Differentiation of Clear Cell Ependymoma of the Cerebellum From Hemangioblastoma by Thallium-201 Single Photon Emission Computed Tomography  -Case Report-

Nagamatsu, Ken Ichi; Kumabe, Toshihiro; Watanabe, Mika; Nakazato, Yoichi; Tominaga, Teiji

doi:10.2176/nmc.49.608

Cited by 5 publications

(11 citation statements)

References 27 publications

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“…Because of the rarity of this histological feature, we reviewed literature for previously reported cerebellar clear-cell [9–14] and intracranial tanycytic [15–24] variant cases (Tables 1 and 2). However, the unique feature in this case—spindly bipolar cells surrounded by clear cells, forming cellular nests—was never described in any of these English-language studies.…”

Section: Discussionmentioning

confidence: 99%

“…CCE is a rare brain tumor, accounting for 0.3% of all gliomas [9]. To date (and to our knowledge), only 27 reports in the English-language literature describe 69 cases [8, 9, 12, 25–30]. CCE has a predilection for the supratentorial region compared with classical ependymoma subtypes.…”

Section: Discussionmentioning

confidence: 99%

“…CCE has a predilection for the supratentorial region compared with classical ependymoma subtypes. Approximately 12 cases reportedly developed in the cerebellum (Table 1) [9–14]. Given the similarities in neuroimaging and histology, differential diagnosis between CCE and HB is clinically challenging.…”

Section: Discussionmentioning

confidence: 99%

“…Of the three variants, clear-cell and tanycytic ependymomas are uncommon. In contrast to the other variants of ependymomas, CCEs are associated with aggressive behavior and early recurrence, even with gross total resection, and need more active management [8, 9]. Here, we present a rare case of cerebellar ependymoma with overlapping features of clear-cell and tanycytic variants in an adult female, which mimicked hemangioblastoma (HB) on histology, thus necessitating immunohistochemistry (IHC) testing for definitive diagnosis.…”

Section: Introductionmentioning

confidence: 99%

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Cerebellar ependymoma with overlapping features of clear-cell and tanycytic variants mimicking hemangioblastoma: a case report and literature review

et al. 2017

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BackgroundImaging and histology of clear-cell ependymoma and cerebellum-based hemangioblastoma are similar; distinguishing between them is a diagnostic challenge.Case presentationA 62-year-old Chinese woman presented with an intermittent headache of 8 years’ duration. Computed tomography and magnetic resonance imaging revealed a mass in the cerebellum. Neurological imaging suggested hemangioblastoma (HB). Histologically, the tumor included cellular and paucicellular areas, in which cells were arranged in nests or diffusely distributed; and a highly vascular area, in which tumor cells were arranged in clusters and separated by capillaries. At low magnification, the tumor mimicked cellular HB, but at high magnification, tumor cells showed clear cytoplasm instead of the vacuolated cytoplasm typically observed in HB. Moreover, spindly, bipolar elements resembling tanycytes were observed within the nest structures. Although these features indicated the possibility of ependymoma, neither true ependymal rosettes nor an ependymal-lined profile was observed. The tumor was characterized by prominent vascularity, but glomeruloid formation was absent. We saw pleomorphism in foci of some tumor giant cells, but pathologic mitosis and palisaded necrosis were absent. Most tumor cells were positive for glial fibrillary acidic protein and S100. Epithelial membrane antigen was expressed with a paranuclear dot-like or a ring-like pattern. The Ki-67 index was approximately 2%. Considering the patient’s symptom, neurological imaging, and pathological findings, she was diagnosed as cerebellar ependymoma (WHO grade II).ConclusionsHere, we report a case of ependymoma with overlapping clear-cell and tanycytic features, and review the literature to evaluate its real incidence. Pathologists should consider this rare diagnosis when confronted with a similar presentation.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Cerebellar ependymoma with overlapping features of clear-cell and tanycytic variants mimicking hemangioblastoma: a case report and literature review

et al. 2017

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“…The region of interest (ROI) of the lesion was manually placed over the area showing the greatest activity, and a normal brain parenchyma ROI was placed contralaterally. We calculated the early and delayed 201 Tl uptake ratios (TlE and TlD, respectively), and the RI was calculated as (TlE-TlD)/TlE (Nagamatsu et al 2009). Both the 67 Ga and 201 Tl studies demonstrated abnormal accumulation in the right cavernous sinus (Fig.…”

Section: Patient Presentationmentioning

confidence: 99%

Utility of Thallium-201 Scintigraphy in Tolosa-Hunt Syndrome

Kakisaka

Kobayashi

Uematsu

et al. 2013

Tohoku J. Exp. Med.

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Tolosa-Hunt syndrome (THS) is a rare disorder, especially in the pediatric population, characterized by unilateral painful ophthalmoplegia with a relapsing-remitting course. Because the diagnosis of THS is based on the exclusion of other causes of painful ophthalmoplegia, attention should be paid to possible alternative diagnoses. Thallium-201 chloride ( 201 Tl) scintigraphy has been used to evaluate tissue histology in clinical oncology with a marker, the retention index (RI). A higher value indicates histological malignancy. Although its utility in pediatric THS has not been discussed, we suggest that 201 Tl scintigraphy may be informative as a marker in the diagnosis. We present an 11-year-old boy with THS who was evaluated with 201 Tl scintigraphy before treatment with corticosteroids, when he had headache, photophobia, and diplopia. The RI of 201 Tl indicated that the lesion would be benign. Although his clinical symptoms did not fulfill the THS criteria completely, his eye symptoms disappeared 2 weeks after corticosteroid treatment, which was not within the 72 h as in the diagnostic criteria of THS. He has been symptom-free for more than 2 years with only an initial 4-week corticosteroid therapy. This report not only shows the potential of 201 Tl scintigraphy to contribute to the correct diagnosis of pediatric THS but also suggests the possibility that the diagnosis of THS could be supported uniquely even in a pediatric THS-suspicious patient who did not fulfill the current THS criteria completely. In conclusion, we suggest that 201 Tl scintigraphy may be useful for making the diagnosis of THS, especially in pediatric patients.

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Nuclear medicine of the cerebellum

Vella

Mascalchi

2018

The Cerebellum: From Embryology to Diagnostic Investigations

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Differentiation of Clear Cell Ependymoma of the Cerebellum From Hemangioblastoma by Thallium-201 Single Photon Emission Computed Tomography -Case Report-

Cited by 5 publications

References 27 publications

Cerebellar ependymoma with overlapping features of clear-cell and tanycytic variants mimicking hemangioblastoma: a case report and literature review

Cerebellar ependymoma with overlapping features of clear-cell and tanycytic variants mimicking hemangioblastoma: a case report and literature review

Utility of Thallium-201 Scintigraphy in Tolosa-Hunt Syndrome

Nuclear medicine of the cerebellum

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