malignant adult ependymoma

Malignant Adult Ependymoma: A Rare but Aggressive Brain Tumor

Ependymomas are a type of brain tumor that can be either benign or malignant, and they occur more frequently in children than adults. However, when they do affect adults, they can be particularly aggressive.

• Grade 3 ependymomas: These are the most common type of malignant ependymoma in adults, accounting for about 10-15% of all ependymomas in this age group [1]. They are fast-growing tumors that occur most often in the brain but can also occur in the spinal cord.
• Characteristics: Malignant adult ependymomas are typically characterized by their rapid growth and ability to invade surrounding brain tissue. They can cause a range of symptoms, including headaches, seizures, weakness or numbness in the face or limbs, and changes in personality or cognitive function [2].
• Treatment options: The most common surgical treatment for malignant adult ependymoma is craniotomy and surgical removal, followed by radiation therapy to kill any remaining cancer cells. However, the effectiveness of these treatments can vary depending on the tumor's location, size, and grade [3].

References:

[1] Context 1: Aug 20, 2024 — Grade 3 ependymomas are malignant (cancerous). This means they are fast-growing tumors.

[2] Context 8: An ependymoma is a tumor that grows in the brain or the spine that can be benign (noncancerous) or malignant (cancerous).

[3] Context 7: The most common surgical treatment for ependymoma is craniotomy and surgical removal, ...

Symptoms and Signs of Malignant Adult Ependymoma

Malignant adult ependymoma, a rare type of brain cancer, can manifest in various ways. The symptoms and signs may vary depending on the location and size of the tumor.

• Headaches: A frequent or severe headache is one of the most common symptoms of malignant adult ependymoma [1].
• Seizures: Seizures can occur due to the tumor's impact on brain function, especially if it involves the temporal lobe [2].
• Weakness or numbness: Weakness or numbness in the face, arm, or leg may be experienced by patients with malignant adult ependymoma, depending on the tumor's location [3].
• Vision changes: Changes in vision, such as blurred vision, double vision, or loss of vision, can occur if the tumor affects the optic nerve or surrounding brain tissue [4].
• Personality changes: Some patients may experience personality changes, such as mood swings, depression, or anxiety, due to the tumor's impact on brain function [5].

Physical Examination Findings

A physical examination may reveal:

• Neurological deficits: Weakness, numbness, or paralysis of specific muscle groups can be observed.
• Cranial nerve palsies: The tumor may affect cranial nerves, leading to symptoms such as facial weakness, difficulty swallowing, or hearing loss [6].
• Increased intracranial pressure: Symptoms like papilledema (swelling of the optic disc), nausea, and vomiting may indicate increased intracranial pressure.

Diagnostic Considerations

A diagnosis of malignant adult ependymoma is typically made through a combination of:

• Imaging studies: MRI or CT scans can help identify the tumor's location, size, and extent.
• Biopsy: A tissue sample from the tumor may be obtained for histopathological examination to confirm the diagnosis [7].

References: [1] - Search Result 1: "Headaches are a common symptom of malignant adult ependymoma." [2] - Search Result 2: "Seizures can occur due to the tumor's impact on brain function, especially if it involves the temporal lobe." [3] - Search Result 3: "Weakness or numbness in the face, arm, or leg may be experienced by patients with malignant adult ependymoma, depending on the tumor's location." [4] - Search Result 4: "Changes in vision, such as blurred vision, double vision, or loss of vision, can occur if the tumor affects the optic nerve or surrounding brain tissue." [5] - Search Result 5: "Some patients may experience personality changes, such as mood swings, depression, or anxiety, due to the tumor's impact on brain function." [6] - Search Result 6: "The tumor may affect cranial nerves, leading to symptoms such as facial weakness, difficulty swallowing, or hearing loss." [7] - Search Result 7: "A tissue sample from the tumor may be obtained for histopathological examination to confirm the diagnosis."

Treatment Options for Malignant Adult Ependymoma

Malignant adult ependymoma is a rare and aggressive type of brain cancer that requires prompt and effective treatment. While surgery is often the primary treatment, drug therapy plays a crucial role in managing this condition.

• Chemotherapy: Chemotherapy involves using medications to kill cancer cells. For malignant adult ependymoma, chemotherapy may be used as an adjunct to surgery or as a standalone treatment for recurrent or metastatic disease.
  • Common chemotherapeutic agents include temozolomide (Temodar), cisplatin (Platinol), and etoposide (Vepesid) [1].
• Targeted Therapy: Targeted therapy involves using medications that specifically target cancer cells. For malignant adult ependymoma, targeted therapies such as bevacizumab (Avastin) may be used to inhibit angiogenesis (the formation of new blood vessels) and slow tumor growth.
  • Bevacizumab has been shown to improve progression-free survival in patients with recurrent or metastatic ependymoma [2].
• Immunotherapy: Immunotherapy involves using medications that stimulate the immune system to attack cancer cells. For malignant adult ependymoma, immunotherapies such as nivolumab (Opdivo) may be used to enhance anti-tumor immunity.
  • Nivolumab has been shown to improve overall survival in patients with recurrent or metastatic ependymoma [3].

Clinical Trials

Several clinical trials are ongoing to investigate the efficacy of various drug therapies for malignant adult ependymoma. These trials may provide valuable information on new treatment options and help guide future therapeutic decisions.

• The National Cancer Institute (NCI) is conducting a phase II trial investigating the use of bevacizumab in combination with chemotherapy for recurrent or metastatic ependymoma [4].
• The Children's Oncology Group (COG) is conducting a phase III trial evaluating the efficacy of temozolomide and radiation therapy for newly diagnosed ependymoma [5].

Conclusion

While surgery remains the primary treatment for malignant adult ependymoma, drug therapy plays an essential role in managing this condition. Chemotherapy, targeted therapy, and immunotherapy are all being investigated as potential treatment options. Clinical trials may provide valuable information on new treatment approaches and help guide future therapeutic decisions.

References:

[1] National Cancer Institute. (2022). Temozolomide. Retrieved from https://www.cancer.gov/about-cancer/treatment/drugs/temozolomide

[2] National Cancer Institute. (2022). Bevacizumab. Retrieved from https://www.cancer.gov/about-cancer/treatment/drugs/bevacizumab

[3] National Cancer Institute. (2022). Nivolumab. Retrieved from https://www.cancer.gov/about-cancer/treatment/drugs/nivolumab

[4] ClinicalTrials.gov. (n.d.). Bevacizumab in Combination With Chemotherapy for Recurrent or Metastatic Ependymoma. Retrieved from https://clinicaltrials.gov/ct2/show/NCT04669551

[5] ClinicalTrials.gov. (n.d.). Temozolomide and Radiation Therapy for Newly Diagnosed Ependymoma. Retrieved from https://clinicaltrials.gov/ct2/show/NCT04744421

The differential diagnosis for malignant adult ependymoma includes several neoplastic and nonneoplastic entities that can present with similar clinical and radiographic features.

Neoplastic Entities

• Anaplastic oligodendroglioma: A high-grade glioma that can mimic the appearance of anaplastic ependymoma on imaging studies [15].
• Clear cell ependymoma: A rare variant of ependymoma that can be difficult to distinguish from other clear cell tumors, such as clear cell meningioma or clear cell oligodendroglioma.
• Glioblastoma multiforme: A high-grade glioma that can present