Subependymoma revisited: clinicopathological evaluation of 83 cases.

OBJECT: Subependymomas are rare ependymal neoplasms. To date, a large clinicopathologic study of these benign neoplasms treated with modern neurosurgical techniques has not been reported. METHODS: Eighty-three cases of subependymoma were retrieved from the files of the Armed Forces Institute of Pathology. Clinicopathological features were reviewed; chromogenic in situ hybridization analysis for chromosome 22 was performed (n = 8), and patient follow-up was obtained (n = 34). Overall, the patients included 68 males and 15 females, 1.5 to 85 years of age (mean, 51.0 years). Twenty-seven cases were discovered at autopsy and the remaining were surgical specimens (n = 56). Tumors arose in the posterior fossa (n = 43), lateral ventricles (n = 37), spinal cord (2) and only one arose in the temporal horn. Tumors ranged in size from 2.0 mm to 60 mm in greatest dimension (mean, 23.0 mm). Eighteen-percent (15/83) of subependymomas exhibited a mixed histologic pattern; that is, subependymoma together with another glial tumor. The most common mixture (13/15) was subependymoma and ependymoma. Surgical excision was used in all symptomatic patients; 10 patients received radiation. Four patients developed a recurrence due to incomplete excision. All patients were without evidence of disease at the last follow-up: alive (n = 28) or dead (n = 8). CONCLUSIONS: Age is the only variable found to be significantly associated with survival. Currently, surgical methods result in an excellent long-term clinical outcome. Subependymomas do not appear to be associated with NF2 mutations.

Identification of relevant prognostic histopathologic features in 69 intracranial ependymomas, excluding myxopapillary ependymomas and subependymomas.

BACKGROUND: The results of attempts to identify histopathologic parameters that contribute to the clinical outcome of patients with ependymomas have been controversial. This may be due to the relative rareness of ependymomas. Furthermore, in many investigations, myxopapillary ependymomas and subependymomas were included and may have confounded results, because those tumors should be considered clinicopathologic entities distinct from the other ependymomas. METHODS: In this retrospective study, the influence of the histologic subtype of ependymoma and of individual histologic features on the outcome of 69 patients with ependymomas was investigated. Myxopapillary ependymomas, subependymomas, and ependymomas with spinal localizations were excluded from the analysis. The ependymomas were subdivided into cellular, papillary, clear cell, and tanycytic subtypes. The study extended over a period of 30 years. RESULTS: No differences in clinical outcome between the four histologic subtypes of ependymomas were revealed. Neither tumor localization (either infratentorial or supratentorial), patient age, nor gender affected survival. The survival of patients who underwent complete tumor resection differed significantly from that of patients who underwent partial resection. In univariate analysis, the features of nuclear atypia, the mitotic index, and the MIB-1 labeling index (LI) significantly influenced survival. With regard to survival, the presence of microcysts, blood vessel density, and the feature of vascular hyalinization demonstrated a trend but did not reach significance. In multivariate analysis, only the mitotic index and the MIB-1 LI were identified as factors with independent prognostic significance (P = 0.027 and P = 0.023, respectively). Both proliferation indices were correlated strongly with each other. CONCLUSIONS: The results of the univariate analysis indicated that, for patients with intracranial ependymoma, nuclear atypia, the mitotic index, and the MIB-1 LI significantly influenced survival. In the multivariate analysis, the mitotic index and the MIB-1 LI were the only features that had independent prognostic significance. Because both showed strong correlations, only one of them should be included in a grading scheme for intracranial ependymomas.

[Operative treatment of the intramedullary tumors with the methylprednisolone usage--preliminary report]. / Leczenie operacyjne guzôw srodrdzeniowych z zastosowaniem methylprednizolonu - doniesienie wstepne.

UNLABELLED: The aim of the study was to assess the intermediate results of the intramedullary tumors treatment with neuroprotection including the methyvlprednisolone (MP) usage. MATERIAL AND METHOD: In the 1995-2003 period 33 patients with intramedullary tumors were operated on in Department of Neurosurgery in Sosnowiec. They were 10 females and 23 males in the age range of 11-61 years. Neuroprotection of the spinal cord in the course of treatment included: determining operational tactics on the basis of magnetic resonance imaging (MRI) performed in three planes, using MP according to NASCIS II and in maintenance dose in the 2-7 day after the operation, SSEP monitoring, myelotomy in the form of anatomical preparation of the posterior longitudinal fissure, sparing big transverse branches of the vasocorona of the posterior column, debulking of the tumor with an ultrasonic aspirator or CO2 laser, closure of the spinal cord after the removal of the tumor with pial sutures and sutures of the arachnoidea. RESULTS: Among the operated tumors 16 had a clear border, the remaining ones were 14 astrocytomas of varying malignancy and infiltration of the white matter of the spinal cord and 3 lipomas. Control MRI revealed a total removal of the lesion in 23 patients (70%), gross total removal in 7 patients (21%) partial removal in three patients (9%). The postoperative condition of the patients 2-3 weeks after the operation showed improvement in 12 cases (37%), no significant changes in 10 cases (30%) and deterioration in 11 cases (33%). CONCLUSION: Appropriate operative tactics together with the use of the MP make the acceptable morbidity rate after radical removal of intramedullary tumors .

[Clinical aspects and pathology of intracranial subependymoma--18 personal cases and review of the literature]. / Klinik und Pathologie intrakranieller Subependymome--18 eigene Fälle und Literaturübersicht.

Intracranial subependymomas are rare, benign tumours (WHO grade I) occupying a special position compared to the other ependymal neoplasms. They often remain asymptomatic and, in consequence, are found incidentally at autopsy. In the present study clinico-pathological data of 84 symptomatic (8 own cases) and 58 asymptomatic tumours (10 own cases) are summarised. Subependymomas are more frequently situated in the fourth (58.4%) than in the lateral ventricle (38.0%). They occur predominantly in middle-aged and elderly males. Tumours in the lateral ventricles manifest themselves more often than those in the fourth ventricle. In general, asymptomatic subependymomas do not exceed a diameter of 1.2 cm. The nature of symptoms, with a median symptomatic period of 12 months, is usually associated with hydrocephalus, which is present in more than 80% of the symptom-producing subependymomas. Growth within the ventricular lumen and sharp demarcation from the surrounding brain tissue allow a complete removal in half of the cases. Radical extirpation can be achieved more often in patients with subependymomas located in the lateral ventricles than in those with tumours arising from the floor of the fourth ventricle. The high operative mortality, at a rate of 28.8% so far, mainly refers to the period before microsurgical technique was established. Recurrences are very rare, spinal seeding has not been found to date. For the assessment of long-term results further detailed compilation and documentation of individual follow-ups is necessary.