Fourteen
ependymomas presenting in 8 men and 6 women between the ages of 18 and 78 years (mean, 53.6 years) comprise the study group. The most common clinical presentations included
ataxia (n = 4),
dizziness/
vertigo (n = 3),
nausea/
vomiting (n = 3),
headaches (n = 3), and incidental finding at autopsy (n = 2).
Tumor locations included fourth ventricle (n = 7), lateral ventricle (n = 4), third ventricle (n = 2), and thoracic spinal cord (n = 1). Eight patients underwent gross total resection, and 4 had subtotal resection.
Tumors were characterized by clustering of cell nuclei arranged against a fibrillary background. Focal cystic degeneration was seen in 10
tumors,
hemosiderin deposition in 8
tumors, sclerotic vessels in 8
tumors, calcifications in 5
tumors, and focal nuclear pleomorphism in 2
tumors. Mitotic figures, vascular endothelial proliferation, and
necrosis were not seen in any of these
tumors. Cell proliferation marker MIB-1 labeling indices (percentage of positive staining
tumor cells) ranged from 0 to 1.4 (mean, 0.3). In comparison, 13
myxopapillary ependymomas had labeling indices ranging from 0 to 5.5 (mean, 1.1). Thirty-nine low-grade
ependymomas had MIB-1 labeling indices of 0.1 to 5.4 (mean, 1.1). Fourteen anaplastic/malignant
ependymomas had MIB-1 labeling indices ranging from 0.4 to 34.0 (mean, 12.8). One
subependymoma was treated with
radiation therapy. Six patients were alive with no evidence of
tumor at a mean follow-up of 94.4 months. Two patients were alive with
residual tumor (follow-up of 4 and 53 months). Two patients died with
tumor at 0.67 and 43.4 months. One patient was lost to follow-up, 1 is a recent case, and 2 were incidental findings at autopsy. None of the patients developed
tumor recurrence.
CONCLUSIONS: