[Downloaded free from http://www.neurologyindia.com on Thursday, May 15, 2014, IP: 202.177.173.189] || Click here to download free Android application for this journal Letters to Editor
Hanuma Srinivas Bhavanam, Alugolu Rajesh, Megha Shantveer Uppin1 Departments of Neurosurgery, and 1Pathology, Nizam’s Institute of Medical Sciences, Punjagutta, Hyderabad, Andhra Pradesh, India E-mail: [email protected]
References 1. 2. 3. 4. 5. 6.
Selvapandian S, Chandy MJ. Tuberculous granuloma of the clivus. Br J Neurosurg 1993;7:581-2. Shenoy SN, Raja A. Tuberculous granuloma of the spheno-clival region. Neurol India 2004;52:129-30. Witcombe JB, Cremin BJ. Tuberculous erosion of the sphenoid bone. Br J Radiol 1978;51:347-50. Turel MK, Rajshekhar V. Sphenoid sinus tuberculosis: A rare cause of visual dysfunction in an adolescent girl. Neurol India 2013;61:179-80. Sencer S, Sencer A, Aydin K, Hepgul K, Poyanli A, Minareci O. Imaging in tuberculosis of the skull and skull-base: Case report. Neuroradiology 2003;45:160-3. Indira Devi B, Tyagi AK, Bhat DI, Santosh V. Tuberculous osteitis of clivus. Neurol India 2003;51:69-70. Access this article online Quick Response Code:
Website: www.neurologyindia.com PMID: *** DOI: 10.4103/0028-3886.132400
Received: 03-02-2014 Review completed: 08-02-2014 Accepted: 09-04-2014
Intraventricular tanycytic ependymoma: An uncommon fibrillary variant Sir, Tanycytic ependymoma is an uncommon fibrillary variant of ependymoma, which was first described in 1978 by Friede and Pollack.[1] Tanycytic ependymoma exhibits a predilection for the spinal cord and very rarely occurs in the supratentorial region. Only a few cases of supratentorial tanycytic ependymomas have been reported in literature.[2] Tanycytes are the common progenitor cells of both ependymal cells that are bipolar with long processes that bridge the neuropil between the ependymal lining and adjacent capillary walls and unipolar astrocytes. The close morphological and immunohistochemical resemblance of normal tanycytes to the tumor cells in tanycytic ependymoma justify their classification as a distinct variant of ependymoma.[2,3] An 8-year-old boy presented with history of uncontrolled vomiting and seizures. Magnetic 200
resonance imaging (MRI) of brain revealed an ill-defined heterogeneous, juxta-ventricular, mass lesion involving the left temporofrontal lobes with associated mass effect, ventricular dilatation, and distortion of the ipsilateral cerebral peduncle [Figure 1]. Surgical resection of the lesion was performed. Histopathological evaluation revealed a moderately cellular fibrillary glial tumor with elongated spindle-shaped cells. The nuclei were regular oval with speckled chromatin. True perivascular pseudorosettes were inconspicuous. Mitoses and necrosis were absent. Positive immunostaining for glial fibrillary acidic protein and absence of diffuse epithelial membrane antigen and S100 expression aided in the diagnosis of tanycytic ependymoma [Figure 2]. Histologically, tanycytic ependymoma is easily confused with other glial and nonglial tumors such as pilocytic astrocytomas, fibrous meningioma, and schwannomas. Pilocytic astrocytoma is an architecturally and cytologically biphasic neoplasm composed of tumor cells in both fascicular and microcystic array. Schwannoma may cause a problem in differentiation, but it is composed of characteristic Antoni A and B structures with foci of nuclear palisading (Verocay bodies). Meningiomas are generally composed of whorls of spindle-shaped cells that are strongly immunoreactive for epithelial membrane antigen. Tanycytic ependymomas show a compact mass of spindle cells with strong glial fibrillary acidic protein (GFAP) positivity in the tumor cell cytoplasm that supports its origin from tanycytes and helps to distinguish it from the other lesions.[3-5] Tanycytic ependymomas are characterized by a more aggressive clinical behavior and propensity for spread through cerebrospinal fluid pathways. [6] Although adequate surgical clearance followed by cranial irradiation constitutes the conventional therapeutic approach, in patients with gross total resections and no evidence of distant spread of tumor, careful observation has been advocated. Radiation is avoided particularly in children, in whom the risk of long-term toxicity from central nervous system irradiation is substantial. Tanycytic ependymoma needs to be distinguished from the other low-grade lesions that come in the histologic differential diagnosis. We report this rare tumor to draw attention to this entity that may uncommonly present in the supratentorial region.[4-6]
Saumya Shukla, Kiran Preet Malhotra, Namrata Punit Awasthi, Nuzhat Husain, Sunil Kumar Singh1 Department of Pathology, Dr. Ram Manohar Lohia Institute of Medical Sciences, Lucknow, 1Department of Neurosurgery, King George’s Medical University, Lucknow, Uttar Pradesh, India E-mail: [email protected] Neurology India | Mar-Apr 2014 | Vol 62 | Issue 2
[Downloaded free from http://www.neurologyindia.com on Thursday, May 15, 2014, IP: 202.177.173.189] || Click here to download free Android application for this journal Letters to Editor
a
b
c
e
f
g
d
h
Figure 1: Axial T1W (a), T2W (b), FLAIR (c), and diffusion-weighted (d) sequences of MRI of the brain depict a heterogeneous, juxta-ventricular, mass lesion involving the left temporofrontal lobes with associated mass effect, ventricular dilatation, and distortion of the ipsilateral cerebral peduncle. The lesion enhances on gadolinium-contrast administration (axial T1-GAD (e), coronal T1-GAD (f), sagittal T1-GAD (g) and shows ‘blooming’ on gradient recall echo (h) sequence. FLAIR = Fluid-attenuated inversion recovery, MRI = Magnetic resonance imaging, GAD = Gadolinium
2.
3. a
b
4. 5.
6.
d
c
Figure 2: (a) Cellular fibrillary glial tumor (H and E, ×20). (b) Glial tumor composed of spindle-shaped cells with regular oval nuclei and speckled chromatin (H and E, ×40). (c) Immunohistochemistry for epithelial membrane antigen-negative (DAB, ×20). (d) Immunohistochemistry for glial fibrillary acidic protein-positive (DAB ×10). H and E = Hematoxylin and Eosin, DAB = 3,3'-Diaminobenzidine
References 1.
Ito T, Ozaki Y, Nakamura H, Tanaka S, Nagashima K. A case of
Neurology India | Mar-Apr 2014 | Vol 62 | Issue 2
tanycytic ependymoma arising from the cerebral hemisphere. Brain Tumor Pathol 2006;23:91-5. Ragel BT, Townsend JJ, Arthur AS, Couldwell WT. Intraventricular tanycytic Ependymoma: Case report and review of the literature. J Neurooncol 2005;71:189-93. R i c h a r d s A L , Ro s e n f e l d J V, G o n z a l e s M F, A s h l e y D , Mc Lean C. Supratentorial tanycytic ependymoma. J Clin Neurosci 2004;11:928-30. Takahashi H. Tanycytic ependymoma. Clin Neurosci 2003;21:494-5. Reis F, Schwingel R, de Morais FC, de Souza Queiroz L. Supratentorial tanycytic ependymoma: An uncommon fibrillary ependymoma variant. Arq Neuropsiquiatr 2011;69:723. Glantz M. Radiotherapy for supratentorial ependymoma Medscape Neurology 2001;3:1.
Access this article online Quick Response Code:
Website: www.neurologyindia.com PMID: *** DOI: 10.4103/0028-3886.132401
Received: 02-12-2013 Review completed: 18-12-2013 Accepted: 01-04-2014
201
Copyright of Neurology India is the property of Medknow Publications & Media Pvt. Ltd. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.
Hanuma Srinivas Bhavanam, Alugolu Rajesh, Megha Shantveer Uppin1 Departments of Neurosurgery, and 1Pathology, Nizam’s Institute of Medical Sciences, Punjagutta, Hyderabad, Andhra Pradesh, India E-mail: [email protected]
References 1. 2. 3. 4. 5. 6.
Selvapandian S, Chandy MJ. Tuberculous granuloma of the clivus. Br J Neurosurg 1993;7:581-2. Shenoy SN, Raja A. Tuberculous granuloma of the spheno-clival region. Neurol India 2004;52:129-30. Witcombe JB, Cremin BJ. Tuberculous erosion of the sphenoid bone. Br J Radiol 1978;51:347-50. Turel MK, Rajshekhar V. Sphenoid sinus tuberculosis: A rare cause of visual dysfunction in an adolescent girl. Neurol India 2013;61:179-80. Sencer S, Sencer A, Aydin K, Hepgul K, Poyanli A, Minareci O. Imaging in tuberculosis of the skull and skull-base: Case report. Neuroradiology 2003;45:160-3. Indira Devi B, Tyagi AK, Bhat DI, Santosh V. Tuberculous osteitis of clivus. Neurol India 2003;51:69-70. Access this article online Quick Response Code:
Website: www.neurologyindia.com PMID: *** DOI: 10.4103/0028-3886.132400
Received: 03-02-2014 Review completed: 08-02-2014 Accepted: 09-04-2014
Intraventricular tanycytic ependymoma: An uncommon fibrillary variant Sir, Tanycytic ependymoma is an uncommon fibrillary variant of ependymoma, which was first described in 1978 by Friede and Pollack.[1] Tanycytic ependymoma exhibits a predilection for the spinal cord and very rarely occurs in the supratentorial region. Only a few cases of supratentorial tanycytic ependymomas have been reported in literature.[2] Tanycytes are the common progenitor cells of both ependymal cells that are bipolar with long processes that bridge the neuropil between the ependymal lining and adjacent capillary walls and unipolar astrocytes. The close morphological and immunohistochemical resemblance of normal tanycytes to the tumor cells in tanycytic ependymoma justify their classification as a distinct variant of ependymoma.[2,3] An 8-year-old boy presented with history of uncontrolled vomiting and seizures. Magnetic 200
resonance imaging (MRI) of brain revealed an ill-defined heterogeneous, juxta-ventricular, mass lesion involving the left temporofrontal lobes with associated mass effect, ventricular dilatation, and distortion of the ipsilateral cerebral peduncle [Figure 1]. Surgical resection of the lesion was performed. Histopathological evaluation revealed a moderately cellular fibrillary glial tumor with elongated spindle-shaped cells. The nuclei were regular oval with speckled chromatin. True perivascular pseudorosettes were inconspicuous. Mitoses and necrosis were absent. Positive immunostaining for glial fibrillary acidic protein and absence of diffuse epithelial membrane antigen and S100 expression aided in the diagnosis of tanycytic ependymoma [Figure 2]. Histologically, tanycytic ependymoma is easily confused with other glial and nonglial tumors such as pilocytic astrocytomas, fibrous meningioma, and schwannomas. Pilocytic astrocytoma is an architecturally and cytologically biphasic neoplasm composed of tumor cells in both fascicular and microcystic array. Schwannoma may cause a problem in differentiation, but it is composed of characteristic Antoni A and B structures with foci of nuclear palisading (Verocay bodies). Meningiomas are generally composed of whorls of spindle-shaped cells that are strongly immunoreactive for epithelial membrane antigen. Tanycytic ependymomas show a compact mass of spindle cells with strong glial fibrillary acidic protein (GFAP) positivity in the tumor cell cytoplasm that supports its origin from tanycytes and helps to distinguish it from the other lesions.[3-5] Tanycytic ependymomas are characterized by a more aggressive clinical behavior and propensity for spread through cerebrospinal fluid pathways. [6] Although adequate surgical clearance followed by cranial irradiation constitutes the conventional therapeutic approach, in patients with gross total resections and no evidence of distant spread of tumor, careful observation has been advocated. Radiation is avoided particularly in children, in whom the risk of long-term toxicity from central nervous system irradiation is substantial. Tanycytic ependymoma needs to be distinguished from the other low-grade lesions that come in the histologic differential diagnosis. We report this rare tumor to draw attention to this entity that may uncommonly present in the supratentorial region.[4-6]
Saumya Shukla, Kiran Preet Malhotra, Namrata Punit Awasthi, Nuzhat Husain, Sunil Kumar Singh1 Department of Pathology, Dr. Ram Manohar Lohia Institute of Medical Sciences, Lucknow, 1Department of Neurosurgery, King George’s Medical University, Lucknow, Uttar Pradesh, India E-mail: [email protected] Neurology India | Mar-Apr 2014 | Vol 62 | Issue 2
[Downloaded free from http://www.neurologyindia.com on Thursday, May 15, 2014, IP: 202.177.173.189] || Click here to download free Android application for this journal Letters to Editor
a
b
c
e
f
g
d
h
Figure 1: Axial T1W (a), T2W (b), FLAIR (c), and diffusion-weighted (d) sequences of MRI of the brain depict a heterogeneous, juxta-ventricular, mass lesion involving the left temporofrontal lobes with associated mass effect, ventricular dilatation, and distortion of the ipsilateral cerebral peduncle. The lesion enhances on gadolinium-contrast administration (axial T1-GAD (e), coronal T1-GAD (f), sagittal T1-GAD (g) and shows ‘blooming’ on gradient recall echo (h) sequence. FLAIR = Fluid-attenuated inversion recovery, MRI = Magnetic resonance imaging, GAD = Gadolinium
2.
3. a
b
4. 5.
6.
d
c
Figure 2: (a) Cellular fibrillary glial tumor (H and E, ×20). (b) Glial tumor composed of spindle-shaped cells with regular oval nuclei and speckled chromatin (H and E, ×40). (c) Immunohistochemistry for epithelial membrane antigen-negative (DAB, ×20). (d) Immunohistochemistry for glial fibrillary acidic protein-positive (DAB ×10). H and E = Hematoxylin and Eosin, DAB = 3,3'-Diaminobenzidine
References 1.
Ito T, Ozaki Y, Nakamura H, Tanaka S, Nagashima K. A case of
Neurology India | Mar-Apr 2014 | Vol 62 | Issue 2
tanycytic ependymoma arising from the cerebral hemisphere. Brain Tumor Pathol 2006;23:91-5. Ragel BT, Townsend JJ, Arthur AS, Couldwell WT. Intraventricular tanycytic Ependymoma: Case report and review of the literature. J Neurooncol 2005;71:189-93. R i c h a r d s A L , Ro s e n f e l d J V, G o n z a l e s M F, A s h l e y D , Mc Lean C. Supratentorial tanycytic ependymoma. J Clin Neurosci 2004;11:928-30. Takahashi H. Tanycytic ependymoma. Clin Neurosci 2003;21:494-5. Reis F, Schwingel R, de Morais FC, de Souza Queiroz L. Supratentorial tanycytic ependymoma: An uncommon fibrillary ependymoma variant. Arq Neuropsiquiatr 2011;69:723. Glantz M. Radiotherapy for supratentorial ependymoma Medscape Neurology 2001;3:1.
Access this article online Quick Response Code:
Website: www.neurologyindia.com PMID: *** DOI: 10.4103/0028-3886.132401
Received: 02-12-2013 Review completed: 18-12-2013 Accepted: 01-04-2014
201
Copyright of Neurology India is the property of Medknow Publications & Media Pvt. Ltd. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.
