Atypical Appearance and Location of Subependymomas: A Report of Two Cases

Jee Hyeon Lee; Eun Soo Kim; Yul Lee; Kwanseop Lee; Mi Jung Kwon; Joon-Ho Song

doi:10.3348/jksr.2018.79.5.294

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Lee, Kim, Lee, Lee, Kwon, and Song: Atypical Appearance and Location of Subependymomas: A Report of Two Cases

Case Report

J Korean Soc Radiol 2018;79(5):294-301.

Published online: 19 January 2018

DOI: https://doi.org/10.3348/jksr.2018.79.5.294

Atypical Appearance and Location of Subependymomas: A Report of Two Cases

Jee Hyeon Lee, MD¹, Eun Soo Kim, MD^1,, Yul Lee, MD¹, Kwanseop Lee, MD¹, Mi Jung Kwon, MD², Joon-Ho Song, MD³

¹Department of Radiology, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea

²Department of Pathology, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea

³Department of Neurosurgery, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea

^∗Corresponding author: Eun Soo Kim, MD Department of Radiology, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, 22 Gwanpyeong-ro 170beon-gil, Dongan-gu, Anyang 14068, Korea. Tel. 82-31-380-5985 Fax. 82-31-380-3878 E-mail: silwater007@hallym.or.kr

Received 28 March 2018 Revised 10 May 2018 Accepted 15 June 2018

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (https://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Subependymomas are rare benign central nervous system tumor which account of 0.7% of all intracranial tumors. Subependymomas show characteristic MR findings according to their location. However, sometimes atypical findings could be found. In addition, subependymomas can occur very rarely in the spinal cord. We report two cases of pathologically confirmed subependymoma, one of which shows atypical appearances in spite of their intraventicular location and the other of which shows rare case of spinal intramedullary subependymoma. We review the clinical symptoms and radiologic findings of two cases

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Keywords: Glioma, Subependymoma, Brain Neoplasms, Spinal Cord

REFERENCES

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8.Jang WY., Lee JK., Lee JH., Kim JH., Kim SH., Lee KH, et al. Intramedullary subependymoma of the thoracic spinal cord. J Clin Neurosci. 2009. 16:851–853.

9.Zenmyo M., Ishido Y., Terahara M., Yamamoto T., Tanimoto A., Komiya S, et al. Intramedullary subependymoma of the cervical spinal cord: a case report with immunohistochemical study. Int J Neurosci. 2010. 120:676–679.

10.Wu Z., Iwanami A., Yasuda A., Mikami S., Toyama Y., Nakamura M. Intramedullary cervicothoracic subependymoma: report of three cases and review of the literature. J Orthop Sci. 2015. 20:927–934.

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Fig. 1

Brain CT and MR images of intraventricular subependymoma in a 54-year-old man with dizziness for 3 weeks. A. Non enhanced CT shows a low density tumor at right lateral ventricle with a high density foci (arrow). B. Contrast enhanced CT shows minimal enhancement in the mass (arrow). C. T1-weighted image reveals a large intraventricular iso-signal intensity mass (arrow) with internal cystic component in right lateral ventricle, abutting to septum pellucidum. The size of the mass is measured to approximately 3.5 × 2.8 × 3.2 cm. D. Fluid-attenuated inversion recovery shows the intraventricular mass showed high signal intensity (arrow) without evidence of extraventricular infiltration. E. There is also scatted foci of hypo-intensity (arrows) on susceptibility weighted image indicating presence of calcific deposits and/or blood. F. The axial contrast enhanced T1-weighted image shows heterogeneous enhancement (arrow).

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Fig. 2

Spine MR images of eccentric intramedullary subependymoma in a 50-year-old man with back pain and radiating left thigh pain. A. The sagittal T2WI shows the intramedullary high signal intensity mass (arrow) at the thoracic 6 level of spinal cord. B. The axial T2WI reveals the high signal intensity mass (arrow) with clear cut demarcated interface between the spinal cord and the tumor and no definite peritumoral edema or infiltration. C. The mass shows hypo-intensity (arrow) on sagittal T1WIs. D, E. The sagittal and axial contrast enhanced T1WIs show no demonstrable enhancement (arrow). T1WI = T1-weighted images, T2WI = T2-weighted image

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Table 1.

Review of the Previously Reported Cases of Subependymoma at Lateral Ventricle

Author (Year)	Patient No.	Age, Y/Sex	Location (Level)	Clinical Presentation	CT Findings			MRI Findings				Treatment	Outcome
Author (Year)	Patient No.	Age, Y/Sex	Location (Level)	Clinical Presentation	Density	Calcification	Enhancement	T1WI	T2WI	Enhancement	SWI	Treatment	Outcome
Nishio et al. (2000) (5)	1	55/M	Right septum pellucidum	Headache (7mo), mental dullness (6 mo), uninary incontinence (5 mo), unsteady and slow gait (4 mo)	Low	No	Scarce	Not examined	Not examined	Not examined	Not examined	Transcortical	No recurrence
												(Total removal)
	2	60/M	Right septum pellucidum	Headache (9 mo), unsteady gait (5 mo)	Low	No	No	Low SI	High SI	Scarce	Not described	Anterior treascallosal interhemispheric	No recurrence
												(Total removal)
	3	51/M	Right septum pellucidum –Corpus callosum, right	None	Low	No	No	Low SI	High SI	Scarce	Not described	Anterior interhemispheric	No growing
												Transcallosal
												(Partial removal)
	4	27/F	Lateral ventricle	None (hyperprolactinemia)	Low	No	No	Low SI	High SI	Heterogeneous	Not described	Frontal craniotomy	No recurrence
												(Total removal)
Adbdel-Aal et al. (2012) (4)	1	31/M	Lateral ventricle	headache, nausea, vomiting, gait disturbances	Not described	Not described	Not described	Iso-Low SI	High SI	Heterogeneous	Not described	Not described in details	No recurrence
Present case	1	54/M	Lateral ventricle	Dizziness	Low	Yes	Minimal	Iso SI	High SI	Heterogeneous	Foci of low SI	Anterior transcallosal	No recurrence
Present case												(Total removal)

SI = signal Intensity, SWI = susceptibility weighted imaging, T1WI = T1-weighted image, T2WI = T2-weighted image

Table 2.

Review of the Previously Reported Cases of Spinal Intramedullary Subependymoma

Author (Year)	Patient No.	Age, Y/Sex	Location (Level)	Clinical Presentation	MRI Findings			Treatment	Outcome
Author (Year)	Patient No.	Age, Y/Sex	Location (Level)	Clinical Presentation	T2WI	Enhancement	Bamboo Leaf Sign	Treatment	Outcome
Kremer et al. (2004) (6)	1	22/F	T11-L2	Numbness in right foot	High SI	No	+	Laminotomy	No recurrence
Yadav et al. (2008) (7)	1	42/M	T5-T9	Weakness of both lower limbs	High SI	No	+	Laminectomy (Total excision)	No recurrence
Jang et al. (2009) (8)	1	37/F	T11-12	Lower back pain radiating to the right leg with numbness	High SI	Heterogeneous	-	Total laminectomy + adjuvant radiotheraphy	No recurrence
Zenmyo et al. (2010) (9	1	63/F	C1-C2	Vague burning pain in the left upper arm	High SI	Faint	-	Laminoplasty	No recurrence
Krishnan et al. (2012)	1	37/F	C3-T4	Neck pain and gait disturbance	High SI	Heterogeneous	+	Cervical laminoplasty (Subtotal excision)	No interval change of residual tumor
Iwasaki et al. (2013)	1	57/F	T11-T12	Paraparesis	High SI	No	-	Laminectomy + posterior midline myelotomy	No recurrence
Wu et al. (2015) (10)	1	19/M	C6-T10	Bilateral knee pain, lower limb weakness	High SI	No	+	Laminoplasty + laminectomy + posterior midline	No interval change of residual tumor
								Myelotomy + adjuvant radiotherapy
	2	60/F	C5-T2	Bilateral lower extremity numbness	High SI	No	+	Laminoplasty + laminectomy + posterior midline	No interval change of residual tumor
								Myelotomy
	3	49/M	C6-T3	Back pain, right lower extremity numbness	High SI	Partial	+	Laminoplasty + laminectomy + posterior midline	No interval change of residual tumor
								Myelotomy
Toi et al. (2016) (2)	1	51/M	T7-T12	Progressive muscle weakness in the right lower extremity, dysesthesia in both lower extremities	High SI	Faint	+	Laminectomy	No recurrence
Present case	1	50/M	T6	Back pain, radiating left thigh pain	High SI	No	_	Laminectomy (Total excision)	No recurrence

SI = signal Intensity, T2WI = T2-weighted image

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