PubMed · 14093340
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G GUIOT, C COMOY. 1963-11-21. [VENTRICULOSCOPY].. https://pubmed.ncbi.nlm.nih.gov/14093340/
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Cavernous malformations (CM) occur very rarely in the ventricular system. We report a patient with a rare location in the third ventricle who had intermittent headaches as the initial symptom.
OBJECTIVE AND IMPORTANCE: Tanycytic ependymomas are a rare ependymoma subtype showing a marked predilection for the spine, with only a few reports of supratentorial tumors. We present a case of a tanycytic ependymoma arising from the lateral and third ventricle. CLINICAL PRESENTATION: The patient was a 55-year-old woman who complained of intermittent, progressively worsening dysequilibrium for several months. The neurologic exam in the neurosurgery clinic was without deficit. INTERVENTION: MRI of the brain revealed a 3-cm, minimally enhancing lesion centered in the superior aspect of the third ventricle. The tumor involved the left wall of the third ventricle, the septum pellucidum, and the anterior horn of the left lateral ventricle. Surgery was recommended for diagnosis and to prevent obstructive hydrocephalus. A gross total resection was achievedvia a transcallosal approach. Postoperatively, the patient remained neurologically intact. CONCLUSION: The long-term prognosis for tanycytic ependymomas is the same or slightly better than for other ependymoma subtypes. The current treatment plan includes gross total resection followed by radiologic surveillance. Repeat resection or radiation treatment will be recommended in the event of recurrence.
We report the case of a 4-year-old girl with a fourth ventricle tumor diagnosed as a cerebellar liponeurocytoma which recurred, showing ependymal differentiation, 14 months after surgery. Magnetic resonance imaging at initial presentation revealed a large mass in the fourth ventricle, and histology showed a neoplasm characterized by a combination of well-differentiated neurocytes and cells resembling adipocytes. The tumor recurrence was histologically identical to the original tumor in some regions, but with fewer adipose-like cells, while other areas presented an endocrine architecture with oligo-like or pleiomorphic cells, and rosette-like arrangements of tumoral cells were seen around the thin vessels, with features similar to cellular ependymoma. The cells in the liponeurocytoma areas expressed synaptophysin, chromogranin A, and epithelial membrane antigen. Glial fibrillary acidic protein was expressed in some dispersed tumoral cells, in lipidized tumoral cells, and in reactive astrocytes. Cytokeratin was focally expressed in the ependymal region of the recurrence. The immunophenotype of our case, with glial, ependymal, and neuronal or neuroendocrine markers, suggest a neurocytoma with lipomatous and ependymal differentiation. This tumor resembled those derived from circumventricular organs. Its localization in the area postrema region led us to hypothesize that it may be derived from this circumventricular organ.