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| LETTER TO EDITOR |
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| Year : 2014 | Volume
: 62
| Issue : 2 | Page : 200-201 |
Intraventricular tanycytic ependymoma: An uncommon fibrillary variant
Saumya Shukla1, Kiran Preet Malhotra1, Namrata Punit Awasthi1, Nuzhat Husain1, Sunil Kumar Singh2
1 Department of Pathology, Dr. Ram Manohar Lohia Institute of Medical Sciences, Lucknow, India
2 Department of Neurosurgery, King George's Medical University, Lucknow, Uttar Pradesh, India
| Date of Submission | 02-Dec-2013 |
| Date of Decision | 18-Dec-2013 |
| Date of Acceptance | 01-Apr-2014 |
| Date of Web Publication | 14-May-2014 |
Correspondence Address:
Saumya Shukla
Department of Pathology, Dr. Ram Manohar Lohia Institute of Medical Sciences, Lucknow
India
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/0028-3886.132401
How to cite this article:
Shukla S, Malhotra KP, Awasthi NP, Husain N, Singh SK. Intraventricular tanycytic ependymoma: An uncommon fibrillary variant. Neurol India 2014;62:200-1 |
Sir,
Tanycytic ependymoma is an uncommon fibrillary variant of ependymoma, which was first described in 1978 by Friede and Pollack. [1] Tanycytic ependymoma exhibits a predilection for the spinal cord and very rarely occurs in the supratentorial region. Only a few cases of supratentorial tanycytic ependymomas have been reported in literature. [2] Tanycytes are the common progenitor cells of both ependymal cells that are bipolar with long processes that bridge the neuropil between the ependymal lining and adjacent capillary walls and unipolar astrocytes. The close morphological and immunohistochemical resemblance of normal tanycytes to the tumor cells in tanycytic ependymoma justify their classification as a distinct variant of ependymoma. [2],[3]
An 8-year-old boy presented with history of uncontrolled vomiting and seizures. Magnetic resonance imaging (MRI) of brain revealed an ill-defined heterogeneous, juxta-ventricular, mass lesion involving the left temporofrontal lobes with associated mass effect, ventricular dilatation, and distortion of the ipsilateral cerebral peduncle [Figure 1]. Surgical resection of the lesion was performed. Histopathological evaluation revealed a moderately cellular fibrillary glial tumor with elongated spindle-shaped cells. The nuclei were regular oval with speckled chromatin. True perivascular pseudorosettes were inconspicuous. Mitoses and necrosis were absent. Positive immunostaining for glial fibrillary acidic protein and absence of diffuse epithelial membrane antigen and S100 expression aided in the diagnosis of tanycytic ependymoma [Figure 2]. | Figure 1: Axial T1W (a), T2W (b), FLAIR (c), and diffusion-weighted (d) sequences of MRI of the brain depict a heterogeneous, juxta-ventricular, mass lesion involving the left temporofrontal lobes with associated mass effect, ventricular dilatation, and distortion of the ipsilateral cerebral peduncle. The lesion enhances on gadolinium-contrast administration (axial T1-GAD (e), coronal T1-GAD (f), sagittal T1-GAD (g) and shows 'blooming' on gradient recall echo (h) sequence. FLAIR = Fluid-attenuated inversion recovery, MRI = Magnetic resonance imaging, GAD = Gadolinium
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 | Figure 2: (a) Cellular fibrillary glial tumor (H and E, ×20). (b) Glial tumor composed of spindle-shaped cells with regular oval nuclei and speckled chromatin (H and E, ×40). (c) Immunohistochemistry for epithelial membrane antigen-negative (DAB, ×20). (d) Immunohistochemistry for glial fibrillary acidic protein-positive (DAB ×10). H and E = Hematoxylin and Eosin, DAB = 3,3'-Diaminobenzidine
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Histologically, tanycytic ependymoma is easily confused with other glial and nonglial tumors such as pilocytic astrocytomas, fibrous meningioma, and schwannomas. Pilocytic astrocytoma is an architecturally and cytologically biphasic neoplasm composed of tumor cells in both fascicular and microcystic array. Schwannoma may cause a problem in differentiation, but it is composed of characteristic Antoni A and B structures with foci of nuclear palisading (Verocay bodies). Meningiomas are generally composed of whorls of spindle-shaped cells that are strongly immunoreactive for epithelial membrane antigen. Tanycytic ependymomas show a compact mass of spindle cells with strong glial fibrillary acidic protein (GFAP) positivity in the tumor cell cytoplasm that supports its origin from tanycytes and helps to distinguish it from the other lesions. [3],[4],[5]
Tanycytic ependymomas are characterized by a more aggressive clinical behavior and propensity for spread through cerebrospinal fluid pathways. [6] Although adequate surgical clearance followed by cranial irradiation constitutes the conventional therapeutic approach, in patients with gross total resections and no evidence of distant spread of tumor, careful observation has been advocated. Radiation is avoided particularly in children, in whom the risk of long-term toxicity from central nervous system irradiation is substantial. Tanycytic ependymoma needs to be distinguished from the other low-grade lesions that come in the histologic differential diagnosis. We report this rare tumor to draw attention to this entity that may uncommonly present in the supratentorial region. [4],[5],[6]
| » References | |  |
| 1. | Ito T, Ozaki Y, Nakamura H, Tanaka S, Nagashima K. A case of tanycytic ependymoma arising from the cerebral hemisphere. Brain Tumor Pathol 2006;23:91-5. 
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| 2. | Ragel BT, Townsend JJ, Arthur AS, Couldwell WT. Intraventricular tanycytic Ependymoma: Case report and review of the literature. J Neurooncol 2005;71:189-93.
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| 3. | Richards AL, Rosenfeld JV, Gonzales MF, Ashley D, Mc Lean C. Supratentorial tanycytic ependymoma. J Clin Neurosci 2004;11:928-30.
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| 4. | Takahashi H. Tanycytic ependymoma. Clin Neurosci 2003;21:494-5.
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| 5. | Reis F, Schwingel R, de Morais FC, de Souza Queiroz L. Supratentorial tanycytic ependymoma: An uncommon fibrillary ependymoma variant. Arq Neuropsiquiatr 2011;69:723.
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| 6. | Glantz M. Radiotherapy for supratentorial ependymoma Medscape Neurology 2001;3:1.
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[Figure 1], [Figure 2]
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