Subependymoma: Difference between revisions

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{{CMG}}{{AE}}{{MMJ}}{{SR}}
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==Historical Perspective==
==Historical Perspective==
*Subependymomas was first discovered by '''Ilya Mark Scheinker''' a Russian physician in 1945.<ref name="pmid18397339">{{cite journal| author=Kurian KM, Jones DT, Marsden F, Openshaw SW, Pearson DM, Ichimura K et al.| title=Genome-wide analysis of subependymomas shows underlying chromosomal copy number changes involving chromosomes 6, 7, 8 and 14 in a proportion of cases. | journal=Brain Pathol | year= 2008 | volume= 18 | issue= 4 | pages= 469-73 | pmid=18397339 | doi=10.1111/j.1750-3639.2008.00148.x | pmc=2659379 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18397339  }} </ref>
Subependymoma was first discovered by Ilya Mark Scheinker, a Russian physician, in 1945.<ref name="pmid18397339">{{cite journal| author=Kurian KM, Jones DT, Marsden F, Openshaw SW, Pearson DM, Ichimura K et al.| title=Genome-wide analysis of subependymomas shows underlying chromosomal copy number changes involving chromosomes 6, 7, 8 and 14 in a proportion of cases. | journal=Brain Pathol | year= 2008 | volume= 18 | issue= 4 | pages= 469-73 | pmid=18397339 | doi=10.1111/j.1750-3639.2008.00148.x | pmc=2659379 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18397339  }} </ref>
 
==Classification==
There is no established system for the [[classification]] of subependymoma.


==Pathophysiology==
==Pathophysiology==
===Pathogenesis===
===Pathogenesis===
*Subependymoma arises from [[subependymal]] glial cells, although it can also arise from [[Astrocyte|astrocytes]] from the [[subependymal]] plate, [[ependymal cells]], and mixed ependymal and astrocytic cells.<ref name="pmid23382616">{{cite journal| author=Saad AF, Bidiwala SB, Layton KF, Snipes GJ, Opatowsky MJ| title=Fourth ventricular subependymoma presenting as worsening headache. | journal=Proc (Bayl Univ Med Cent) | year= 2013 | volume= 26 | issue= 1 | pages= 52-4 | pmid=23382616 | doi= | pmc=PMC3523772 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23382616  }} </ref><ref name="pmid22747714">{{cite journal| author=Jain A, Amin AG, Jain P, Burger P, Jallo GI, Lim M et al.| title=Subependymoma: clinical features and surgical outcomes. | journal=Neurol Res | year= 2012 | volume= 34 | issue= 7 | pages= 677-84 | pmid=22747714 | doi=10.1179/1743132812Y.0000000064 | pmc=4618470 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22747714  }} </ref>
Subependymoma arises from [[subependymal]] [[Glial cell|glial cells]], although it can also arise from [[Astrocyte|astrocytes]] from the [[subependymal]] plate, [[ependymal cells]], and mixed ependymal and astrocytic cells.<ref name="pmid23382616">{{cite journal| author=Saad AF, Bidiwala SB, Layton KF, Snipes GJ, Opatowsky MJ| title=Fourth ventricular subependymoma presenting as worsening headache. | journal=Proc (Bayl Univ Med Cent) | year= 2013 | volume= 26 | issue= 1 | pages= 52-4 | pmid=23382616 | doi= | pmc=PMC3523772 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23382616  }} </ref><ref name="pmid22747714">{{cite journal| author=Jain A, Amin AG, Jain P, Burger P, Jallo GI, Lim M et al.| title=Subependymoma: clinical features and surgical outcomes. | journal=Neurol Res | year= 2012 | volume= 34 | issue= 7 | pages= 677-84 | pmid=22747714 | doi=10.1179/1743132812Y.0000000064 | pmc=4618470 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22747714  }} </ref>


===Gross Pathology===
===Gross Pathology===
*Subependymoma is most commonly seen in the [[fourth ventricle]], but can arise anywhere where there is [[ependyma]]. The distribution in the [[ventricular system]] is as follows:<ref name="pathoilogysubepenymoma1">Pathology of subependymoma. Dr Bruno Di Muzio and A.Prof Frank Gaillard et al. Radiopaedia 2016. http://radiopaedia.org/articles/subependymoma. Accessed on January 12, 2016</ref><ref name="pmid22747714" />
Subependymoma is most commonly seen in the [[fourth ventricle]], but it can arise anywhere where there is [[ependyma]]. The distribution in the [[ventricular system]] is as follows:<ref name="pathoilogysubepenymoma1">Pathology of subependymoma. Dr Bruno Di Muzio and A.Prof Frank Gaillard et al. Radiopaedia 2016. http://radiopaedia.org/articles/subependymoma. Accessed on January 12, 2016</ref><ref name="pmid22747714" />
**[[Fourth ventricle]]: 50-60%
 
**[[Lateral ventricles]] (usually frontal horns): 30-40%
*[[Fourth ventricle]]: 50 - 60%
**[[Third ventricle]]: rare
*[[Lateral ventricles]] (usually frontal horns): 30 - 40%
**[[Central canal|Central canal of the spinal cord]]: rare
*[[Third ventricle]]: rare
*[[Central canal|Central canal of the spinal cord]]: rare
 
*On gross pathology, subependymoma is characterized by a small, white to grey, firm, well circumscribed, solid, [[avascular]] mass attached to the ventricular wall by a narrow [[Pedicles|pedicle]].<ref name="pmid23382616" /><ref name="pmid22747714" />
*On gross pathology, subependymoma is characterized by a small, white to grey, firm, well circumscribed, solid, [[avascular]] mass attached to the ventricular wall by a narrow [[Pedicles|pedicle]].<ref name="pmid23382616" /><ref name="pmid22747714" />


===Microscopic Pathology===
===Microscopic Pathology===
*On microscopic histopathological analysis, subependymoma is characterized by microcystic spaces and bland appearing cells without appreciable [[atypia|nuclear atypia]] or [[mitoses]]. The nuclei tend to form clusters. No high grade features (mitoses, [[Ki-67 (Biology)|Ki-67]] / [[MIB1|MIBI]] index > 1.5%, necrosis) are present. Loose pseudorosettes are observed.<ref name="pathoilogysubepenymoma1" />
On [[microscopic]] [[Histopathology|histopathological]] [[analysis]], subependymoma is characterized by the following features:<ref name="pathoilogysubepenymoma1" />
 
* Microcystic spaces and bland appearing [[Cell (biology)|cells]] without appreciable [[atypia|nuclear atypia]] or [[mitoses]].  
* The [[Cell nucleus|nuclei]] tend to form clusters.  
* No high grade features ([[Mitosis|mitoses]], [[Ki-67 (Biology)|Ki-67]] / [[MIB1|MIBI]] index > 1.5%, [[necrosis]]) are present.  
* Loose pseudorosettes are observed.


===Immunohistochemistry===
===Immunohistochemistry===
*Subependymoma is demonstrated by positivity to [[tumor marker]] such as [[GFAP]].<ref name="pathoilogysubepenymoma1" />
Subependymoma is characterized by positive [[tumor marker]] [[GFAP]]. Mixed populations of [[Cell (biology)|cells]] may be variably positive for:<ref name="pathoilogysubepenymoma1" /><ref name="pmid28804038">{{cite journal| author=D'Amico RS, Praver M, Zanazzi GJ, Englander ZK, Sims JS, Samanamud JL et al.| title=Subependymomas Are Low-Grade Heterogeneous Glial Neoplasms Defined by Subventricular Zone Lineage Markers. | journal=World Neurosurg | year= 2017 | volume= 107 | issue=  | pages= 451-463 | pmid=28804038 | doi=10.1016/j.wneu.2017.08.009 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28804038  }} </ref>
*Also mixed populations of cells may be variably positive for:<ref name="pmid28804038">{{cite journal| author=D'Amico RS, Praver M, Zanazzi GJ, Englander ZK, Sims JS, Samanamud JL et al.| title=Subependymomas Are Low-Grade Heterogeneous Glial Neoplasms Defined by Subventricular Zone Lineage Markers. | journal=World Neurosurg | year= 2017 | volume= 107 | issue=  | pages= 451-463 | pmid=28804038 | doi=10.1016/j.wneu.2017.08.009 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28804038  }} </ref>
**Olig2
**NHERF1
**[[Sox2]]
**[[CD44]]


==Differentiating Subependymoma from other Diseases==
*Olig2
*NHERF1
*[[Sox2]]
*[[CD44]]


*Subependymoma must be differentiated from:<ref name="ddxse1">Intraventricular neoplasms and lesions. Dr Henry Knipe and Dr Vinod G Maller et al. Radiopaedia 2016. http://radiopaedia.org/articles/intraventricular-neoplasms-and-lesions. Accessed on January 12, 2016</ref><ref name="pmid22747714" />
==Causes==
**'''Neoplasms of the ventri­cular wall and septum pellucidum'''
The cause of the development of subependymoma has not been identified.
***[[Ependymoma]]
 
***[[Adult brain tumors classification|Central neurocytoma]]
==Differentiating Subependymoma from Other Diseases==
***[[Subependymal giant cell astrocytoma]]
Subependymoma must be differentiated from:<ref name="ddxse1">Intraventricular neoplasms and lesions. Dr Henry Knipe and Dr Vinod G Maller et al. Radiopaedia 2016. http://radiopaedia.org/articles/intraventricular-neoplasms-and-lesions. Accessed on January 12, 2016</ref><ref name="pmid22747714" />
**'''Neoplasms of the choroid plexus'''
 
***[[Choroid plexus]] papilloma and [[carcinoma]]
*'''Neoplasms of the ventri­cular wall and septum pellucidum'''
**'''Others'''
**[[Ependymoma]]
***[[meningioma|Intraventricular meningioma]]
**[[Adult brain tumors classification|Central neurocytoma]]
***[[intracerebral metastasis|Intraventricular metastasis]]
**[[Subependymal giant cell astrocytoma]]
***[[Oligodendroglioma]]
*'''Neoplasms of the choroid plexus'''
***[[Pilocytic astrocytoma]]
**[[Choroid plexus]] papilloma and [[carcinoma]]
***[[Glioblastoma multiforme]]
*'''Others'''
***[[Medulloblastoma]]
**[[meningioma|Intraventricular meningioma]]
***[[teratoma|Intraventricular teratoma]]
**[[intracerebral metastasis|Intraventricular metastasis]]
**[[Oligodendroglioma]]
**[[Pilocytic astrocytoma]]
**[[Glioblastoma multiforme]]
**[[Medulloblastoma]]
**[[teratoma|Intraventricular teratoma]]


==Epidemiology and Demographics==
==Epidemiology and Demographics==
===Frequency and incidence===
===Frequency and Incidence===
*The frequency of asymptomatic subependymomas was 0.4% in 1,000 serial routine necropsies and 0.7% in symptomatic subependymomas from 1,000 serial surgical specimens of intracranial neoplasms.<ref name="pmid2929389">{{cite journal| author=Matsumura A, Ahyai A, Hori A, Schaake T| title=Intracerebral subependymomas. Clinical and neuropathological analyses with special reference to the possible existence of a less benign variant. | journal=Acta Neurochir (Wien) | year= 1989 | volume= 96 | issue= 1-2 | pages= 15-25 | pmid=2929389 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2929389  }} </ref>
*The frequency of [[asymptomatic]] subependymomas was 0.4% in 1,000 serial routine necropsies and 0.7% in [[symptomatic]] subependymomas from 1,000 serial [[Surgery|surgical]] specimens of [[Cranium|intracranial]] [[Neoplasm|neoplasms]].<ref name="pmid2929389">{{cite journal| author=Matsumura A, Ahyai A, Hori A, Schaake T| title=Intracerebral subependymomas. Clinical and neuropathological analyses with special reference to the possible existence of a less benign variant. | journal=Acta Neurochir (Wien) | year= 1989 | volume= 96 | issue= 1-2 | pages= 15-25 | pmid=2929389 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2929389  }} </ref>
* The incidence of subependymoma was estimated to be 0.7 incidence cases per 100,000 of patients with pathologically proven intracranial neoplasms.<ref name="pmid22121350">{{cite journal| author=Kurukumbi M, Muley A, Ramidi G, Wynn Z, Trouth AJ| title=A rare case of subependymoma with an atypical presentation: a case report. | journal=Case Rep Neurol | year= 2011 | volume= 3 | issue= 3 | pages= 227-32 | pmid=22121350 | doi=10.1159/000333061 | pmc=3223030 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22121350  }} </ref>
* The [[incidence]] of subependymoma was estimated to be 0.7 cases per 100,000 individuals with [[Pathological|pathologically]] proven [[Cranium|intracranial]] [[Neoplasm|neoplasms]].<ref name="pmid22121350">{{cite journal| author=Kurukumbi M, Muley A, Ramidi G, Wynn Z, Trouth AJ| title=A rare case of subependymoma with an atypical presentation: a case report. | journal=Case Rep Neurol | year= 2011 | volume= 3 | issue= 3 | pages= 227-32 | pmid=22121350 | doi=10.1159/000333061 | pmc=3223030 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22121350  }} </ref>
===Age===
===Age===


* Patients of all age groups may develop subependymoma.
*[[Patient|Patients]] of all age groups may develop subependymoma.


*Subependymoma is a rare disease that tends to affect mi<nowiki/>ddle-aged adults and the elderly population (typically 5th to 6th decades).<ref name="epidemiosubepe1">Epidemiology of subependymoma. Dr Bruno Di Muzio and A.Prof Frank Gaillard et al. Radiopaedia 2016. http://radiopaedia.org/articles/subependymoma. Accessed on January 12, 2016</ref>
*Subependymoma is a rare [[disease]] that tends to affect mi<nowiki/>ddle-aged adults and the elderly population (typically in the 5th to 6th decades).<ref name="epidemiosubepe1">Epidemiology of subependymoma. Dr Bruno Di Muzio and A.Prof Frank Gaillard et al. Radiopaedia 2016. http://radiopaedia.org/articles/subependymoma. Accessed on January 12, 2016</ref>


===Gender===
===Gender===
*Males are more commonly affected with subependymoma than females. The male to female ratio is approximately 2.3 to 1.<ref name="epidemiosubepe1" />
*Males are more commonly affected with subependymoma than females.  
*The male to female ratio is approximately 2.3 to 1.<ref name="epidemiosubepe1" />


==Risk Factors==
==Risk Factors==
The [[Risk factor|risk factors]] in the development of subependymoma are not well defined.


*The risk factors in the development of subependymoma are not well defined.
== Natural History, Complications, and Prognosis ==
 
== Natural History, Complications and Prognosis ==
===Natural History===
 
*If left untreated, patients with subependymoma may progress to develop [[seizures]] and [[obstructive hydrocephalus]].<ref name="clinicalpresentationsubep1">Clinical presentation of subependymoma. Dr Bruno Di Muzio and A.Prof Frank Gaillard et al. Radiopaedia 2016. http://radiopaedia.org/articles/subependymoma. Accessed on January 12, 2016</ref>
*Subependymoma is a slow growing tumor with an indolent course.


===Complications===
*If left untreated, [[patients]] with subependymoma may progress to develop [[seizures]] and [[obstructive hydrocephalus]].<ref name="clinicalpresentationsubep1">Clinical presentation of subependymoma. Dr Bruno Di Muzio and A.Prof Frank Gaillard et al. Radiopaedia 2016. http://radiopaedia.org/articles/subependymoma. Accessed on January 12, 2016</ref>
*Subependymoma is a slow-growing [[tumor]] with an indolent course.<ref name="pmid16639322">{{cite journal| author=Ragel BT, Osborn AG, Whang K, Townsend JJ, Jensen RL, Couldwell WT| title=Subependymomas: an analysis of clinical and imaging features. | journal=Neurosurgery | year= 2006 | volume= 58 | issue= 5 | pages= 881-90; discussion 881-90 | pmid=16639322 | doi=10.1227/01.NEU.0000209928.04532.09 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16639322  }} </ref><ref name="pmid28804038">{{cite journal| author=D'Amico RS, Praver M, Zanazzi GJ, Englander ZK, Sims JS, Samanamud JL et al.| title=Subependymomas Are Low-Grade Heterogeneous Glial Neoplasms Defined by Subventricular Zone Lineage Markers. | journal=World Neurosurg | year= 2017 | volume= 107 | issue=  | pages= 451-463 | pmid=28804038 | doi=10.1016/j.wneu.2017.08.009 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28804038  }} </ref>


*[[Obstructive hydrocephalus]] is a common complication of subependymoma.<ref name="clinicalpresentationsubep1" />
*[[Obstructive hydrocephalus]] is a common complication of subependymoma.<ref name="clinicalpresentationsubep1" />


===Prognosis===
*The [[prognosis]] of subependymoma is excellent with complete [[excision]] of the [[tumor]].<ref name="pmid23382616" /><ref name="pmid10320142">{{cite journal| author=Prayson RA, Suh JH| title=Subependymomas: clinicopathologic study of 14 tumors, including comparative MIB-1 immunohistochemical analysis with other ependymal neoplasms. | journal=Arch Pathol Lab Med | year= 1999 | volume= 123 | issue= 4 | pages= 306-9 | pmid=10320142 | doi=10.1043/0003-9985(1999)123<0306:S>2.0.CO;2 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10320142  }} </ref>
 
*Common [[Complication (medicine)|complications]] of subependymoma are [[hydrocephalus]] and focal [[Neurology|neurological]] deficits due to [[Mass effect (medicine)|mass effect]].<ref name="pmid22747714">{{cite journal| author=Jain A, Amin AG, Jain P, Burger P, Jallo GI, Lim M et al.| title=Subependymoma: clinical features and surgical outcomes. | journal=Neurol Res | year= 2012 | volume= 34 | issue= 7 | pages= 677-84 | pmid=22747714 | doi=10.1179/1743132812Y.0000000064 | pmc=4618470 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22747714  }} </ref>
*The prognosis of subependymoma is excellent with complete excision of the [[tumor]].<ref name="pmid23382616" /><ref name="pmid10320142">{{cite journal| author=Prayson RA, Suh JH| title=Subependymomas: clinicopathologic study of 14 tumors, including comparative MIB-1 immunohistochemical analysis with other ependymal neoplasms. | journal=Arch Pathol Lab Med | year= 1999 | volume= 123 | issue= 4 | pages= 306-9 | pmid=10320142 | doi=10.1043/0003-9985(1999)123<0306:S>2.0.CO;2 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10320142  }} </ref>
 
*The majority of patients with [disease name] remain asymptomatic for [duration/years].
*Early clinical features include [manifestation 1], [manifestation 2], and [manifestation 3].
*If left untreated, [#%] of patients with [disease name] may progress to develop [manifestation 1], [manifestation 2], and [manifestation 3].
*Common complications of [disease name] include [complication 1], [complication 2], and [complication 3].
*Prognosis is generally [excellent/good/poor], and the [1/5/10­year mortality/survival rate] of patients with [disease name] is approximately [#%].


== Diagnosis ==
== Diagnosis ==
===Diagnostic Criteria===
*The diagnosis of [disease name] is made when at least [number] of the following [number] diagnostic criteria are met:
:*[criterion 1]
:*[criterion 2]
:*[criterion 3]
:*[criterion 4]
===Symptoms===
===Symptoms===
*Typically patients of subependymoma are asymptomatic and small lesions are discovered incidentally.
*Typically [[Patient|patients]] of subependymoma are [[asymptomatic]] and small [[Lesion|lesions]] are discovered incidentally.
*Symptoms of subependymoma include:<ref name="symptsubependymoma1">{{cite journal|last= KE|first= Changshu|title= Subependymoma: a case report and the review of literatures |doi=10.3969/j.issn.1672-6731.2011.01.021|url= http://www.cjcnn.org/index.php/cjcnn/article/view/323}}</ref>
*[[Symptoms]] of subependymoma include:<ref name="symptsubependymoma1">{{cite journal|last= KE|first= Changshu|title= Subependymoma: a case report and the review of literatures |doi=10.3969/j.issn.1672-6731.2011.01.021|url= http://www.cjcnn.org/index.php/cjcnn/article/view/323}}</ref><ref name="pmid2278665">{{cite journal| author=Park YK, Choi WS, Leem W, Kim YW, Yang MH| title=Symptomatic subependymoma--a case report. | journal=J Korean Med Sci | year= 1990 | volume= 5 | issue= 2 | pages= 111-5 | pmid=2278665 | doi=10.3346/jkms.1990.5.2.111 | pmc=3053733 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2278665  }} </ref><ref name="pmid22747714">{{cite journal| author=Jain A, Amin AG, Jain P, Burger P, Jallo GI, Lim M et al.| title=Subependymoma: clinical features and surgical outcomes. | journal=Neurol Res | year= 2012 | volume= 34 | issue= 7 | pages= 677-84 | pmid=22747714 | doi=10.1179/1743132812Y.0000000064 | pmc=4618470 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22747714  }} </ref>
**'''Symptoms due to elevated intracranial pressure'''
**'''Symptoms due to elevated intracranial pressure'''
***[[Headache]]
***[[Headache]]
Line 109: Line 103:
=== Physical Examination ===
=== Physical Examination ===


*Patients with [disease name] usually appear [general appearance].
*[[Patient|Patients]] with subependymoma usually appear normal.
*Physical examination may be remarkable for:
*[[Physical examination]] may be remarkable for:<ref name="pmid23607015">{{cite journal| author=Bokhari R, Ghanem A, Alahwal M, Baeesa S| title=Primary isolated lymphoma of the fourth ventricle in an immunocompetent patient. | journal=Case Rep Oncol Med | year= 2013 | volume= 2013 | issue=  | pages= 614658 | pmid=23607015 | doi=10.1155/2013/614658 | pmc=3625557 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23607015  }} </ref><ref name="pmid17761056">{{cite journal| author=Hamilton W, Kernick D| title=Clinical features of primary brain tumours: a case-control study using electronic primary care records. | journal=Br J Gen Pract | year= 2007 | volume= 57 | issue= 542 | pages= 695-9 | pmid=17761056 | doi= | pmc=2151783 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17761056  }} </ref><ref name="pmid16547083">{{cite journal| author=Wilne SH, Ferris RC, Nathwani A, Kennedy CR| title=The presenting features of brain tumours: a review of 200 cases. | journal=Arch Dis Child | year= 2006 | volume= 91 | issue= 6 | pages= 502-6 | pmid=16547083 | doi=10.1136/adc.2005.090266 | pmc=2082784 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16547083  }} </ref><ref name="pmid26926614">{{cite journal| author=Perkins A, Liu G| title=Primary Brain Tumors in Adults: Diagnosis and Treatment. | journal=Am Fam Physician | year= 2016 | volume= 93 | issue= 3 | pages= 211-7 | pmid=26926614 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26926614  }} </ref><ref name="pmid22747714">{{cite journal| author=Jain A, Amin AG, Jain P, Burger P, Jallo GI, Lim M et al.| title=Subependymoma: clinical features and surgical outcomes. | journal=Neurol Res | year= 2012 | volume= 34 | issue= 7 | pages= 677-84 | pmid=22747714 | doi=10.1179/1743132812Y.0000000064 | pmc=4618470 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22747714  }} </ref><ref name="pmid25361493">{{cite journal| author=Bi Z, Ren X, Zhang J, Jia W| title=Clinical, radiological, and pathological features in 43 cases of intracranial subependymoma. | journal=J Neurosurg | year= 2015 | volume= 122 | issue= 1 | pages= 49-60 | pmid=25361493 | doi=10.3171/2014.9.JNS14155 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25361493  }} </ref>


:*[finding 1]
:*Abnormal [[pupillary reflex]]
:*[finding 2]
:*[[Visual field]] defects
:*[finding 3]
:*[[Gait]] changes
:*[finding 4]
:*Bilateral [[Babinski sign]]
:*[finding 5]
:*Depressed [[Glasgow coma score|Glasgow coma score (GCS)]]
:*[finding 6]
:*Decreased [[muscle]] strength
:*Decreased [[Deep tendon reflex|deep tendon reflexes]]
:*[[Sensation]] defects
:*[[Hearing (sense)|Hearing]] problems and abnormal [[Rinne test|Rinne]] and [[Weber test|Weber tests]]


=== Laboratory Findings ===
=== Laboratory Findings ===
There are no specific laboratory findings associated with subependymoma.


*There are no specific laboratory findings associated with [disease name].
===Electrocardiogram===
There are no [[The electrocardiogram|ECG]] findings associated with subependymoma.


*A  [positive/negative] [test name] is diagnostic of [disease name].
=== X-ray ===
*An [elevated/reduced] concentration of [serum/blood/urinary/CSF/other] [lab test] is diagnostic of [disease name].
There are no [[X-rays|x-ray]] findings associated with subependymoma.
*Other laboratory findings consistent with the diagnosis of [disease name] include [abnormal test 1], [abnormal test 2], and [abnormal test 3].
 
===Echocardiography or Ultrasound===
===Imaging Findings===
There are no [[echocardiography]]/[[ultrasound]] findings associated with sybependymoma.
 
===CT scan===
[[Head]] [[Computed tomography|CT scan]] is helpful in the [[diagnosis]] of subependymoma. On [[Computed tomography|CT scan]], subependymoma is characterized by:<ref name="radiographicfeaturessubepenedymoma1">Radiographic features of subependymoma. Dr Bruno Di Muzio and A.Prof Frank Gaillard et al. Radiopaedia 2016. http://radiopaedia.org/articles/subependymoma. Accessed on January 12, 2016</ref>
 
* Iso- and hypodense intraventricular mass
* Positive [[Mass effect (medicine)|mass effect]]
* No enhancement
* If large, it may have [[cystic]] or even [[Calcification|calcific]] components
* No [[vasogenic edema]]


*Head [[Computed tomography|CT scan]] is helpful in the diagnosis of subependymoma. On CT scan, subependymoma is characterized by:<ref name="radiographicfeaturessubepenedymoma1">Radiographic features of subependymoma. Dr Bruno Di Muzio and A.Prof Frank Gaillard et al. Radiopaedia 2016. http://radiopaedia.org/articles/subependymoma. Accessed on January 12, 2016</ref>
=== MRI ===
[[Brain]] [[MRI]] is helpful in the [[diagnosis]] of subependymoma. On [[MRI]], subependymoma is characterized by:
{| style="border: 0px; font-size: 90%; margin: 3px; width:1000px"
| valign="top" |
|+
! style="background: #4479BA; width: 300px;" |{{fontcolor|#FFF|MRI component}}
! style="background: #4479BA; width: 800px;" |{{fontcolor|#FFF|Findings}}
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" align="center" |
T1 weighted image
| style="padding: 5px 5px; background: #F5F5F5;" |
*Iso - hypointense compared to [[white matter]]
*[[Homogeneous]] but may be [[heterogeneous]] in larger [[Lesion|lesions]]
|-
| style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" align="center" |
T2 weighted image
| style="padding: 5px 5px; background: #F5F5F5;" |
*Hyperintense compared to adjacent [[White matter|white]] and [[grey matter]]
*[[Heterogeneous|Heterogeneity]] may be seen in larger [[Lesion|lesions]], with susceptibility related signal drop-out due to [[Calcification|calcifications]]
*No adjacent [[Parenchyma|parenchymal]] [[edema]] (as no [[brain]] [[Invasive (medical)|invasion]] is present)
|-
| style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" align="center" |
T1 weighted image with contrast
| style="padding: 5px 5px; background: #F5F5F5;" |
*Little or no enhancement
|}


:*Iso- and hypodense intraventricular mass
=== Other Imaging Findings ===
:*Positive mass effect
There are no other [[imaging]] findings associated with subependymoma.
:*No enhancement
:*If large, it may have [[cystic]] or even [[Calcification|calcific]] components
:*No [[vasogenic edema]]


=== Other Diagnostic Studies ===
=== Other Diagnostic Studies ===
There are no other [[Diagnosis|diagnostic]] studies associated with subependymoma.


*[Disease name] may also be diagnosed using [diagnostic study name].
*Findings on [diagnostic study name] include [finding 1], [finding 2], and [finding 3].
== Treatment ==
=== Medical Therapy ===
=== Medical Therapy ===
There is no medical therapy available for the treatment of subependymoma.


*There is no treatment for [disease name]; the mainstay of therapy is supportive care.
*The mainstay of therapy for [disease name] is [medical therapy 1] and [medical therapy 2].
*[Medical therapy 1] acts by [mechanism of action 1].
*Response to [medical therapy 1] can be monitored with [test/physical finding/imaging] every [frequency/duration].
=== Surgery ===
=== Surgery ===
[[Surgery]] is the mainstay of [[therapy]] for subependymoma. Incidental intraventricular subependymoma can be managed conservatively through MRI surveillance. [[Resection|Surgical resection]] is indicated for:<ref name="pmid22747714" /><ref name="pmid28232153">{{cite journal| author=Nguyen HS, Doan N, Gelsomino M, Shabani S| title=Intracranial Subependymoma: A SEER Analysis 2004-2013. | journal=World Neurosurg | year= 2017 | volume= 101 | issue=  | pages= 599-605 | pmid=28232153 | doi=10.1016/j.wneu.2017.02.019 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28232153  }} </ref><ref name="pmid29915887">{{cite journal| author=Varma A, Giraldi D, Mills S, Brodbelt AR, Jenkinson MD| title=Surgical management and long-term outcome of intracranial subependymoma. | journal=Acta Neurochir (Wien) | year= 2018 | volume= 160 | issue= 9 | pages= 1793-1799 | pmid=29915887 | doi=10.1007/s00701-018-3570-4 | pmc=6105212 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=29915887  }} </ref>


*Surgery is the mainstay of therapy for [disease name].
*[[Symptomatic]] [[Tumor|tumors]]
*[Surgical procedure] in conjunction with [chemotherapy/radiation] is the most common approach to the treatment of [disease name].
*[[Tumors]] without a clear [[imaging]] [[diagnosis]]
*[Surgical procedure] can only be performed for patients with [disease stage] [disease name].
=== Prevention ===


*There are no primary preventive measures available for [disease name].
=== Primary Prevention ===
There are no established measures for the [[Prevention (medical)|secondary prevention]] of subependymoma.
*Effective measures for the primary prevention of [disease name] include [measure1], [measure2], and [measure3].


*Once diagnosed and successfully treated, patients with [disease name] are followed-up every [duration]. Follow-up testing includes [test 1], [test 2], and [test 3].
=== Secondary Prevention ===
There are no established measures for the [[Prevention (medical)|primary prevention]] of subependymoma.


==References==
==References==
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[[Category:Pick One of 28 Approved]]
[[Category:Pick One of 28 Approved]]


__NOTOC__{{WS}}
__NOTOC__
{{WH}}
 
 
*
 
==Biopsy==
*[[Biopsy]] of the subependymoma [[tumor]], taken through a needle during a simple surgical procedure, helps to confirm the diagnosis.<ref name="diagnosisse1">Diagnosis of subependymoma. Wikipedia 2016. https://en.wikipedia.org/wiki/Subependymoma. Accessed on January 8, 2016</ref>
 
==Treatment==
*The predominant therapy for subependymoma is [[surgery|surgical resection]].
 
==References==
==References==
{{reflist|2}}
{{reflist|2}}

Latest revision as of 19:57, 7 July 2020

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Mohamadmostafa Jahansouz M.D.[2]Sujit Routray, M.D. [3]

Historical Perspective

Subependymoma was first discovered by Ilya Mark Scheinker, a Russian physician, in 1945.[1]

Classification

There is no established system for the classification of subependymoma.

Pathophysiology

Pathogenesis

Subependymoma arises from subependymal glial cells, although it can also arise from astrocytes from the subependymal plate, ependymal cells, and mixed ependymal and astrocytic cells.[2][3]

Gross Pathology

Subependymoma is most commonly seen in the fourth ventricle, but it can arise anywhere where there is ependyma. The distribution in the ventricular system is as follows:[4][3]

  • On gross pathology, subependymoma is characterized by a small, white to grey, firm, well circumscribed, solid, avascular mass attached to the ventricular wall by a narrow pedicle.[2][3]

Microscopic Pathology

On microscopic histopathological analysis, subependymoma is characterized by the following features:[4]

Immunohistochemistry

Subependymoma is characterized by positive tumor marker GFAP. Mixed populations of cells may be variably positive for:[4][5]

Causes

The cause of the development of subependymoma has not been identified.

Differentiating Subependymoma from Other Diseases

Subependymoma must be differentiated from:[6][3]

Epidemiology and Demographics

Frequency and Incidence

Age

  • Patients of all age groups may develop subependymoma.
  • Subependymoma is a rare disease that tends to affect middle-aged adults and the elderly population (typically in the 5th to 6th decades).[9]

Gender

  • Males are more commonly affected with subependymoma than females.
  • The male to female ratio is approximately 2.3 to 1.[9]

Risk Factors

The risk factors in the development of subependymoma are not well defined.

Natural History, Complications, and Prognosis

Diagnosis

Symptoms

Physical Examination

Laboratory Findings

There are no specific laboratory findings associated with subependymoma.

Electrocardiogram

There are no ECG findings associated with subependymoma.

X-ray

There are no x-ray findings associated with subependymoma.

Echocardiography or Ultrasound

There are no echocardiography/ultrasound findings associated with sybependymoma.

CT scan

Head CT scan is helpful in the diagnosis of subependymoma. On CT scan, subependymoma is characterized by:[20]

MRI

Brain MRI is helpful in the diagnosis of subependymoma. On MRI, subependymoma is characterized by:

MRI component Findings

T1 weighted image

T2 weighted image

T1 weighted image with contrast

  • Little or no enhancement

Other Imaging Findings

There are no other imaging findings associated with subependymoma.

Other Diagnostic Studies

There are no other diagnostic studies associated with subependymoma.

Medical Therapy

There is no medical therapy available for the treatment of subependymoma.

Surgery

Surgery is the mainstay of therapy for subependymoma. Incidental intraventricular subependymoma can be managed conservatively through MRI surveillance. Surgical resection is indicated for:[3][21][22]

Primary Prevention

There are no established measures for the secondary prevention of subependymoma.

Secondary Prevention

There are no established measures for the primary prevention of subependymoma.

References

  1. ↑ Kurian KM, Jones DT, Marsden F, Openshaw SW, Pearson DM, Ichimura K; et al. (2008). "Genome-wide analysis of subependymomas shows underlying chromosomal copy number changes involving chromosomes 6, 7, 8 and 14 in a proportion of cases". Brain Pathol. 18 (4): 469–73. doi:10.1111/j.1750-3639.2008.00148.x. PMC 2659379. PMID 18397339.
  2. ↑ 2.0 2.1 2.2 Saad AF, Bidiwala SB, Layton KF, Snipes GJ, Opatowsky MJ (2013). "Fourth ventricular subependymoma presenting as worsening headache". Proc (Bayl Univ Med Cent). 26 (1): 52–4. PMC 3523772. PMID 23382616.
  3. ↑ 3.0 3.1 3.2 3.3 3.4 3.5 3.6 3.7 Jain A, Amin AG, Jain P, Burger P, Jallo GI, Lim M; et al. (2012). "Subependymoma: clinical features and surgical outcomes". Neurol Res. 34 (7): 677–84. doi:10.1179/1743132812Y.0000000064. PMC 4618470. PMID 22747714.
  4. ↑ 4.0 4.1 4.2 Pathology of subependymoma. Dr Bruno Di Muzio and A.Prof Frank Gaillard et al. Radiopaedia 2016. http://radiopaedia.org/articles/subependymoma. Accessed on January 12, 2016
  5. ↑ 5.0 5.1 D'Amico RS, Praver M, Zanazzi GJ, Englander ZK, Sims JS, Samanamud JL; et al. (2017). "Subependymomas Are Low-Grade Heterogeneous Glial Neoplasms Defined by Subventricular Zone Lineage Markers". World Neurosurg. 107: 451–463. doi:10.1016/j.wneu.2017.08.009. PMID 28804038.
  6. ↑ Intraventricular neoplasms and lesions. Dr Henry Knipe and Dr Vinod G Maller et al. Radiopaedia 2016. http://radiopaedia.org/articles/intraventricular-neoplasms-and-lesions. Accessed on January 12, 2016
  7. ↑ Matsumura A, Ahyai A, Hori A, Schaake T (1989). "Intracerebral subependymomas. Clinical and neuropathological analyses with special reference to the possible existence of a less benign variant". Acta Neurochir (Wien). 96 (1–2): 15–25. PMID 2929389.
  8. ↑ Kurukumbi M, Muley A, Ramidi G, Wynn Z, Trouth AJ (2011). "A rare case of subependymoma with an atypical presentation: a case report". Case Rep Neurol. 3 (3): 227–32. doi:10.1159/000333061. PMC 3223030. PMID 22121350.
  9. ↑ 9.0 9.1 Epidemiology of subependymoma. Dr Bruno Di Muzio and A.Prof Frank Gaillard et al. Radiopaedia 2016. http://radiopaedia.org/articles/subependymoma. Accessed on January 12, 2016
  10. ↑ 10.0 10.1 Clinical presentation of subependymoma. Dr Bruno Di Muzio and A.Prof Frank Gaillard et al. Radiopaedia 2016. http://radiopaedia.org/articles/subependymoma. Accessed on January 12, 2016
  11. ↑ Ragel BT, Osborn AG, Whang K, Townsend JJ, Jensen RL, Couldwell WT (2006). "Subependymomas: an analysis of clinical and imaging features". Neurosurgery. 58 (5): 881–90, discussion 881-90. doi:10.1227/01.NEU.0000209928.04532.09. PMID 16639322.
  12. ↑ Prayson RA, Suh JH (1999). "Subependymomas: clinicopathologic study of 14 tumors, including comparative MIB-1 immunohistochemical analysis with other ependymal neoplasms". Arch Pathol Lab Med. 123 (4): 306–9. doi:10.1043/0003-9985(1999)123<0306:S>2.0.CO;2. PMID 10320142.
  13. ↑ KE, Changshu. "Subependymoma: a case report and the review of literatures". doi:10.3969/j.issn.1672-6731.2011.01.021.
  14. ↑ Park YK, Choi WS, Leem W, Kim YW, Yang MH (1990). "Symptomatic subependymoma--a case report". J Korean Med Sci. 5 (2): 111–5. doi:10.3346/jkms.1990.5.2.111. PMC 3053733. PMID 2278665.
  15. ↑ Bokhari R, Ghanem A, Alahwal M, Baeesa S (2013). "Primary isolated lymphoma of the fourth ventricle in an immunocompetent patient". Case Rep Oncol Med. 2013: 614658. doi:10.1155/2013/614658. PMC 3625557. PMID 23607015.
  16. ↑ Hamilton W, Kernick D (2007). "Clinical features of primary brain tumours: a case-control study using electronic primary care records". Br J Gen Pract. 57 (542): 695–9. PMC 2151783. PMID 17761056.
  17. ↑ Wilne SH, Ferris RC, Nathwani A, Kennedy CR (2006). "The presenting features of brain tumours: a review of 200 cases". Arch Dis Child. 91 (6): 502–6. doi:10.1136/adc.2005.090266. PMC 2082784. PMID 16547083.
  18. ↑ Perkins A, Liu G (2016). "Primary Brain Tumors in Adults: Diagnosis and Treatment". Am Fam Physician. 93 (3): 211–7. PMID 26926614.
  19. ↑ Bi Z, Ren X, Zhang J, Jia W (2015). "Clinical, radiological, and pathological features in 43 cases of intracranial subependymoma". J Neurosurg. 122 (1): 49–60. doi:10.3171/2014.9.JNS14155. PMID 25361493.
  20. ↑ Radiographic features of subependymoma. Dr Bruno Di Muzio and A.Prof Frank Gaillard et al. Radiopaedia 2016. http://radiopaedia.org/articles/subependymoma. Accessed on January 12, 2016
  21. ↑ Nguyen HS, Doan N, Gelsomino M, Shabani S (2017). "Intracranial Subependymoma: A SEER Analysis 2004-2013". World Neurosurg. 101: 599–605. doi:10.1016/j.wneu.2017.02.019. PMID 28232153.
  22. ↑ Varma A, Giraldi D, Mills S, Brodbelt AR, Jenkinson MD (2018). "Surgical management and long-term outcome of intracranial subependymoma". Acta Neurochir (Wien). 160 (9): 1793–1799. doi:10.1007/s00701-018-3570-4. PMC 6105212. PMID 29915887.


References

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