Fourth ventricular ependymoma with a distant intraventricular metastasis: Report of a rare case

Abstract

Ependymoma is one of the uncommon tumors of the central nervous system (CNS) in the adult age group. These tumors have a distinct propensity for metastasis, both within and outside the CNS. However, dissemination at the time of first presentation and retrograde dissemination of the tumor is rare. We report the case of a patient with fourth ventricular anaplastic ependymoma who presented with left lateral ventricular metastasis which was anatomically different from the primary tumor. We describe the clinic-pathological detail of the patient and discuss the probable pathophysiological basis for this rare presentation and its significance in management of the patient.

Chordoid Glioma with Intraventricular Dissemination: A Case Report with Perfusion MR Imaging Features

“…Brain tumors arising from the ependymal lining of the ventricles are likely to have cerebrospinal fluid (CSF) seeding. For example, CSF seeding has been seen in about 8% to 33% of patients with ependymoma at presentation ( 7 ). Although intraventricular seeding of diffuse WHO grade II glioma is rare, it can occur during follow-up period after incomplete resections of primary tumor ( 8 ).…”

Simultaneous cerebrospinal fluid and hematologic metastases in a high-grade ependymoma

“…Unfortunately, the rarity of these conditions makes it difficult to establish an accurate survival rates. [ 2 ]…”

“…The scenario of intracranial tumors showing metastasis to an extraneural location has been intensely studied, but the mechanism of this spread of disease is not yet fully understood. [ 2 16 27 ] A clear prerequisite seems to be tumor access to extracranial soft tissue, blood, or CSF. Several hypotheses of the underlying mechanisms have been brought up and include: direct tumor invasion of the dural sinuses, tumor access to local lymphatic vessels, spread to adjacent extracranial tissue, and, most commonly, CSF seeding via the ventricular system leading to drop or spinal metastases.…”

“…[ 20 ] Due to CSF dynamics, the spinal cord is the most likely location for tumor seeding, though a very few case reports have demonstrated spinal cord and/or infratentorial to supratentorial spread as well. [ 2 ]…”

Cerebellopontine angle ependymoma in a young adult

“…[1,2] These lesions usually displace surrounding tissue as well as the brainstem leading to mal-rotate, thus changing the anatomy and altering the posterior fossa structures as they grow. [1,3,4] Clinically, they are usually silent at the initial stage until they advance into giant sizes. On imaging, these lesions are distinctly heterogeneous because of calcification, hemorrhage, cystic nature, or necrosis.…”