Ependymoma (hemorrhagic)

Discussion:

In a 30 year old the differential for a posterior fossa hemorrhagic mass is mainly between a hemangioblastoma and an ependymoma, although hemorrhage in both is quite uncommon. Pilocytic astrocytomas can rarely hemorrhage as can medulloblastomas, however in both cases the age group is a little atypical. Metastases would be unusual in a patient of this age. 

Pathology

The sections  show  multiple  fragments of  variably  but up to  moderately cellular tumor.  Part of the tumor has an ependymal lining but the tumor has a  distinctive  pattern  of moderately   pleomorphic  oval  nuclei with speckled   chromatin  in a   neurofibrillary   background.     Perivascular pseudorosetting  is a  prominent  feature.   In areas,  true  rosettes with lumens are also noted.  Areas of tumor necrosis are not seen but there are focal collections  of hemosiderin-laden  macrophages and  focal fibrosis is noted.  An occasional  mitotic figure is noted.   The features are those of  a classical  ependymoma.

DIAGNOSIS :  Posterior fossa tumor - ependymoma, WHO grade 2.

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