Histopathologic Classification of Childhood Ependymoma
The classification of brain tumors is based on both histopathological
characteristics and location in the brain. Ependymomas are divided into the
following categories:
- Subependymoma (World Health Organization [WHO] Grade I).
- Myxopapillary ependymoma (WHO Grade I).
- Ependymoma (WHO Grade II). Variants include cellular, papillary,
tanycytic, clear cell, and mixed.
- Anaplastic (also known as malignant) ependymoma (WHO Grade III).
The most recent WHO classification of brain tumors
maintains the term “ependymoma” for tumors that are histologically benign and
malignant ependymoma for those that have malignant characteristics.[1] These
categories are based on the nuclear/cytoplasmic ratio, number of nuclei and
mitotic figures, and the degree of nuclear atypia. Contemporary studies have
failed to show significant differences in how these tumors behave on the basis of
histologic classification alone,[2-5] although a small experience from a single-institution study suggested that patients with clear cell ependymoma may be at higher risk for treatment failure,[6] confirmation is required in a larger group of unselected patients.
Myxopapillary
ependymomas, which typically present in the filum terminale and
cauda equina, are also considered a separate entity. Ependymoblastomas (for more information, refer to the PDQ summary Childhood Central Nervous System Embryonal Tumors), which generally
behave more like medulloblastomas or cortical neuroectodermal tumors, are
considered separate entities from ependymomas and are now classified with the embryonal tumors.[1]
The pathologic
classification of pediatric brain tumors is a specialized area that is
undergoing evolution; review of the diagnostic tissue by a neuropathologist who
has particular expertise in this area is strongly recommended.
References
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Kleihues P, Burger PC, Scheithauer BW: The new WHO classification of brain tumours. Brain Pathol 3 (3): 255-68, 1993.
[PUBMED Abstract]
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Goldwein JW, Leahy JM, Packer RJ, et al.: Intracranial ependymomas in children. Int J Radiat Oncol Biol Phys 19 (6): 1497-502, 1990.
[PUBMED Abstract]
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Rousseau P, Habrand JL, Sarrazin D, et al.: Treatment of intracranial ependymomas of children: review of a 15-year experience. Int J Radiat Oncol Biol Phys 28 (2): 381-6, 1994.
[PUBMED Abstract]
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Chiu JK, Woo SY, Ater J, et al.: Intracranial ependymoma in children: analysis of prognostic factors. J Neurooncol 13 (3): 283-90, 1992.
[PUBMED Abstract]
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Pollack IF, Gerszten PC, Martinez AJ, et al.: Intracranial ependymomas of childhood: long-term outcome and prognostic factors. Neurosurgery 37 (4): 655-66; discussion 666-7, 1995.
[PUBMED Abstract]
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Fouladi M, Helton K, Dalton J, et al.: Clear cell ependymoma: a clinicopathologic and radiographic analysis of 10 patients. Cancer 98 (10): 2232-44, 2003.
[PUBMED Abstract]
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