high grade ependymoma

High-grade ependymomas are typically diagnosed using a combination of physical and neurological exams, imaging tests, and surgical procedures.

Physical and Neurological Exam A thorough physical and neurological exam is usually the first step in diagnosing high-grade ependymoma. This involves checking for any abnormalities in vision, hearing, balance, coordination, strength, and reflexes. Problems in one or more of these areas may provide clues about the part of the brain or spinal cord that could be affected by a tumor [11].

Imaging Tests Imaging tests are essential in diagnosing high-grade ependymoma. These tests include:

• MRI (Magnetic Resonance Imaging): This test uses large magnets and a computer to create images of the inside of your body, including the brain or spinal cord. Contrast-enhanced MRI is considered the gold standard imaging study for ependymoma [8].
• CT (Computed Tomography) scans: These tests use X-rays and computers to create detailed images of the brain or spinal cord.
• PET (Positron Emission Tomography) scans: These tests use small amounts of radioactive material to create images of the brain or spinal cord.

Surgical Procedures In some cases, a surgical procedure may be necessary to obtain a tissue sample for diagnosis. This is usually done under general anesthesia and involves removing a small portion of the tumor for examination by a neuropathologist [6].

Other Diagnostic Tests Additional diagnostic tests may include:

• CSF (Cerebrospinal Fluid) analysis: A sample of cerebrospinal fluid may be taken to look for tumor cells or other abnormalities.
• Biopsy: A biopsy involves removing a small portion of tissue from the tumor and examining it under a microscope.

It's worth noting that high-grade ependymomas have a higher risk of recurrence, but aggressive treatment can still lead to positive outcomes [2]. Younger children, especially those under the age of five, may have a more challenging prognosis due to the difficulty of completely removing the tumor.

High Grade Ependymoma Differential Diagnosis

High-grade ependymomas are a type of brain tumor that can be challenging to diagnose due to their similarity in appearance to other types of tumors. The differential diagnosis for high-grade ependymoma includes several neoplasms with high glial cellularity, such as:

• Anaplastic oligodendroglioma: This is a rare and aggressive type of brain tumor that can be difficult to distinguish from anaplastic ependymoma.
• Clear cell ependymoma: This subtype of ependymoma is characterized by clear cells with a high nuclear-to-cytoplasmic ratio, which can make it challenging to differentiate from other types of tumors.
• Astrocytoma: High-grade astrocytomas can have similar histological features to anaplastic ependymomas, making differential diagnosis difficult.
• Glioblastoma: This is the most aggressive type of brain tumor and can be mistaken for high-grade ependymoma due to its rapid growth and infiltration into surrounding brain tissue.

Key Features to Consider

When considering a differential diagnosis for high-grade ependymoma, it's essential to examine the following features:

• Histological appearance: High-grade ependymomas typically have a high cellularity with papillary structures and clear cytoplasm.
• Location: Ependymomas often arise from or near the lining of the ventricles, which can help differentiate them from other types of tumors.
• Imaging characteristics: On MRI, high-grade ependymomas are iso- to hypointense in T1-weighted images and iso- to hyperintense in T2-weighted sequences.

References

• [3] Utility of histological grading is debated; the 2021 WHO still recommend assigning either WHO grade 2 or grade 3 to an ependymoma, according to its histopathological features as a part of differential diagnosis.
• [11] On MRI, high-grade ependymomas are iso- to hypointense in T1-weighted images and iso- to hyperintense in T2-weighted sequences. Among the possible differential diagnosis of intraventricular ependymoma, CPC should be considered.
• [15] CNS high grade tumors with BCOR alterations have been described to carry typical ependymoma-like features and have also been diagnosed as such in the past.

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