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Recurrent pituitary ependymoma: a complex clinical problem

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Abstract

Ependymomas rarely arise from the region of the pituitary fossa, with only four cases previously reported in the literature. We present a complex case of a recurrent ependymoma of the parasellar region which has been difficult to clinically manage due to its tendency to recurrence. Our patient has had four operations over the last 28 years, with external beam radiotherapy, but still has residual tumor and is currently panhypopituitary and with significant visual loss. We believe there is considerable uncertainty as to the optimal management of any future progression, which seems likely, and are currently considering the use of radiosurgery with careful sparing of the optic chiasm, or possibly the chemotherapeutic agent temozolomide. Our case emphasises the recurrent nature of this rare but difficult tumor.

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References

  1. Barone BM, Elvidge AR (1970) Ependymomas: a clinical survey. J Neurosurg 33:428–438

    Article  CAS  PubMed  Google Scholar 

  2. Mork SJ, Loken AC (1977) Ependymoma: a follow-up study of 101 cases. Cancer 40:907–915. doi 10.1002/1097-0142(197708)40:2<907::AID-CNCR2820400247>3.0.CO;2-2

  3. Wiestler O, Schiffer D, Coons S et al (2000) Ependymoma. In: Kleihues P, Cavenee W (eds) Tumours of the nervous system pathology and genetics: World Health Organisation international classification of tumours. IARC Press, Lyon, pp 72–81

    Google Scholar 

  4. Furie DM, Provenzale JM (1995) Supratentorial ependymomas and subependymomas: CT and MR appearance. J Comput Assist Tomogr 19:518–526. doi:10.1097/00004728-199507000-00002

    Article  CAS  PubMed  Google Scholar 

  5. Guyotat J, Signorelli F, Desme S et al (2002) Intracranial ependymomas in adult patients: analyses of prognostic factors. J Neurooncol 60:255–268. doi:10.1023/A:1021136029072

    Article  CAS  PubMed  Google Scholar 

  6. Schwartz T, Kim S, Glick RS et al (1999) Supratentorial ependymomas in adult patients. Neurosurgery 44:721–731. doi:10.1097/00006123-199904000-00018

    Article  CAS  PubMed  Google Scholar 

  7. Salazar OM, Rubin P, Bassano D, Marcial VA (1975) Improved survival of patients with intracranial ependymomas by irradiation: dose selection and field extension. Cancer 35:1563–1573. doi 10.1002/1097-0142(197506)35:6<1563::AID-CNCR2820350614>3.0.CO;2-I

  8. Roncaroli F, Consales A, Fioravanti A, Cenacchi G (2005) Supratentorial cortical ependymoma: report of three cases. Neurosurgery 57:E192–E204. doi:10.1227/01.NEU.0000164171.29292.D6

    Article  PubMed  Google Scholar 

  9. Vinchon M, Soto-Ares G, Riffaud L et al (2001) Supratentorial ependymomas in children. Pediatr Neurosurg 34:77–87. doi:10.1159/000055999

    Article  CAS  PubMed  Google Scholar 

  10. Louis DN (2000) WHO classification of tumours of the central nervous system. IARC Press, Lyon

    Google Scholar 

  11. Sarkisian S, Schultz AL (1956) Pituitary ependymoma. US Armed Forces Med J 7:1813–1816

    CAS  Google Scholar 

  12. Winer JB, Lidov H, Scaravilli F (1989) An ependymoma involving the pituitary fossa. J Neurol Neurosurg Psychiatry 52:1443–1444

    Article  CAS  PubMed  Google Scholar 

  13. Thomson S, Chakrabarty A, Marks P (2001) Ependymoma of the neurohypophysis. Br J Neurosurg 15:277–278. doi:10.1080/026886901750353764

    Article  CAS  PubMed  Google Scholar 

  14. Mukhida K, Asa S, Gentili F, Shannon P (2006) Ependymoma of the pituitary fossa. Case report and review of the literature. J Neurosurg 105:616–620. doi:10.3171/jns.2006.105.4.616

    Article  PubMed  Google Scholar 

  15. Kovalic J, Flaris N, Grigsby P et al (1993) Intracranial ependymoma long term outcome, patterns of failure. J Neurooncol 15:125–131. doi:10.1007/BF01053933

    Article  CAS  PubMed  Google Scholar 

  16. Healey E, Barnes P, Kupsky W et al (1991) The prognostic significance of postoperative residual tumor in ependymoma. Neurosurgery 28:666–671. doi:10.1097/00006123-199105000-00005

    Article  CAS  PubMed  Google Scholar 

  17. Oya N, Shibamoto Y, Nagata Y et al (2002) Postoperative radiotherapy for intracranial ependymoma: analysis of prognostic factors and patterns of failure. J Neurooncol 56:87–94. doi:10.1023/A:1014442106111

    Article  PubMed  Google Scholar 

  18. Centeno RS, Lee AA, Winter J, Barba D (1986) Supratentorial ependymoma: neuroimaging and clinicopathological correlation. J Neurosurg 64:209–215

    Article  CAS  PubMed  Google Scholar 

  19. Lyons M, Kelly PJ (1991) Posterior fossa ependymomas: a report of 30 cases and review of the literature. Neurosurgery 28:659–664. doi:10.1097/00006123-199105000-00004

    Article  CAS  PubMed  Google Scholar 

  20. Choi J-Y, Chang K-H, Yu IK et al (2002) Intracranial and spinal ependmomas: review of MR images in 61 patients. Korean J Radiol 3:219–228

    Article  PubMed  Google Scholar 

  21. Qiu S-j, Zhang X-l (2003) MRI features of 13 cases of intracranial ependymoma. Yi Junyi Daxue Xuebao 23:1224–1225

    Google Scholar 

  22. Tortori-Donati P, Fondelli M et al (1995) Ependymomas of the posterior tumour fosaa: CT and MRI findings. Neuroradiology 37:238–243. doi:10.1007/BF01578265

    Article  CAS  PubMed  Google Scholar 

  23. Pollack IF, Gerszten PC, Martinez AJ et al (1995) Intracranial ependymomas of childhood: long term outcome and prognostic factors. Neurosurgery 37:655–666

    Article  CAS  PubMed  Google Scholar 

  24. Metullus P, Barrie M, Figarella-Branger D et al (2007) Multicenter French study on adult intracranial ependymomas: prognostic factors analysis and therapeutic considerations from a cohort of 152 patients. Brain 130:1338–1349. doi:10.1093/brain/awm046

    Article  Google Scholar 

  25. Jiang T-H, Wang H-S, Tsay P-K et al (2004) Multivariate analysis of clinical prognostic risk factors in children with intracranial ependymoma. J Neurooncol 68:255–261. doi:10.1023/B:NEON.0000033383.84900.c1

    Article  Google Scholar 

  26. Korshunov A, Golanov A, Sycheva R, Timirgaz V (2004) The histologic grade is a main prognostic factor for patients with intracranial ependymomas treated in the microneurosurgical era. Cancer 100:1230–1237. doi:10.1002/cncr.20075

    Article  PubMed  Google Scholar 

  27. Massimino M, Gandola L, Giangaspero F et al (2004) Hyperfractionated radiotherapy and chemotherapy for childhood ependymoma: final results of the first prospective AIEOP (Associazione Italiana di Ematalogia-Oncologia Pediatrica) study. Int J Radiat Oncol Biol Phys 58:1336–1345. doi:10.1016/j.ijrobp.2003.08.030

    Article  PubMed  Google Scholar 

  28. Rogers L, Pueschel J, Spetzler R et al (2005) Is gross-total resection sufficient treatment for posterior fossa ependymomas? J Neurosurg 102:629–636

    Article  PubMed  Google Scholar 

  29. Kawabata Y, Takahashi J, Arakawa Y, Hashimoto N (2005) Long-term outcome in patients harbouring intracranial ependymoma. J Neurosurg 103:31–37

    Article  PubMed  Google Scholar 

  30. Kurt E, Zheng P-P, Hop WCJ et al (2006) Identification of relevant prognostic histopathologic features in 69 intracranial ependymomas, excluding myxopapillary ependymomas and subependymomas. Cancer 106:388–395. doi:10.1002/cncr.21608

    Article  PubMed  Google Scholar 

  31. Goldwein JW, Glauser TA, Packer RJ et al (1990) Recurrent intacranial ependymomas in children: survival, patterns of failure and prognostic factors. Cancer 66:557–563. doi 10.1002/1097-0142(19900801)66:3<557::AID-CNCR2820660325>3.0.CO;2-8

  32. Reni M, Brandes AA, Vavassori V et al (2004) A multicenter study of prognosis and treatment of adult brain ependymal tumours. Cancer 100:1221–1229. doi:10.1002/cncr.20074

    Article  PubMed  Google Scholar 

  33. Paulino AC, Wen B-C, Buatti JM, Hussey DH (2002) Intracranial ependymomas: an analysis of prognostic factors and patterns of failure. Am J Clin Oncol 25:117–122. doi:10.1097/00000421-200204000-00003

    Article  PubMed  Google Scholar 

  34. Taylor R (2004) Review of radiotherapy dose and volume for intracranial ependymoma. Pediatr Blood Cancer 42:457–460. doi:10.1002/pbc.10470

    Article  PubMed  Google Scholar 

  35. Kim Y, Fayos J (1977) Intracranial ependymomas. Radiology 124:805–808

    CAS  PubMed  Google Scholar 

  36. Paulino A, Wen B (2000) The significance of radiotherapy treatment duration in intracranial ependymoma. Int J Radiat Oncol Biol Phys 47:585–589. doi:10.1016/S0360-3016(99)00535-0

    Article  CAS  PubMed  Google Scholar 

  37. Mansur DB, Drzymala RE, Rich KM et al (2004) The efficacy of stereotactic radiosurgery in the management of intracranial ependymoma. J Neurooncol 66:187–190. doi:10.1023/B:NEON.0000013472.50749.84

    Article  PubMed  Google Scholar 

  38. Lo SS, Abdulrahman R, Desrosiers P, Fakiris A (2006) The role of Gamma Knife Radiosurgery in the management of unresectable gross disease or gross residual disease after surgery in ependymoma. J Neurooncol 79:51–56. doi:10.1007/s11060-005-9112-y

    Article  PubMed  Google Scholar 

  39. Palma L, Celli P, Cantore G (1993) Supratentorial ependymomas of the first two decades of life. Long term follow-up of 20 cases (including two subependymomas). Neurosurgery 32:169–175. doi:10.1097/00006123-199302000-00003

    Article  CAS  PubMed  Google Scholar 

  40. Reni M, Gatta G, Mazza E, Vecht C (2007) Ependymoma. Crit Rev Oncol Haematol 63:81–89. doi:10.1016/j.critrevonc.2007.03.004

    Article  Google Scholar 

  41. Gornet M, Buckner J, Marks R et al (1999) Chemotherapy for advanced CNS ependymoma. J Neurooncol 45:61–67. doi:10.1023/A:1006394407245

    Article  CAS  PubMed  Google Scholar 

  42. Brandes A, Cavallo G, Reni M et al (2005) A multicenter retrospective study of chemotherapy for recurrent intracranial ependymal tumours in adults by the Gruppo Italiano Cooperativo di Neuro-Oncologia. Cancer 104:143–148. doi:10.1002/cncr.21110

    Article  PubMed  Google Scholar 

  43. Sandri A, Massimino M, Mostradicasa L et al (2005) Treatment with oral etoposide for childhood recurrent ependymoma. J Pediatr Haematol Oncol 27:486–490

    Article  Google Scholar 

  44. Salazar O, Castro-Vita H, VanHoute P et al (1983) Improved survival in cases of intracranial ependymoma after radiation therapy. J Neurosurg 59:652–659

    Article  CAS  PubMed  Google Scholar 

  45. Oya S, Fujimata T, Asai A, Kirino T (2001) Recurrence of infantile supratentorial ependymoma after 23-year remission following surgical removal and radiation therapy. Tumori 87:104–108

    CAS  PubMed  Google Scholar 

  46. Chang SM, Prados MD, Yung W et al (2004) Phase II study of neoadjuvant 1, 3-bis(2chloroethyl)-1-nitrosurea and temozolomide for newly diagnosed anaplastic glioma: a North American Brain Tumor Consortium Trial. Cancer 100:1712–1716. doi:10.1002/cncr.20157

    Article  CAS  PubMed  Google Scholar 

  47. Stupp R, Mason WP, van der Bent MJ et al (2005) Radiotherapy plus concomitant and adjuvant temozolomide for glioblastoma. N Engl J Med 352:987–996. doi:10.1056/NEJMoa043330

    Article  CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Endocrinology, Barts and the London School of Medicine, London, UK

    Rosie Belcher & Harvinder S. Chahal

  2. Department of Radiology, Barts and the London School of Medicine, London, UK

    Jane Evanson

  3. Department of Neurosurgery, Barts and the London School of Medicine, London, UK

    Farhad Afshar

  4. Department of Histopathology, Barts and the London School of Medicine, London, UK

    Silvia Marino

  5. Department of Endocrinology, St. Bartholomew’s Hospital, London, EC1A 7BE, UK

    Ashley B. Grossman

Authors
  1. Rosie Belcher
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  2. Harvinder S. Chahal
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  3. Jane Evanson
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  4. Farhad Afshar
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  5. Silvia Marino
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  6. Ashley B. Grossman
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Correspondence to Ashley B. Grossman.

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Belcher, R., Chahal, H.S., Evanson, J. et al. Recurrent pituitary ependymoma: a complex clinical problem. Pituitary 13, 176–182 (2010). https://doi.org/10.1007/s11102-008-0139-x

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