Lack of histopathological correlation of malignant ependymomas with postoperative survival

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✓ It is widely believed that an important determinant of clinical behavior and prognosis in patients harboring an ependymoma is the histological grade of malignancy of the tumor. Excluding from the present analysis examples of ependymoblastoma (a highly cellular, embryonal tumor occurring in children, with a notably poor prognosis and a tendency to subarachnoid spread), an attempt was made to correlate 15 cases of histologically malignant ependymoma with clinical recurrence and postoperative patient survival times. Ten patients (67%) were alive from 15 months to 14 years after surgery (median survival time 8.8 years); one patient had a histologically benign recurrence 11 years after surgical resection. Five patients (33%) died from a local recurrence of their tumor; their postoperative survival times ranged from 13 months to 6 years (median 2.5 years).

The prognosis of malignant ependymomas is therefore highly variable. No correlation was possible between the tumor's histological features, site, or likelihood of recurrence. This lack of clinicohistopathological concordance contrasts with the known correlations that exist in astrocytomas.

Article Information

Address reprint requests to: Lucien J. Rubinstein, M.D., Division of Neuropathology, Department of Pathology, University of Virginia School of Medicine, Charlottesville, Virginia 22908.

© AANS, except where prohibited by US copyright law.

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Figures

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    Case 1 (14 years postoperative survival). Photomicrograph showing ependymal rosette in malignant ependymoma. PTAH, × 900.

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    Case 1. Photomicrograph of another field showing loss of architectural pattern, increase in cellularity, and mitotic figures (arrows). H & E, × 600.

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    Case 1. Photomicrograph showing focal necroses and cellular pleomorphism in the tumor. H & E, × 300.

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    Case 1. Photomicrograph showing vascular endothelial proliferations. Note mitotic figures in tumor cells (arrows). H & E, × 600.

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