CASE STUDY: EPENDYMOMA

Olivia Rozsits

PATIENT DESCRIPTION

33 year old white male

Posterior fossa ependymoma
Status post gross total resection of a grade 2
ependymoma
Recently underwent repair of a psuedomeningocele

PATIENT HISTORY

Social
Previous smoker, pack per
day for 2 years (Quit 9 years
ago)
Occasional alcohol use (2x per
week)
Obese (weight 273.4 lbs)

Family
Paternal grandmother Lung Cancer
Paternal grandfather prostate
cancer
Aunt with history of colorectal
cancer

PATIENT MEDICAL HISTORY

Gastroesophageal reflux disease
History of low testosterone
Wisdom tooth extraction
Posterior fossa craniectomy with c1 laminectomy and
gross total resection of posterior fossa tumor (5/23/16)
Peg feeding tube placed
Repair of psuedomeningocele (7/22/16)

PRESENTING SIGNS

Nausea & vomiting

Headache

Papilledema

Ataxia

Nystagmus

Visual symptoms

Gaze palsy

Extreme fatigue
Poor appetite/weight loss
dizziness

Bulbar palsy
Facial weakness

PATIENT PRESENTATION
Presents to urgent care with complaints of intermittent neck pain
Prescribed prednisone
Stopped prednisone and presented to emergency room on 5/14/16
Cervical spine films showed no abnormalities
Prescribed Medrol dosepak and oral analgesics
Returned to emergency room 5/19/16 with pain and onset of nausea & vomiting
Ct of brain showed cerebellar mass inferiorly which extended inferiorly into upper
cervical region
MRI of brain showed enhancing mass situated posterior to the cervical medullary
junction and upper cord extending into the 4th ventricle
Ct of chest, abdomen, and pelvis showed no evidence of primary lesions or
metastatic disease

 Ependymomas usually
located along, within, or
next to the ventricular
system
Methods of Spread:
Crainiospinal fluid

MEDICATIONS

Naproxen prn (for pain/soreness)

Valium (taken at night for sleep)
Clomid (for reproductive
complications)
Asmanex (for sinus inflammation)
Dexamethasone

EPIDEMIOLOGY/
ETIOLOGY

HISTOLOGY
Subependymomas (G1): typically

Make up only about 2% of brain tumors

slow-growing
Sixth most common brain tumor in
children

Myxopapillary Ependymomas (G1):

typically slow-growing

About 30% of pediatric ependymomas are

diagnosed in children younger than age 3
Cause of brain tumors is unknown

Ependymomas (G2): most common,

can be further divided
Anaplastic ependymomas (G3): faster
growing tumors

TREATMENT OPTIONS
Surgical resection of tumor
Radiation recommended for older children and adults following surgery
Role of chemotherapy unknown but may be used to treat tumors that have grown
back after radiation therapy
Spinal cord ependymomas have best chance of cure with surgery but side effects may
cause nerve damage
an uncommon tumor and we are relying mostly on single institution reviews for
guidance regarding management

SECOND OPINION
Patient presented to James Cancer Hospital for
second opinion Dr. Raval
Confirmed who Grade 2 posterior fossa
ependymoma
Significant inability to move tongue, muffled
speech, significant fullness over posterior neck
MRI revealed large post-op psuedomeningocele with
expansion
No signs of hydrocephalus or new cerebellar
symptoms

RADIATION THERAPY TREATMENT

Radiation therapy used

post-op or adjuvant
Fields dependent on
tumor resection-often
german helmet
Total dose 50005400cGy

Prescribed dose:
4500cGy
25 fxns: 180cGy/fxn
Vmat 6MV
G1: 181-179 Coll: 45
146MU
G2: 179-181 Coll: 315
162MU

TREATMENT SETUP AND

IMMOBILIZATION

Aquaplast mask
Knee sponge
B headrest
Blue ring

CRITICAL ORGANS

Brain

5000 cGy

Brainstem

4500 cGy

Spinal cord

4700 cGy

Optic nerve

5000 cGy

Optic
chiasm

5000 cGy

TREATMENT SIDE EFFECTS

Skin: dryness, itching, redness, blisters, hair loss

Brain: temporary swelling, headaches, blindness, dementia,
stroke
Ears: irritation of ear canal, decreased hearing
Eyes: cataract formation, loss of vision
Spinal cord: permanent arm/leg weakness or loss of function

METASTATIC
SITES

Intraventricular metastasis
Craniospinal fluid
Usually do not grow into
normal brain tissue

PROGNOSIS &
SURVIVAL
5 year relative survival rate
dependent on age
5-10: 40-50%
20-44: 91%
45-54: 86%
55-64: 85%

REFERENCES
Ependymoma. Brain Tumor Symptoms, Treatment, Support, Research.
http://www.abta.org/brain-tumor- information/types-of-tumors/ependymoma.html?
referrer=https://www.google.com/. Accessed
September 28, 2016.
Washington CM, Leaver DT.Principles and Practice of Radiation Therapy. St. Louis,
MO: Mosby Elsevier;
2010.
Survival rates for selected adult brain and spinal cord tumors. Survival rates for
selected adult brain and
spinal cord tumors.
http://www.cancer.org/cancer/braincnstumorsinadults/detailedguide/brain-andspinal-cord-tumors-in-adults-survival-rates. Accessed September 28, 2016.
Ruths Lecture on CNS Tumors