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→Classic ependymoma: Update
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==Microscopic== | ==Microscopic== | ||
===Classic ependymoma=== | ===Classic ependymoma=== | ||
*Come in two CNS WHO grades: 2 and 3. | |||
*Usu. sharply demarcated from surrounding brain parenchyma. | |||
Features: | Features: | ||
*Cells have a "tadpole-like" morphology. | *Cells have a "tadpole-like" morphology. | ||
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*Nuclear features monotonous, i.e. "boring".<ref>MUN. 6 Oct 2009.</ref> | *Nuclear features monotonous, i.e. "boring".<ref>MUN. 6 Oct 2009.</ref> | ||
**There is little variation in size, shape and staining. | **There is little variation in size, shape and staining. | ||
*Hyalinized vessels. | |||
*Calcification. | |||
*Rare cases with cartilagineous metaplasia.<ref>{{Cite journal | last1 = Wang | first1 = X. | last2 = Zhang | first2 = S. | last3 = Ye | first3 = Y. | last4 = Chen | first4 = Y. | last5 = Liu | first5 = X. | title = Ependymoma with cartilaginous metaplasia might have more aggressive behavior: a case report and literature review. | journal = Brain Tumor Pathol | volume = 29 | issue = 3 | pages = 172-6 | month = Jul | year = 2012 | doi = 10.1007/s10014-011-0079-4 | PMID = 22228122 }}</ref> | *Rare cases with cartilagineous metaplasia.<ref>{{Cite journal | last1 = Wang | first1 = X. | last2 = Zhang | first2 = S. | last3 = Ye | first3 = Y. | last4 = Chen | first4 = Y. | last5 = Liu | first5 = X. | title = Ependymoma with cartilaginous metaplasia might have more aggressive behavior: a case report and literature review. | journal = Brain Tumor Pathol | volume = 29 | issue = 3 | pages = 172-6 | month = Jul | year = 2012 | doi = 10.1007/s10014-011-0079-4 | PMID = 22228122 }}</ref> | ||
*Branching capillaries usu. only in supratentorial ependymomas. | |||
DDx (classic ependymoma): | DDx (classic ependymoma): | ||
*[[Subependymoma]]. | *[[Subependymoma]]. | ||
*[[Glioblastoma]] (GBM). | *[[Glioblastoma]] (GBM). | ||
*Gliomas with BCOR internal tandem duplication. | |||
*[[Astroblastoma]], MN1-altered. | |||
**Invasive border = GBM; circumscribed border of lesion = ependymoma. | **Invasive border = GBM; circumscribed border of lesion = ependymoma. | ||
*[[Pilocytic astrocytoma]] (Tanycytic ependymoma) | *[[Pilocytic astrocytoma]] (Tanycytic ependymoma) | ||
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File:EMA_ependymoma_periluminal.jpg | Periluminal EMA positivity in a ependymoma. (WC/jensflorian) | File:EMA_ependymoma_periluminal.jpg | Periluminal EMA positivity in a ependymoma. (WC/jensflorian) | ||
File:Ependymoma_EMA.jpg | Dot-like EMA immunreactivity n a ependymoma. (WC/Marvin101) | File:Ependymoma_EMA.jpg | Dot-like EMA immunreactivity n a ependymoma. (WC/Marvin101) | ||
File:Tanycytic ependymoma HE.jpg | Tanycytic ependymoma must not confused with [[pilocytic astrocytoma]]. (WC/jensflorian) | File:Tanycytic ependymoma HE.jpg | Tanycytic morphology in ependymoma must not confused with [[pilocytic astrocytoma]]. (WC/jensflorian) | ||
File:Tanicytic_ependymoma_x10.jpg | Tanycytic ependymoma - low mag. (WC/jensflorian) | File:Tanicytic_ependymoma_x10.jpg | Tanycytic morphology in ependymoma - low mag. (WC/jensflorian) | ||
File:Papillary_Ependymoma.jpg | Papillary ependymoma - low mag. (WC/jensflorian) | File:Papillary_Ependymoma.jpg | Papillary morphology in ependymoma - low mag. (WC/jensflorian) | ||
File:Papillary_ependymoma_HE_x40.jpg | Papillary ependymoma - intermed. mag. (WC/jensflorian) | File:Papillary_ependymoma_HE_x40.jpg | Papillary morphology in ependymoma - intermed. mag. (WC/jensflorian) | ||
File:Clear_cell_ependymoma_HE.jpg | Clear cell ependymoma may mimic [[oligodendroglioma]]. (WC/jensflorian) | File:Clear_cell_ependymoma_HE.jpg | Clear cell morphology in ependymoma may mimic [[oligodendroglioma]]. (WC/jensflorian) | ||
File:HE_anaplastic_epedymomas_mitoses_pleomorphism.jpg | Brisk mitotic activity in a anaplastic ependymoma. (WC/jensflorian) | File:HE_anaplastic_epedymomas_mitoses_pleomorphism.jpg | Brisk mitotic activity in a anaplastic ependymoma. (WC/jensflorian) | ||
File:Cartilaginous metaplasia ependymoma.jpg|Metaplastic transformation in an anaplastic ependymoma. (WC/jensflorian) | File:Cartilaginous metaplasia ependymoma.jpg|Metaplastic transformation in an anaplastic ependymoma. (WC/jensflorian) | ||
File:Ependymoma_L1CAM_IHC.jpg | L1CAM immunohistochemistry indicates presence of | File:Ependymoma_L1CAM_IHC.jpg | L1CAM immunohistochemistry indicates presence of ZFTA-fusion. | ||
File:Ependymoma_NFkappaB_IHC.jpg | Nuclear NFkappaB IHC indicates presence of | File:Ependymoma_NFkappaB_IHC.jpg | Nuclear NFkappaB IHC indicates presence of ZFTA-fusion. | ||
</gallery> | </gallery> | ||