Abstract
Subependymomas are slow-growing, benign neoplasms that are rarely found in the spinal cord. Because of the differences in the treatment plans, it might be very helpful for neurosurgeons to intraoperatively establish a diagnosis of spinal subependymoma, differentiated from other spinal intramedullary tumors. In this study, we analyzed frozen sections of spinal subependymomas to identify potential histological clues of spinal subependymomas to differentiate them from tumors that mimic spinal subependymoma. We reviewed the frozen sections and the corresponding permanent slides for 7 cases of spinal subependymoma. The spinal subependymomas showed several characteristic patterns, including, most importantly, an eccentric or both central and eccentric location in the axial plane. Histologically, they showed a (1) well-demarcated and multinodular mass with (2) low or moderate cellularity, (3) a microlobular pattern, and (4) small clusters of neoplastic cells. These features appear to be very specific to spinal subependymomas and could help differentiate them from ependymomas or astrocytomas. Although we might not be able to provide an exact diagnosis of all spinal subependymomas using these histological features, we hope that they help neuropathologists and neurosurgeons to adequately diagnose and treat spinal subependymomas.
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References
McLendon RE, Schiffer D, Rosenblum MK, Wiestler OD (2007) Subpendymoma. In: Louis DN, Ohgaki H, Wiestler OD, Cavenee WK (eds) WHO classification of tumours of the central nervous system. International Agency for Research on Cancer, Lyon, pp 70–71
Jallo GI, Zagzag D, Epstein F (1996) Intramedullary subependymoma of the spinal cord. Neurosurgery 38(2):251–257
Wu L, Yang T, Deng X, Yang C, Zhao L, Fang J, Wang G, Yang J, Xu Y (2014) Surgical outcomes in spinal cord subependymomas: an institutional experience. J Neurooncol 116(1):99–106. doi:10.1007/s11060-013-1256-6
Wu Z, Iwanami A, Yasuda A, Mikami S, Toyama Y, Nakamura M (2014) Intramedullary cervicothoracic subependymoma: report of three cases and review of the literature. J Orthop Sci. doi:10.1007/s00776-014-0585-4
Chamberlain MC, Tredway TL (2011) Adult primary intradural spinal cord tumors: a review. Curr Neurol Neurosci Rep 11(3):320–328. doi:10.1007/s11910-011-0190-2
Rao S, Rajkumar A, Ehtesham MD, Duvuru P (2009) Challenges in neurosurgical intraoperative consultation. Neurology India 57(4):464–468. doi:10.4103/0028-3886.55598
Dario A, Fachinetti P, Cerati M, Dorizzi A (2001) Subependymoma of the spinal cord: case report and review of the literature. J Clini Neurosci Off J Neurosurg Soc Australasia 8(1):48–50. doi:10.1054/jocn.2000.0794
Iwasaki M, Hida K, Aoyama T, Houkin K (2013) Thoracolumbar intramedullary subependymoma with multiple cystic formation: a case report and review. Eur Spine J 22(Suppl 3):S317–S320. doi:10.1007/s00586-012-2357-1
Pagni CA, Canavero S, Giordana MT, Mascalchi M, Arnetoli G (1992) Spinal intramedullary subependymomas: case report and review of the literature. Neurosurgery 30(1):115–117
Salvati M, Raco A, Artico M, Artizzu S, Ciappetta P (1992) Subependymoma of the spinal cord. Case report and review of the literature. Neurosurg Rev 15(1):65–69
Sarkar C, Mukhopadhyay S, Ralte AM, Sharma MC, Gupta A, Gaikwad S, Mehta VS (2003) Intramedullary subependymoma of the spinal cord: a case report and review of literature. Clin Neurol Neurosurg 106(1):63–68
Shimada S, Ishizawa K, Horiguchi H, Shimada T, Hirose T (2003) Subependymoma of the spinal cord and review of the literature. Pathol Int 53(3):169–173
McCormick PC, Torres R, Post KD, Stein BM (1990) Intramedullary ependymoma of the spinal cord. J Neurosurg 72(4):523–532. doi:10.3171/jns.1990.72.4.0523
Aghakhani N, David P, Parker F, Lacroix C, Benoudiba F, Tadie M (2008) Intramedullary spinal ependymomas: analysis of a consecutive series of 82 adult cases with particular attention to patients with no preoperative neurological deficit. Neurosurgery 62(6):1279–1285. doi:10.1227/01.neu.0000333299.26566.15
Manzano G, Green BA, Vanni S, Levi AD (2008) Contemporary management of adult intramedullary spinal tumors-pathology and neurological outcomes related to surgical resection. Spinal Cord 46(8):540–546. doi:10.1038/sc.2008.51
Pajtler KW, Witt H, Sill M, Jones DT, Hovestadt V, Kratochwil F, Wani K, Tatevossian R, Punchihewa C, Johann P, Reimand J, Warnatz HJ, Ryzhova M, Mack S, Ramaswamy V, Capper D, Schweizer L, Sieber L, Wittmann A, Huang Z, van Sluis P, Volckmann R, Koster J, Versteeg R, Fults D, Toledano H, Avigad S, Hoffman LM, Donson AM, Foreman N, Hewer E, Zitterbart K, Gilbert M, Armstrong TS, Gupta N, Allen JC, Karajannis MA, Zagzag D, Hasselblatt M, Kulozik AE, Witt O, Collins VP, von Hoff K, Rutkowski S, Pietsch T, Bader G, Yaspo ML, von Deimling A, Lichter P, Taylor MD, Gilbertson R, Ellison DW, Aldape K, Korshunov A, Kool M, Pfister SM (2015) Molecular classification of ependymal tumors across all CNS compartments, histopathological grades, and age groups. Cancer Cell 27(5):728–743. doi:10.1016/j.ccell.2015.04.002
Gajjar A, Bowers DC, Karajannis MA, Leary S, Witt H, Gottardo NG (2015) Pediatric brain tumors: innovative genomic information is transforming the diagnostic and clinical landscape. J Clin Oncol 33(27):2986–2998. doi:10.1200/JCO.2014.59.9217
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This study was supported by a National Research Foundation of Korea (NRF) grant funded by the South Korean government’s Ministry of Education, Science and Technology (MEST) 2013 (NRF-2013R1A1A2007357).
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Choi, S.K., Lee, S.H., Kim, B. et al. Findings from frozen sections of spinal subependymomas: Is it possible to differentiate this diagnosis from other common spinal tumors?. Brain Tumor Pathol 33, 19–26 (2016). https://doi.org/10.1007/s10014-015-0237-1
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DOI: https://doi.org/10.1007/s10014-015-0237-1