Abstract
We report the case of a 13-year-old girl presenting with left-sided hemiparesis, altered sensorium and episodic headache with bouts of projectile vomiting. Imaging revealed a large heterodense intraventricular mass lesion displaying focal calcification and hyperintensity on T1- and T2- weighted fluid attenuated inversion recovery (FLAIR) magnetic resonance images suggesting the presence of intratumoral fat. Histologically, the tumour showed sheets of glial cells, focal perithelial rosettes and individual cells showing fat vacuoles. The morphological impression was of an ependymoma with lipomatous differentiation. Glial fibrillary acid protein (GFAP) immunohistochemistry revealed positivity in the cytoplasmic processes of the tumour cells as well as in the cytoplasmic rim of the cells having an adipocytic appearance. S100 and vimentin were also immunoreactive. Ultrastructural studies confirmed the ependymal differentiation of the tumour and the presence of an osmiophilic fat component confirming the diagnosis. After 1 year of follow-up, the patient presented with similar complaints and MRI evidence of recurrence of the tumour. A comprehensive literature review revealed that half of the reported cases of this pattern recurred suggesting a possibly tenacious clinical course.
Similar content being viewed by others
References
Ruchoux MM, Kepes JJ, Dhellemmes P et al (1998) Lipomatous differentiation in ependymomas: a report of three cases and comparison with similar changes reported in other central nervous system neoplasms of neuroectodermal origin. Am J Surg Pathol 22:338–346
Sharma MC, Arora R, Lakhtakia R, Mahapatra AK, Sarkar C (2000) Ependymoma with extensive lipidization mimicking adipose tissue: a report of five cases. Pathol Oncol Res 6:136–140
Chang WT, Finn L (2001) MR appearance of lipoependymoma in a 5 year old boy. AJR Am J Roentgenol 177:1475–1478
Kepes JJ, Rubinstein LJ (1981) Malignant gliomas with heavily lipidized (foamy) tumor cells: a report of three cases with immunoperoxidase study. Cancer 47:2451–2459
Malatesta P, Appolloni I, Calzolari F (2008) Radial glia and neural stem cells. Cell Tissue Res 331:165–178
Budka H (1974) Intracranial lipomatous hamartomas (intracranial “lipomas”). A study of 13 cases including combinations with medulloblastoma, colloid and epidermoid cysts, angiomatosis and other malformations. Acta Neuropathol 28:205–222
Uematsu Y, Rojas-Corona RR, Llena JF, Hirano A (1989) Distribution of epithelial membrane antigen in normal and neoplastic human ependyma. Acta Neuropathol 78:325–328
Hirato J, Nakazato Y, Iijima M, Yokoo H, Sasaki A, Yokota M, Ono N, Hirato M, Inoue H (1997) An unusual variant of ependymoma with extensive tumor cell vacuolization. Acta Neuropathol 93:310–316
Ailawadhi P, Chandra PS, Sharma MC, Mahapatra AK (2012) Central liponeurocytoma. Case report and review of literature. Indian J Neurosurg 1:82–84
Mcguire SC, Sainani KL, Fisher PG (2009) Both location and age predict survival in ependymoma: a SEER study. Pediatr Blood Cancer 52:65–69
Godfraind C (2009) Classification and controversies in pathology of ependymomas. Childs Nerv Syst 25:1185–1193
Acknowledgments
None.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Ethical adherence
The present work was performed after taking informed consent from the patient and a sincere effort has been made to uphold patient confidentiality.
Conflict of interest
None.
Financial assistance/funding
Nil.
Rights and permissions
About this article
Cite this article
Gaur, K., Batra, V.V., Gupta, R. et al. Lipomatous ependymoma: report of a rare differentiation pattern with a comprehensive review of literature. Brain Tumor Pathol 33, 209–215 (2016). https://doi.org/10.1007/s10014-016-0253-9
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10014-016-0253-9