Brain Tumor Res Treat.  2017 Oct;5(2):94-98. 10.14791/btrt.2017.5.2.94.

Pituitary Ependymoma, 10-Year Follow-Up after Partial Resection and Radiation Therapy

Affiliations
  • 1Department of Neurosurgery, Seoul National University College of Medicine, Seoul, Korea.
  • 2Proton Therapy Center, National Cancer Center, Goyang, Korea.
  • 3Department of Pathology, National Cancer Center, Goyang, Korea.
  • 4Neuro-Oncology Clinic, National Cancer Center, Goyang, Korea. nsshin@ncc.re.kr

Abstract

Ependymoma usually arises within the ventricles and central canal of the spinal cord. These tumors, found in the sellar region, are extremely rare. We report a case of pituitary ependymoma followed up over 10 years. A 59-year-old male patient presented with fatigue, general weakness, erectile dysfunction, and loss of body hair, including pubic hair. Brain magnetic resonance imaging (MRI) revealed a 3.3×3.5×2.3-cm sellar and suprasellar snowman-shaped enhancing mass. The tumor was partially resected via the trans-sphenoidal approach followed by postoperative radiation therapy. The pathologic confirmation was pituitary ependymoma. At the 10-year follow up, MRI revealed no evidence of tumor progression. With lack of knowledge about pituitary ependymoma, our case is the only case in which the disease has been well controlled over a long period of time without tumor progression.

Keyword

Pituitary gland; Pituitary neoplasms; Ependymoma

MeSH Terms

Brain
Ependymoma*
Erectile Dysfunction
Fatigue
Follow-Up Studies*
Hair
Humans
Magnetic Resonance Imaging
Male
Middle Aged
Pituitary Gland
Pituitary Neoplasms
Spinal Cord

Figure

  • Fig. 1 Sagittal view (A) and coronal view (B) of sellar magnetic resonance imaging with gadolinium enhancement revealed a 3.3×3.5×2.3-cm well-enhancing sellar mass extending to suprasellar area with snowman-shaped appearance (arrows).

  • Fig. 2 The tumor is highly cellular and composed of small round-to-oval cells. Diagnostic perivascular rosettes (B) and true ependymal rosettes (D) are frequently noted. However, this tumor also shows strong resemblance to that of pituitary adenoma. Various morphologic patterns of this tumor a quite similar to diffuse (A), pseudorosetting (B), papillary (C), and glandular (D) patterns of pituitary adenoma (hematoxylin and eosin staining, ×200).

  • Fig. 3 Immunohistochemical findings of the tumor. The tumor is positive for S100 protein (A, ×200) and glial fibrillary acidic protein (B, ×200). Diffuse membranous staining is noted in CD99 (C, ×200). Characteristic dot-like positivity in epithelial membrane antigen is also present (D, ×400).

  • Fig. 4 Sagittal view (A) and coronal view (B) of immediate postoperative sellar MRI. A 3×2.3-cm enhancing mass extends to suprasellar area (arrows). Compared with preoperative sellar MRI, the size of the mass decreased. A fat graft showing T1 high signal intensity is inserted to sphenoidal sinus. MRI, magnetic resonance imaging.

  • Fig. 5 Serial follow-up sellar MRIs after treatment. A and B: A follow-up sellar MRI, after adjuvant radiation therapy. It showed markedly decreased size of mass. A residual mass was 1.7×2.1-cm sized, and its compressive effect on optic chiasm was much relieved (arrows). C and D: A sellar MRI of 10 year follow-up. There is 9×7-mm sized, T2 subtle high signal intensity lesion in left side of pituitary fossa. The lobulated contour mass is hypoenhanced compared with surrounding normal parenchyme (arrows). There is no evidence of tumor progression. MRI, magnetic resonance imaging.


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