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| NEUROIMAGE |
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| Year : 2012 | Volume
: 60
| Issue : 6 | Page : 684-685 |
Mirror image subependymoma
Rajinder Kumar, Avijit Sarkari, Aanchal Kakkar
All India Institute of Medical Sciences, New Delhi, India
| Date of Web Publication | 29-Dec-2012 |
Correspondence Address:
Rajinder Kumar
All India Institute of Medical Sciences, New Delhi
India
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/0028-3886.105228
How to cite this article:
Kumar R, Sarkari A, Kakkar A. Mirror image subependymoma
. Neurol India 2012;60:684-5 |
Subependymoma is a rare, benign neoplasm, accounting for less than 1% of all intracranial neoplasms. We present a case of large symptomatic bilateral subependymoma with mirror image pattern.
A 25-year-old male presented with features of raised intracranial pressure. Magnetic resonance image (MRI) showed large non-homogenous space-occupying lesions iso- to hypo-intense on T1-weighted image (T1WI) [Figure 1] and hyperintense on T2-weighted image (T2WI) [Figure 2] in bilateral occipital region in a 'mirror-image' pattern. Patient underwent staged tumor excision six weeks apart. Histopathological examination of the excised tumor on both the sides showed similar features. The tumor had clusters of monomorphic cells embedded in fibrillary matrix. There was diffuse immunopositivity for GFAP. The tumor cells were immunonegative for NeuN, synaptophysin, chromogranin, NF and EMA [Figure 3]a-d. Postoperative computed tomography (CT) scan revealed complete tumor excision [Figure 4]. Patient is well at three years of follow-up. | Figure 1: T1W1 MRI showing iso to hypointense lesion in bilateral occipital region
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 | Figure 3: (a-d) Histopathological features of the resected right-side tumor showing clustered nuclei in a dense fibrillary background with monomorphic round to oval nuclei in low (a) and high power (b) The left-side tumor showed similar morphological features on low and high magnification (c and d)
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 | Figure 4: Postoperative CT scan at follow-up showing complete tumor excision
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Tumors with mirror image pattern are a rare entity. This has been described with gliomas in the corpus callosum, thalamus, insular region, multicentric gliomas and rarely in metastasis. [1] It has not been described in subependymomas so far. These tumors have indolent growth so that most are still diagnosed at autopsy. [2] Such large subependymomas are very rare. Size at presentation is directly related to tumor location, with tumors that block cerebrospinal fluid (CSF) pathways presenting with smaller dimensions than tumors not impeding CSF flow. [2],[3]
On CT these lesions appear as hypodense to isodense with cystic components with poor contrast enhancement. They are hypo- to isointense on T1WI, hyperintense onT2WI and have minimal to moderate enhancement. MR-spectroscopy shows findings consistent with low-grade tumors. The differential diagnosis includes ependymoma, choroid plexus papilloma, metastasis, rarely meningioma, central neurocytoma and subependymal giant cell astrocytcoma. [4]
| » References | |  |
| 1. | Borkar SA, Tandon V, Kale SS, Mahapatra AK. Mirror image insular glioma. Neurol India 2010;58:978-9. 
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| 2. | Nishio S, Morioka T, Mihara F, Fukui M. Subependymoma of the lateral ventricles. Neurosurg Rev 2000;23:98-103.
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| 3. | Maiuri F, Gangemi M, Iaconetta G, Signorelli F, Del Basso De Caro M. Symptomatic subependymomas of the lateral ventricles. Report of eight cases. Clin Neurol Neurosurg 1997;99:17-22.
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| 4. | Ragel BT, Osborn AG, Whang K, Townsend JJ, Jensen RL, Couldwell WT. Subependymomas: An analysis of clinical and imaging features. Neurosurgery 2006;58:881-90.
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[Figure 1], [Figure 2], [Figure 3], [Figure 4]
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