gms | German Medical Science

70. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC)
Joint Meeting mit der Skandinavischen Gesellschaft für Neurochirurgie

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

12.05. - 15.05.2019, Würzburg

A collective of four subependymomas with atypical MR behavior and clinical progress

Ein Kollektiv von vier Subependymomen mit untypischem MR-Verhalten und klinischem Verlauf

Meeting Abstract

  • presenting/speaker Christian Schwalbe - Asklepios Klinikum Nord/Heidberg, Neurochirurgie, Hamburg, Deutschland
  • Paul Kremer - Asklepios Klinikum Nord/Heidberg, Neurochirurgie, Hamburg, Deutschland
  • Claudia Goetz - Asklepios Klinikum Nord/Heidberg, Neurochirurgie, Hamburg, Deutschland
  • Volker Hesselmann - Asklepios Klinikum Nord/Heidberg, Neuroradiologie, Hamburg, Deutschland
  • Ann-Kathrin Mager - Asklepios Klinikum Nord/Heidberg, Neuroradiologie, Hamburg, Deutschland
  • Joachim Gottschalk - Asklepios Klinikum Hamburg Nord, Neuropathologie, Hamburg, Deutschland
  • Michael Friese - Asklepios Klinikum Hamburg Nord, Neuropathologie, Hamburg, Deutschland

Deutsche Gesellschaft für Neurochirurgie. 70. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit der Skandinavischen Gesellschaft für Neurochirurgie. Würzburg, 12.-15.05.2019. Düsseldorf: German Medical Science GMS Publishing House; 2019. DocP173

doi: 10.3205/19dgnc509, urn:nbn:de:0183-19dgnc5096

Veröffentlicht: 8. Mai 2019

© 2019 Schwalbe et al.
Dieser Artikel ist ein Open-Access-Artikel und steht unter den Lizenzbedingungen der Creative Commons Attribution 4.0 License (Namensnennung). Lizenz-Angaben siehe http://creativecommons.org/licenses/by/4.0/.


Gliederung

Text

Objective: Subependymomas are slow, non-invasive growing, largely benign Tumors, developed from the inner walls of the ventricular system. MR morphological described as well delimited lobular, occasionally calcifying, intra- or paraventricular mass, with partial cystic portion and little to no edema [1]. Case studies found a more heterogeneous morphology [2]. Also our collective showed MR morphological criteria that made the diagnosis Subependymom improbable. One case showed histologically a central malignisation during tumor progress. Should subpendymomas be considered more often in therapy planning of ventricular tumors? Can subependymomas malignant, contrary to previous opinions?

Methods: Four cases of unusual subependymomas, in patients 18, 20, 27 and 52 years old, between 2006–17.

Results:

  • In the first case, the diagnosis was confirmed by biopsy 10 years prior to excision. At that time, instead of an excision, SEED’s were implanted in the tumor tissue. After resection 10 years later, the tumor showed a central malignisation but at the rim continued be a Subependymoma.
  • The second case showed MR-morphologically a strongly vascularized, centrally strong contrast agent accumulating, inhomogeneously delineatable, nodular mass with low edema, supposed to resulting from the right cerebellar tonsil with parts in the IV ventricle and intraspinal. Most likely to be a arteriovenous malformation.
  • The third case was MR-morphological supposed to be a pilocytic astrocytoma because of its cystic configuration with inhomogeneous nodular mass at the dorsal rim.
  • The fourth case was MR-morphological supposed to be a pineal cyst of the III ventricle, which due to a KM accumulation in the dorsal part could also be considered to be a pinealeom.

Conclusion: All tumors studied were proportionally subependymomas, indicating that this entity MR- morphologically occur much more heterogeneous than previously described [1]. It is important to consider differential diagnosis, since at a subependymoma the complete excision is the treatment of choice. The Pinealis cyst or AV-Malformation considered in our cases, if clinically unobtrusive or small, could also be observed. A spontaneous malignisation of a subependymoma, as believed in the first case, can not be assumed and could be a consequence of the SEED implantation.