4/21/2009 Case 2: Ependymoma

Presented by: Dr. Kozarski - University Hospital SUNY HSCB

Clinical History:

A 6-month-old male twin without significant past medical history was brought to the Emergency Room after 3 days of lethargy, persistent vomiting and poor feeding.  According to the mother, the baby was in his usual state of health when, 3 days prior to admission, he fell from the bed while sleeping.  After falling, the baby was symptomatic as above.  Neuroradiologocial workup revealed an intraventricular tumor in the posterior fossa.  Both scheduled surgery and frozen section were cancelled due to the poor clinical status of the patient, who expired soon afterwards.

Diagnostic Notes:

Discussion centered around grading of ependymoma, since foci of vascular endothelial hyperplasia and necrosis were found.  Some references would provide a diagnosis of focal atypia, while some at the meeting or sending in opinions gave grades ranging from low to high.  It was also mentioned that for posterior fossa tumors grading does not affect treatment and prognosis, while extensive sectioning, if warranted by initial focal findings, would be more in order for a supratentorial ependymoma where grade is related to treatment and prognosis.  However, a point generally not considered was also brought out, and that is the possibility of organ donation in a case such as this.  Transplant services would require a grade of 2 versus 3 or 4 to use the organs since they would likely not use organs from a donor with a high-grade brain tumor.  There was also speculation on time cutoff for a tumor to be congenital, the time offered in a publication being 2 months of age.

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