in AE. Subtotal resection was done in 45% cases in CCE and 65% in AE. Radiotherapy was given in 60% patients in CCE and in 50% in AE. Recurrence was there in 80% cases of CCE and 55% in AE. Repeat Surgery was done in 30% cases of CCE and 34% cases of AE. Median Progression free survival was 8 months(range 3-28 months), and Overall survival was 10 months(range 3-41 months) in CCE. Median Progression free survival was 4 months (range 0.5-53 months), Overall survival was 14 months (range 1.5- 36 months) in AE. The median Progression free survival was better in Clear Cell variant than Anaplastic Ependymoma, this could be explained by a higher Gross total resection in CCE, whereas the median Overall survival was worse in Clear Cell variant group.