Case reportSupratentorial tanycytic ependymoma
Introduction
Tanycytes are a specialised population of ependymal cells found mainly in the primitive nervous system. During the foetal period, they constitute a considerable proportion of the ependymal lining but represent only a small part of the adult ependyma.[1], [2], [3] They are associated with circumventricular organs and are present in highest concentration in the ventral portion of the third ventricle.[1], [4], [5], [6] This, and their association with both CSF and vasculature provide evidence for transport capabilities and involvement in neuroendocrine function.[1], [4], [5], [6]
Tanycytic ependymoma is a highly fibrillary tumour, which lacks the histological hallmark features of ependymoma. It has been reported in the spinal cord, where it displays a cervical preponderance, and intracranially, more commonly infratentorially. Presentation depends on localisation, with supratentorial cases presenting with seizures or symptoms of raised intracranial pressure. The age group of the reviewed cases of tanycytic ependymoma, both spinal and intracranial, ranged from 13 to 55 years, with a mean age at diagnosis of 37.9 years for spinal cases and 35.7 years for intracranial cases. This includes both pure and mixed types.[1], [3], [4], [7], [8], [9], [10]
Section snippets
History
A 17-year old male presented with a single generalised epileptic seizure and was found lying face down at home, with some twitching of his left hand and a clenched jaw. On examination, he had no abnormal neurological signs and his optic fundi were normal. He was placed on carbamazepine, which controlled his seizures.
The computed tomographic (CT) scan showed a small area of calcification in the subcortical white matter of the left frontal lobe, and the magnetic resonance (MR) scan revealed an
Discussion
Ependymomas constitute 3–9% of all neuroepithelial tumours and represent approximately 50–60% of spinal gliomas.[11], [12] The histopathological features of ependymoma include moderate cellularity, rare or absent mitoses, round to oval nuclei with abundant dense chromatin, ependymal rosettes and perivascular pseudorosettes. Ependymal rosettes; columnar cells arranged around a central lumen, whilst diagnostic for ependymoma, occur in only a minority of cases.[11], [12], [13]
The term “tanycytic
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