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N. Montano, MD, P. De Bonis, MD, F. Doglietto, MD, A. Cianfoni, MD, R. Pallini, MD, L. Lauriola, MD and G. Maira, MD

From the Institute of Neurosurgery (N.M., P.D.B., F.D., R.P., G.M.), Institute of Radiology (A.C.), and Institute of Pathology (L.L.), Catholic University School of Medicine, Rome, Italy.


Figure 116
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  		Figure 1 Brain neuroimaging

Nonenhanced CT (A), MRI with axial T2-WI (B), sagittal non-enhanced (C) and enhanced (D) T1-WI, showing a heterogeneous, solid-cystic, hemorrhagic and calcific mass in the cisterna magna and in the inferior portion of the fourth ventricle. A blood-fluid level is visible in the cystic portion (arrow) and contrast enhancement is evident in the solid intraventricular portion. The mass obstructed the fourth ventricle with resulting hydrocephalus.

 

Figure 216
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  		Figure 2 Surgical and histologic images

(A, B) Intraoperative view confirming the hemorrhagic component of the lesion (A) and documenting the floor of the fourth ventricle free of disease at the end of tumor removal (B). (C–E) Histologic examination showed monomorphic cells with regular round nucleus and dispersed chromatin; tumor cells of the perivascular area were arranged radially around the vessels, forming perivascular pseudorosettes, with prominent perivascular immunoreaction for glial fibrillary acid protein (D) and epithelial membrane antigen (E). Mitoses and necrosis were absent. Diagnosis: WHO grade II ependymoma.