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Indian Journal of Pathology and Oncology


Ependymomas: A clinicopathologic study


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Author Details: Asha Sharad Shenoy, Kanchan S. Kothari, Imran Shaikh, Ajay Phadke, Naina Goel

Volume : 3

Issue : 3

Online ISSN : 2394-6792

Print ISSN : 2394-6784

Article First Page : 470

Article End Page : 478


Abstract

Introduction: Ependymomas are glial neoplasms that account for 4-8% of primary CNS neoplasms. Considerable controversy exists with regards to their prognosis and management, owing to their rarity and heterogeneity.
Objectives: To study the clinical and pathologic features of ependymomas and evaluate their important prognostic variables.
Materials and Methods: A 10 year retrospective study was carried out. The age, sex, location, clinical presentation, radiologic findings, microscopy, type of excision and follow up findings were studied.
Results: 168 ependymomas were identified in a total of 6628 biopsies((2.53%). Majority were seen in the second decade (42/168), M:F ratio was 2:1. 15.48% (26 cases) occurred in the supratentorial compartment, 36.92% (62 cases) infratentorially, and 47.61% (80 cases) in the spinal cord. 90% of the intracranial tumors presented with features of raised ICT while patients with spinal tumors had focal motor deficits. There were  146 classic grade II ependymomas(78.5%), most common location being the posterior fossa, 36  myxopapillary ependymomas(17.8%), all seen in the lumbosacral region and 6 anaplastic ependymomas(3.57%). Anaplastic ependymomas were seen supratentorially in children and young adults while the peak of myxopapillary tumours was in third and fourth decades. 105 patients underwent gross or near total excision while in 16 it was partial or subtotal.
 Follow up was available in 73 patients. 9 patients died in the immediate post – operative period. Follow up for the rest varied from 3 months to 9 years. Anaplastic ependymomas were associated with a poorer prognosis. In supratentorial and lumbosacral tumours there was no difference in survival between gross total and subtotal excision while in adult infratentorial grade II ependymomas and cervical ependymomas, gross total excision had a better three year survival.
Conclusions: The prognosis of ependymomas is multifactorial and depends on histologic type and extent of surgical removal