Anaplastic ependymoma simulating glioblastoma in the cerebrum of an adult |
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Authors: | Masayuki Shintaku Kenji Hashimoto |
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Institution: | (1) Department of Pathology, Osaka Red Cross Hospital, Tennoji, Osaka 543-8555, Japan;(2) Department of Neurosurgery, Osaka Red Cross Hospital, Osaka, Japan;(3) Present address: Department of Neurosurgery, Hamamatsu Rosai Hospital, Hamamatsu, Japan |
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Abstract: | A case of anaplastic ependymoma of the cerebral hemisphere in which the histopathological features closely simulated those
of glioblastoma is reported. The patient was a 72-year-old woman with a large, well-demarcated tumor in the left temporal
lobe. The tumor was totally extirpated, but recurred 18 months later, and the patient died after 4 months. The extirpated
tumor was well circumscribed from the surrounding brain tissue and consisted of a sheet-like, dense proliferation of atypical,
short spindle or polygonal cells. Extensive geographic necrosis with nuclear pseudopalisading was seen. Although perivascular
pseudorosettes were observed in many areas, true ependymal rosettes were absent. Immunohistochemistry for glial fibrillary
acidic protein and epithelial membrane antigen and ultrastructural study confirmed the ependymal nature of tumor cells. The
histopathological spectrum of anaplastic ependymoma is very wide and reflects the basically dual characteristics of ependymal
cells: epithelial and glial phenotypes. The present case indicates that some anaplastic ependymomas strongly express the glial
phenotype and also show remarkable anaplastic cytological features, thus closely simulating glioblastoma. The diagnostic criteria
for anaplastic ependymoma, and the nosological position of highly anaplastic ependymoma and its possible clinical implications,
are briefly discussed. |
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