Unusual features of ependymoma in a patient with Parkinson's disease. (January 2019)

• Record Type: Journal Article
• Authors: Witton, Leslie A.; Fong, Crystal; Reddy, Kesava; Provias, John; Lu, Jian-Qiang
• Is Part Of: Journal of clinical neuroscience. Volume 59(2019)
• Page Start: 310
• Page End: 312
• Publication Date: 2019-01
• Subjects: Parkinson's disease -- Ependymoma -- Comorbidity -- Tumorigenesis -- α-Synucleinopathy -- Lewy pathology; Brain -- Surgery -- Periodicals; Neurosciences -- Periodicals; Nervous system -- Surgery -- Periodicals; Brain -- surgery -- Periodicals; Neurosurgical Procedures -- Periodicals; Neurosciences -- Periodicals; Electronic journals; 616.8
• DOI: 10.1016/j.jocn.2018.10.124
• Languages: English
• ISSNs: 0967-5868

Abstract

Highlights: Ependymoma may develop atypically in the background of Parkinson's disease (PD). Ependymoma associated with PD may show unusual imaging and pathologic features. α-Synucleinopathy may be involved in the tumorigenesis of ependymomas. Abstract: The diagnosis and management of ependymoma may be challenging when there is a comorbidity of ependymoma and Parkinson's disease (PD). We report the first case to demonstrate unusual clinical and pathological features of an ependymoma associated with PD. A 77-year-old male with a history of PD had brain magnetic resonance imaging (MRI) that showed signal abnormalities in the right temporal lobe, most consistent with a low-grade glioma. He underwent an imaging-guided resection of that lesion, which pathological examination revealed mild hypercellularity with gliosis but no neoplasm, as well as Lewy bodies (LBs) and α-synucleinopathy in the temporal cortex compatible with advanced PD. Follow-up MRI exhibited tumor-like progression of signal abnormalities in that brain region. Twenty-nine months after the first resection, a head computerized tomography scan disclosed an obvious mass centered in the right temporal lobe. A second resection was performed for the mass, which pathological examination revealed an ependymoma with focal anaplasia and additional unusual features including an infiltrative growth pattern and intermixed α-synuclein positivity with electron microscopy finding of LB-like inclusions. Our observation suggests that an ependymoma in the patient with PD may present with unusual features possibly due to altered tumorigenesis and disease progression associated with α-synucleinopathy.