1/22. Disseminated spinal and cerebral ependymoma with unusual histological pattern: clinicopathological study of a case with retrograde tumor spread.The subject of this study is a case of anaplastic ependymoma originally arising from the central canal of the lower spinal cord followed by the 13 years history of events of upper spinal dissemination and retrograde intracranial spread. The specimens from four subsequent surgeries generally displayed the same microscopic features of neoplastic tissue and were consistent with the diagnosis of anaplastic ependymoma. The histological diagnosis was based upon the high cellularity, considerable nuclear atypia and pleomorphism, brisk mitotic activity, focally exhibited vascular endothelial proliferation and extensive necrosis. Apart from the typical pattern of ependymoma, the tumors contained areas composed almost entirely of large, uniform clear cells or pseudogemistocytes indicating the morphological heterogeneity of neoplastic cells population. The surgical specimens from four surgical resections shared light microscopic similarities suggesting spinal and intracranial dissemination from the primary spinal tumor. Since the retrograde spread via the cerebrospinal fluid (CSF) pathway is extremely rare, the authors of this study discuss the mechanism of such way of tumor metastases.- - - - - - - - - - ranking = 1keywords = canal (Clic here for more details about this article) |
2/22. Myelographic evaluation of nontraumatic spinal canal obstruction: a new approach.A new technique simplifies the evaluation of the spinal canal above obstructing lesions encountered during myelography via the lumbar route. After the demonstration of a block with 2--4 ml Pantopaque, a second injection of 2--4 ml Pantopaque is made through the lumbar needle with the patient in 45 degree Trendelenberg (or any degree necessary to keep the initial contast bolus against the inferior margin of the obstruction). In all 10 cases in this series, the second injection easily displaced contrast around and above obstructions that could not be overcome by gravity thereby obviating a lateral cervical or cisternal puncture. No technical failures of complications were encountered. The method is not recommended in cases of traumatic spinal canal obstruction.- - - - - - - - - - ranking = 192.57087485546keywords = spinal canal, canal (Clic here for more details about this article) |
3/22. Cervical subluxation after surgery and irradiation of childhood ependymoma.Aggressive resection followed by postoperative radiation therapy directed at the tumor bed characterizes the treatment of childhood infratentorial ependymoma. Tumor resection often requires access to the upper portion of the cervical spinal canal, which places the patient at risk of complications, including destabilization. Two cases of cervical subluxation after surgery and irradiation for infratentorial ependymoma are presented and discussed to identify factors that may be responsible for this uncommon treatment complication. Cervical laminotomies, multiple surgeries, postoperative infection and the addition of radiation therapy may be contributory. Because second resection will be an important component of the next generation of cooperative group studies for infratentorial tumors, the incidence and severity of this treatment-related complication should be documented and efforts should be made to image the upper portion of the cervical spine during routine follow-up.- - - - - - - - - - ranking = 32.095145809243keywords = spinal canal, canal (Clic here for more details about this article) |
4/22. Case of clear cell ependymoma of medulla oblongata: clinicopathological and immunohistochemical study with literature review.Clear cell ependymoma has been included in the WHO classification of the central nervous system in 1993, after the first report by Kawano et al. Since then, only a few cases have been reported. Most clear cell ependymoma cases reported in the literature so far were located in the supra-tentorial compartment and/or cerebellum, and one case was in the cervical spinal cord. We report a case of clear cell ependymoma whose histological features were sufficient for the diagnosis and was unusually located in the fourth ventricle originating from the medulla oblongata. The tumor showed uniform tumor cells with perinuclear halo, nuclei being centrally located. Most of the tumor cells were arranged as perivascular pseudorosettes, and no ependymal canals or rosettes were evident. Mitotic figures were not frequent. Immunohistochemically, the tumor cells were strongly reactive for glial fibrillary acidic protein and vimentin, and weak and dot-like positive for epithelial membrane antigen. Clear cell change of the tumor cells appeared to be fixation artifact because this feature was not evident in the frozen section.- - - - - - - - - - ranking = 1keywords = canal (Clic here for more details about this article) |
5/22. Parenchymal anaplastic ependymoma with intratumoral hemorrhage: a case report.We report an unusual case of a 56-year-old woman with a supratentorial anaplastic ependymoma localized in the parenchyma without continuity with the ventricular system and brain surface. The patient presented with vertigo, and a calcified mass was detected in the left temporal parenchyma. Five years later, she had seizure of the right extremities. Computed tomographic scanning and magnetic resonance imaging revealed an enhanced mass with an intratumoral hemorrhage adjacent to the calcified mass. Subtotal removal of the tumor was performed. The histological analysis revealed that the tumor was an anaplastic ependymoma. After focal radiation therapy (50 Gy), the outcome was favorable, although the residual lesion was still seen on the images. Ependymomas usually arise from the cells lining the ventricular system and the central canal of the spinal cord. We discuss the summary of published cases of supratentorial ectopic ependymoma since the first case in 1995.- - - - - - - - - - ranking = 1keywords = canal (Clic here for more details about this article) |
6/22. November 2004: intradural mass of the cauda equina in a woman in her early 60s.November 2004. A 63-year-old woman presented with slowly aggravating lower back pain and recent urinary urge incontinence. MRI revealed a sharply-delineated, partly cystic intradural mass with inhomogenous contrast-enhancement and ectatic vessels at the upper pole. An ependymoma was suspected, and the tumor was resected in toto. Histologically, at first glance, the tumor strongly resembled an ependymoma, showing a monomorphic cellular pattern, perivascular pseudorosettes and ependymal canal-like structures. However, the finding of a delicate collagen capsule, compartmentation of tumor cells into zellballen and the presence of ganglionic cells were untypical. These features were indicative of a paraganglioma with a gangliocytic component. Immunoreactivity of the tumor cells for neuroendocrine antigens, the detection of GFAP-positive sustentacular cells and the ultrastructural confirmation of neurosecretory granules substantiated this diagnosis. The clinical, radiological and morphological similarity between ependymomas, which are far more common in the cauda equina region than paragangliomas, has led to substantial diagnostic confusion in the past.- - - - - - - - - - ranking = 1keywords = canal (Clic here for more details about this article) |
7/22. Primary extraneural myxopapillary ependymoma of the broad ligament.Primary extraneural ependymomas are rare tumors that arise in ectopic sites, including pulmonary, sacrococcygeal region, ovarian, and paraovarian tissues. Four such ependymomas reported in the literature involve the paraovarian tissues, including 2 broad ligament ependymomas. Here we describe a myxopapillary ependymoma of the broad ligament in a 22-year-old woman, which may be the first tumor of this type to be reported in this location. Cytology, histology, cytochemistry, immunohistochemistry, and flow cytometry ploidy analysis are studied and described. Identification of perivascular ependymal rosettes, ependymal canals, vimentin and glial fibrillary acidic protein immunoreactivity, cytochemical staining of blepharoplasts or terminal bars by phosphotungstic acid hematoxylin, and presence of multiple foci of myxoid degeneration among the ependymal rosettes characterized a myxopapillary ependymoma.- - - - - - - - - - ranking = 1keywords = canal (Clic here for more details about this article) |
8/22. Mediastinal ependymoma.A mediastinal ependymoma in a 35-year-old Caucasian woman is reported. The tumor was located in a paravertebral posterior mediastinal location. No continuity with the spinal canal or with the lung was identified. The diagnosis was confirmed by immunoperoxidase staining for glial fibrillary protein and by the presence of cilia within intracytoplasmic vacuoles. To the best of our knowledge, this is the second reported case of ependymoma in this location.- - - - - - - - - - ranking = 32.095145809243keywords = spinal canal, canal (Clic here for more details about this article) |
9/22. An update on the surgical treatment of malignant pineal region tumors.Our current pineal region tumor series (n = 34) now spans 11 years and currently includes 15 patients with malignant pineal region tumors, only 3 of whom had pure germinomas. Complete gross microsurgical excision of well-encapsulated tumors was possible in 9 of 13 patients (69%) who underwent definitive surgical exploration. Subtotal excision only was possible in 2 of the other patients. In the remaining 2 patients who had pineal germinomas, a less aggressive subtotal excision was done because of the known radiosensitivity of this tumor. Four of the operative patients had a tumor of mixed histology with benign and malignant components, emphasizing the need for adequate tissue sampling (Table 20.2). Eleven of the 13 surgical patients received postoperative craniospinal radiation; a 6-month-old girl who had a gross total excision of a pineoblastoma was too young to be irradiated. Ten of the patients continue to do well up to 12 years postoperatively. In view of the fact that only 3 of the 15 patients had pure germinomas, these results appear to be better than those reported with shunting and radiotherapy. Only one of our surgical patients developed postoperative metastases, an embryonal cell tumor that spread to the spinal canal. In the 34 patients in this series with lesions of the pineal region, surgical exploration was associated with only one death (a patient with metastatic adenocarcinoma). As is common with the occipital transtentorial approach, a postoperative hemanopsia is common but usually transient. The wide exposure of this approach, however, may be responsible for the greater proportion of complete gross excisions of malignant pineal tumors using other approaches (24). We have also shown the importance of tumor markers and that germinomas are very sensitive to chemotherapy. Thus, microsurgery for pineal tumors provides a viable potential for complete gross tumor extirpation even with malignant lesions, and/or adequate tissue for diagnosis which is necessary in appropriate therapeutic planning for radiotherapy and/or chemotherapy. The traditional therapeutic approach of empiric radiotherapy without a tissue diagnosis for pineal lesions may no longer be acceptable.- - - - - - - - - - ranking = 32.095145809243keywords = spinal canal, canal (Clic here for more details about this article) |
10/22. Secondary ependymoma presenting as a presacral mass.Ependymomas are common types of tumors occurring within the brain and usually derive from the ependymal lining, especially of the ventricles. Ependymomas also occur, usually within the spinal canal, as primary intramedullary lesions or as late "drop" metastases from intracranial ependymomas. Extradural ependymomas are rare. They could occur as intraspinal or extraspinal lesions. We hereby report a case of an extradural (intraspinal) lesion with extraspinal extension, the extraspinal lesion being presacral in position, which presented with urinary and colonic symptoms. The lesions were secondary ependymoma subsequent to an intracranial ependymoma previously treated by combined surgery, radiotherapy, and chemotherapy 4 years earlier. The extradural and extraspinal site of the secondary lesion as well as its mode of presentation are noteworthy.- - - - - - - - - - ranking = 32.095145809243keywords = spinal canal, canal (Clic here for more details about this article) |
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