Supratentorial extraventricular anaplastic ependymoma with extracranial metastasis

Pachella, Laura A; Kamiya-Matsuoka, Carlos; Lee, Eva Lu T.; Olar, Adriana; Yung, W. K. Alfred

doi:10.1016/j.jocn.2014.09.006

Cited by 15 publications

(20 citation statements)

References 12 publications

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“…Although these pathways were mainly described for other pediatric and adult CNS tumors, including medulloblastomas and glioblastomas, such routes were also deemed responsible for most extra-neural metastases from IEs ( 57 , 62 , 63 ). This is further supported by the fact that the most frequent secondary lesions found in our review described the involvement of lymph nodes, lungs, and scalp ( 7 , 8 , 43 , 48 ). The presence of multifocal extra-neural metastases in most of our pooled patients also suggests that hematogenous and lymphatic routes are not mutually exclusive but may coexist, especially in aggressive grade-III IEs ( 6 , 30 , 32 , 34 ).…”

Section: Discussionsupporting

confidence: 80%

Extra-Neural Metastases From Primary Intracranial Ependymomas: A Systematic Review

Palmisciano

Ferini²,

Barone

et al. 2022

Front. Oncol.

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BackgroundPrimary intracranial ependymomas (IE) are rare brain tumors rarely metastasizing outside the central nervous system. We systematically reviewed the literature on extra-neural metastases from primary IEs.MethodsPubMed, Scopus, Web-of-Science, and Cochrane were searched following the PRISMA guidelines to include studies of extra-neural metastases from primary IEs. Clinical features, management strategies, and survival were analyzed.ResultsWe collected 48 patients from 43 studies. Median age was 13 years (range, 2-65). Primary IEs were frequently located in the parietal (22.9%) and frontal (16.7%) lobes, and mostly treated with resection (95.8%) and/or radiotherapy (62.5%). Most IEs were of grade-III (79.1%), and few of grade-I (6.3%) or grade-II (14.6%). 45 patients experienced intracranial recurrences, mostly treated with resection (86.7%), radiotherapy (60%), and/or chemotherapy (24.4%). Median time-interval from primary IEs was 28 months (range, 0-140). Most extra-neural metastases were diagnosed at imaging (37.5%) or autopsy (35.4%). Extra-neural metastases were multifocal in 38 patients (79.1%), mostly involving cervical or hilar lymph-nodes (66.7%), lung/pleura (47.9%), and/or scalp (29.1%). Surgical resection (31.3%), chemotherapy (31.3%) and locoregional radiotherapy (18.8%) were the most common treatments for extra-neural metastases, but 28 (58.3%) patients were not treated. At last follow-up, 37 patients died with median overall-survivals from primary IEs of 36 months (range, 1-239), and from extra-neural metastases of 3 months (range, 0.1-36). Overall-survival was significantly longer in patients with grade-I and II IEs (P=0.040).ConclusionExtra-neural metastases from primary IEs are rare, but mostly occur at later disease stages. Multidisciplinary management strategies should be intended mostly for palliation.

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Section: Discussionsupporting

confidence: 80%

Extra-Neural Metastases From Primary Intracranial Ependymomas: A Systematic Review

Palmisciano

Ferini²,

Barone

et al. 2022

Front. Oncol.

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“…Extracranial metastases, with involvement of lung, pleura and lymph nodes, have been described in isolated works of the literature. 6–11 We report the case of a supratentorial anaplastic ependymoma with metastases to the spine, liver and lymph node presenting less than one year from clinical onset.…”

Section: Introductionmentioning

confidence: 99%

Systemic metastases from central nervous system ependymoma: case report and review of the literature

et al. 2017

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Ependymal tumours in adults are rare, accounting for less than 4% of primary tumours of the central nervous system, and exceptionally metastasise outside the nervous system. In this study, we present a case of anaplastic ependymoma, which developed metastases outside the nervous system less than a year after its clinical onset. A healthy 65-year-old woman suddenly presented with drowsiness of unknown origin, accompanied by ingravescent fatigue, inability to maintain the upright posture, headache, nausea and vomiting. Computed tomography study performed in the emergency department showed the presence of an inhomogeneously hypodense area, with temporoparietal extension and median line deviation. After surgical excision, performed after two days, the bioptic examination demonstrated an anaplastic ependymoma with multiple areas of necrosis. The patient was submitted to adjuvant radiation therapy. At magnetic resonance imaging follow-up, performed three months after surgery, neither local recurrences nor typical 'drop metastases' to the spinal area were observed. Three months later, magnetic resonance imaging control revealed bone metastases and recurrences in the left insula and at the ipsilateral cerebellar hemisphere. Total body computed tomography examination showed metastases in the liver, vertebrae and pelvic bones, and involvement of paratracheal lymph nodes.

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“…Cytomorphology in conjunction with ancillary studies performed on cellblock sections permitted in this case the accurate diagnosis of metastatic ependymoma. More cases of ENM arising from primary intracranial anaplastic ependymomas have been reported recently [34-37] including one case each with involvement of the mastoid region [36] and the bilateral parotid glands [37]. Classic and anaplastic ependymoma correspond to WHO grades II and III, respectively.…”

Section: Discussionmentioning

confidence: 99%

Cytology of Extraneural Metastases of Nonhematolymphoid Primary Central Nervous System Tumors: Six Cases with Histopathological Correlation and Literature Update

2021

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Introduction: Extraneural/-cranial metastases (ENM) of primary central nervous system (CNS) tumors are rare and may be diagnostically challenging. We describe the cytomorphological and pertinent clinical features of ENM in a case series assessed by fine-needle aspiration (FNA). A search of the laboratory information systems of 2 tertiary care centers in Toronto (2000–2015) was performed. Cases with direct extracranial/-spinal extension of CNS neoplasms were excluded. Microscopic slides of FNA and surgical specimens were reviewed. Demographic and clinicopathological data were retrieved. Case Presentation: Six cases were identified with the original diagnoses of glioblastoma, glioblastoma with primitive neuroectodermal tumor-like components, anaplastic ependymoma, myxopapillary ependymoma, atypical meningioma, and hemangiopericytoma. Median patient age at first diagnosis was 44 years (range 22–56). The time interval between initial diagnosis and first metastatic disease manifestation was 3 months to 19 years. All FNA diagnoses were rendered correctly. In 4 cases, immunohistochemistry was used to support the diagnosis. All cases had prior surgical intervention at the primary tumor site. In 4 cases, the ENM location was the ipsilateral parotid or buccal area. Two primary tumors in midline location developed ENM in the scapular area. Discussion/Conclusion: ENM are a rare manifestation of a range of different primary CNS tumors and may involve the ipsilateral head and neck mimicking clinically a salivary gland neoplasm. FNA can rapidly discriminate ENM from other, potentially more indolent conditions. Awareness of the clinical history is paramount to avoid diagnostic confusion.

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Supratentorial extraventricular anaplastic ependymoma with extracranial metastasis

Cited by 15 publications

References 12 publications

Extra-Neural Metastases From Primary Intracranial Ependymomas: A Systematic Review

Extra-Neural Metastases From Primary Intracranial Ependymomas: A Systematic Review

Systemic metastases from central nervous system ependymoma: case report and review of the literature

Cytology of Extraneural Metastases of Nonhematolymphoid Primary Central Nervous System Tumors: Six Cases with Histopathological Correlation and Literature Update

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